Here’s one of the biggest contradictions facing young people today: tobacco companies aren’t allowed to market their products to teenagers under 18 in the United States, yet the future of Big Tobacco depends upon this age group. 

According to the Surgeon General's fact sheet on youth tobacco consumption, "Nearly 9 out of 10 smokers started smoking by age 18, and 99% started by age 26. Progression from occasional to daily smoking almost always occurs by age 26."

Robin Koval, president and CEO of Legacy for Health, a non-profit organization dedicated to educating the public about the health risks of smoking, told ATTN: that this dynamic has started to shift.  

“Actually what's happening now is we're seeing a lot of initiation happening among college age, young adults, and that's obviously very cleverly orchestrated by the tobacco industry because these young people are legal,” Koval told ATTN:.

Teenagers and young adults in the United States today have grown up in a society much more attuned to the dangers of cigarettes than the society in which their parents and grandparents grew up. Anti-smoking ads abound in the media and even on the streets. (A sign in West L.A. that I used to pass every day keeps a running tally of annual smoking deaths.) Smoking is prohibited in airplanes, in restaurants, and on an increasing number of college campuses. CVS recently made the decision to stop selling cigarettes, despite the guaranteed adverse effect on their bottom line. 

These efforts by the government, the media, and major corporations are paying off: just 8 percent of teens smoke today, according to Koval, while in 2000, 23 percent of teens smoked. 

Smoking kills an estimated 540,000 Americans per year. According to a 2014 U.S. Surgeon General's report, tobacco is responsible for over 20 million premature deaths since 1964, when the first Surgeon General report was released. And Big Tobacco isn’t backing down – according to Koval, tobacco companies spend around $9 billion per year on advertising. 

Koval thinks that today’s teenagers could be the generation that turns the tide on Big Tobacco once and for all, and Legacy is dedicated to giving teens the resources and information to do just that. 

Using positive peer pressure to change mindsets

The truth campaign, an initiative by Legacy aimed at ending teenage smoking, recently released a video with ad agency 72andSunny that features YouTube and Vine stars waxing poetic about Tinder. The message? More smoking equals fewer dates - or at least fewer Tinder matches. Text within the video proclaims: "Fact: You get double the matches if you're not smoking in your profile pics." 

According to Koval, when the video was released on February 4th during the Grammys, #LeftSwipeDat was the #1 trending topic on Twitter. The video inverts the cliché of teens peer pressuring one another to smoke by suggesting that smoking is diametrically opposed to Tinder success. The truth campaign’s incorporation of this popular dating app/time-passer into a PSA aimed at young people was a smart move, considering peer pressure and image cultivation have always played a large role in teenagers’ decisions to smoke. 

"Back in the good old days, if we were friends, and I smoked, and you aspired to be like me, we influenced one another in the physical, real world,” Koval said. “But now if I post a picture of myself smoking, I have the power to influence the entire planet.”

“You become….literally an unpaid spokesperson for the tobacco industry when you post a picture of yourself with a cigarette," Koval said. 

The truth campaign has also eschewed scare tactics with this effort (as in, don’t smoke or this is what your lungs will look like!) and have relied instead on positive peer pressure.

“We think it's much more powerful, rather than acting like their parents and telling them 'don't do this, don't do that,'" Koval said, "to have a peer-to-peer conversation, to talk to them in a way that is going to engage them with things like humor, through creating content that they're going to want to share within their own network.“

While “Left Swipe Dat” takes aim at the perception of smoking as cool, John Oliver's tobacco segment on “Last Week Tonight” set its sights on the questionable marketing tactics of Big Tobacco. In the 18-minute segment, Oliver exposed a few of Philip Morris International’s more deplorable international practices:

In response to the overwhelming outcry following the “Last Week Tonight” episode, Philip Morris International (PMI) released a statement: “'Last Week Tonight with John Oliver' is a parody show, known for getting a laugh through exaggeration and presenting partial views in the name of humor. The segment includes many mischaracterizations of our company, including our approach to marketing and regulation, which have been embellished in the spirit of comedic license.”

Despite Big Tobacco’s many losses over the past few years and despite the strides made in decreasing the prevalence of teenage smoking, the battle is far from over: misconceptions about social smoking and the rising popularity of e-cigarettes among teens threaten to slow or erode recent progress.

Misconceptions about social smoking

In a Reddit thread for Millennials who smoke, many users credited social pressure and/or lack of social skills as factors that contributed to their first experience with cigarettes. Cigarette breaks, whether at parties or at the office, afford a natural opportunity for conversation and those who struggle to find these opportunities otherwise might find it difficult to “just say no.”

"We've seen some data that says that 60 percent of young people don't actually think that light and intermittent smoking is very harmful,” Koval said. But addicted or not, said Koval, "you’re still sucking all that poison into your lungs.” 

"We do hear from young people that social smoking, because they don't consider it real smoking...helps you connect with people, helps you feel like part of a group, helps you look like you're a little dangerous, which can be cool when you're a young person,” Koval said. “And because it's not ‘real’ smoking, it doesn't carry a lot of the stigma, so that’s one of the reasons we’re focusing on it a lot." 

Many young people think flavored cigars and hookah are much safer than cigarettes “when the truth is [hookah] is the same awful combination of chemicals, and a two-hour session can be like smoking a hundred cigarettes,” Koval said. 

Transition to e-cigarettes

One area in which nicotine consumption is rising among teens, an area that doesn’t carry the same social stigma as heavy cigarette smoking, is e-cigarettes, which aren’t quite as risk-free as many young people assume. Smoking e-cigarettes, or vaping, doesn’t involve tobacco, the source of smoke in traditional cigarettes, but does involve nicotine, which is not conducive to healthy brain development in children and teens. 

According to Koval, many teens don’t even know what’s in e-cigarettes. Some young people think e-cigarettes simply consist of water vapor, rather than nicotine and chemicals. 

A December 2014 report released by Monitoring the Future and the University of Michigan demonstrated that the use of e-cigarettes has eclipsed the use of cigarettes among teens. The Food and Drug Administration (FDA) has yet to finalize its regulations on e-cigarettes. In the meantime, public confidence is waning – if not among teens, then at least among older Americans. 

According to the American Journal of Preventative Medicine, while 84.7 percent of smokers viewed cigarettes as more harmful than e-cigarettes in 2010, only 65 percent of smokers agreed that cigarettes were more harmful in 2013. E-cigarettes are used by some cigarette smokers as a way to cut back on or quit traditional cigarettes, but for others, smoking e-cigarettes may lead to smoking traditional cigarettes.

"The science may prove, and it seems that it very well may, that e-cigarettes are a real benefit to committed smokers who can't or are unwilling to quit smoking using other methods, and that potentially is a great thing,” Koval said. “But at the same time, nicotine is not a good idea for kids. It is addictive, it does impact your brain, it does put you in a position of becoming more susceptible to other forms of nicotine like traditional cigarettes. We don't know yet whether it's a gateway or not."

The American Journal of Preventative Medicine reports that e-cigarette sales in the United States currently are equivalent to only 1 percent of traditional cigarette sales. This small percentage might suggest that e-cigarettes and their health consequences are negligible, but that isn't the case. The health effects of e-cigarettes have been studied far less extensively than the effects of traditional cigarettes, and the nicotine present in e-cigarettes may lead teenagers (and adults) to become addicted before e-cigarettes are fully understood or regulated. 

While many people think that e-cigarettes are relatively harmless, a recent study from the University of Rochester points to the often overlooked and understudied damaging effects of e-cigarettes on lungs. The study’s authors note in their abstract that “[t]he consumption of electronic cigarettes (e-cigs) with a variety of e-liquids/e-juices is alarmingly increasing without the unrealized potential harmful health effects…exposure to e-cig aerosols/juices incurs measurable oxidative and inflammatory responses in lung cells and tissues that could lead to unrealized health consequences.”

Koval and the truth campaign recommend that e-cigarette companies avoid flavors that might appeal especially to teens and support the end of Internet sale of e-cigarettes or, at least, strict restrictions on Internet sales. 

“We in public health have a responsibility to accurately educate the public (about) what the benefits and risks of e-cigarettes are,” Koval said. “It's not surprising that kids are confused. Everybody's a little confused, and that’s because the science isn't complete, the regulations aren't out there. We don't even have product standards." 

If you're looking for tools for help quitting smoking, check out the EX campaign, also run by Legacy for Health, to receive a free plan, or the recently launched Nobituary.com, which allows smokers’ loved ones to write them obituaries to encourage them to quit. And “in the spirit of comedic license,” let’s make sure that Philip Morris International hasn’t seen the last of Jeff the Diseased Lung.

But above all, let’s not forget the power held by today’s teenagers and young adults.  

"The thing that I would tell young people right now is they have an amazing opportunity to truly be part of history,” Koval said. “When you think of where smoking rates are now, this literally could be the generation that ends smoking. That would be probably the biggest public health victory this country has ever seen. This is the generation that can do it...That's an amazing opportunity and I hope they take us up on it."