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Health Reports & Data

Tobacco Use


Making cigarettes more difficult to obtain can help discourage young people from starting or continuing to smoke. Activities to decrease young people’s access to cigarettes are part of a comprehensive approach to reducing the number of young people who start smoking. In Hawaii, it is illegal to sell cigarettes to persons under the age of 18 years and much effort has gone into increasing compliance with the law. In fact, Hawaii has one of the highest compliance rates in the nation. Nevertheless, many young people still have access to cigarettes through other sources. Monitoring how and where minors acquire cigarettes is important for planning interventions to address these sources of cigarettes.


Tobacco use is highly addictive and quitting can be difficult. It often takes multiple attempts before a person is able to finally quit. Although it is possible to quit using tobacco without help, evidence shows that people who use support services such as classes, self-help materials and telephone quitlines have a higher chance of success. Many young people try to quit smoking each year, but few use cessation programs.


Tobacco use by youth and young adults causes both immediate and long-term damage. One of the most serious health effects is nicotine addiction, which prolongs tobacco use and can lead to severe health consequences. The younger a person is when they start using tobacco, the more likely they’ll become addicted. Prevention of initiation of tobacco use is critical in reducing the negative public health impact of tobacco.

Mass Media

Young people are surrounded by images promoting tobacco use. According to the Campaign for Tobacco Free Kids, the tobacco industry spends $48.2 million per year on marketing in Hawaii. Research studies have found young people to be twice as sensitive to tobacco advertising as adults. Indeed, up to one-third of underage experimentation with smoking is attributable to tobacco company advertising. Countering these pro-tobacco images with mass media campaigns providing information that will motivate children and adolescents to remain tobacco-free are part of a comprehensive approach to reducing tobacco use.


Tobacco use is the leading cause of preventable death and illness in Hawaii and the United States. Cigarettes are the most commonly used form of tobacco, but tobacco is also available in cigars, smokeless tobacco (SLT—such as chewing tobacco, snuff or dip), pipe tobacco, Bidis and Kreteks. Tobacco is habit forming in all its forms and tobacco addiction primarily begins during adolescence. In the long term, smoking increases the risk of lung and other cancers, heart disease and emphysema. Current smoking by young people is associated with serious health problems such as reduced lung capacity and physical fitness.


Students spend a significant portion of their waking hours at school; hence schools can play a crucial role in preventing and reducing tobacco use in children and adolescents. Hawaii schools have implemented comprehensive anti-tobacco policies whereby smoking is not allowed on any public school campus, by anyone or at anytime. Evidence shows that education programs that include instruction on the physical and social consequences of tobacco use, social influences on tobacco use, peer norms, and life skills can prevent or reduce tobacco use among students.

Secondhand Smoke (SHS)

Secondhand smoke (SHS) is the combination of exhaled smoke from a smoker and “sidestream” smoke from the burning tip of a cigarette. Secondhand smoke (sometimes called involuntary smoking, environmental tobacco smoke, or passive smoking) is a known cause of lung cancer, heart disease and chronic lung ailments such as bronchitis and asthma. According to a recent U.S. Surgeon General Report, SHS exposure causes diseases and premature death in children and adults who do not smoke. Children exposed to SHS have an increased risk of sudden infant death syndrome (SIDS), acute respiratory infections, ear problems and more severe asthma. The scientific evidence indicates that there is no safe level of exposure to SHS.