The New Threat to Gen Z’s Smoking-Free Future

In a remarkable public health success story, Gen Z—today’s middle and high school students—has recorded the lowest smoking rates in history according to recent CDC and FDA data. With overall smoking rates in the US declining to about 11.9% of the population, Dr. Neil W. Schluger, dean of the School of Medicine at New York Medical College and practicing pulmonologist, calls this trend “a great public health success story that has occurred over the past 20 years.” The dramatic shift is particularly striking when compared to the mid-1990s, when approximately one-third of high schoolers smoked cigarettes. Today, that number has plummeted to less than 3%, according to the American Lung Association. This generational shift represents one of the most significant public health victories in recent decades, saving countless young lives from the devastating health effects of tobacco addiction.

However, a concerning counter-movement is emerging that threatens to undo this progress. Social media is becoming ground zero for what some experts describe as the “re-glamorization” of smoking. Popular Instagram accounts like @Cigfluencers, with over 83,000 followers, regularly post images of celebrities smoking cigarettes, often with captions that explicitly connect smoking with attractiveness. “SMOKING HOT!” reads one caption beneath a provocative image of singer Sabrina Carpenter smoking over a bathroom sink, followed by “Also, Smoking = Hot.” The account features numerous celebrities caught in the act of smoking—Ben Affleck, Jeremy Allen White, and Natalie Portman among them—creating a visual narrative that smoking remains a behavior of the beautiful and successful. Dr. Judith J. Prochaska, a professor at Stanford University who researches tobacco dependence treatments, warns that “Influencers can be influenced by marketing dollars and can attract younger generations, particularly if the channels used are popular among younger people, such as with social media.”

The timing of this glamorization attempt is particularly troubling because research consistently shows that adolescents and young adults who view smoking-related content face an increased likelihood of using tobacco products in the future. These risks are significantly amplified when young people actively engage with tobacco content on social media platforms where they spend hours each day. Truth Initiative CEO Robin Koval describes the situation as “a dangerous contradiction for young people who take their cues from pop culture and celebrity influencers, and are especially vulnerable to believe that smoking is more popular than it really is.” A recent opinion piece published in The BMJ characterized smoking’s cultural resurgence as an “unwelcome throw-back for public health” that risks “re-igniting a harmful cultural association between cigarettes and coolness, to which young people are particularly vulnerable.” This calculated attempt to make smoking seem cool again could potentially reverse decades of progress in reducing youth smoking rates.

While cigarette smoking has declined among Gen Z, health experts remain concerned about alternative nicotine delivery systems, particularly e-cigarettes. Dr. Daniel J. Boffa, vice chair of the American College of Surgeons Commission on Cancer and thoracic surgery division chief at Yale School of Medicine, notes that approximately 8% of Gen Z teens use e-cigarettes, which represents a significant concern since “we really don’t know the long-term effect of e-cigarettes yet, and some young adults will switch over from e-cigarettes to smoking tobacco.” The US experienced a troubling surge in vaping rates in 2019, largely attributed to the brand JUUL, which gained popularity among youth due to its high nicotine delivery, discreet design, appealing flavors, and targeted marketing strategies. Dr. Prochaska adds that e-cigarette use continues to rise among young adults, partly because adolescent users are aging into young adulthood while maintaining their nicotine habits. This pattern of nicotine experimentation and dependency mirrors historical patterns that led to lifelong smoking habits in previous generations.

The health consequences of smoking initiation during youth cannot be overstated. Dr. Boffa emphasizes that over 90% of long-term smokers began before turning 18, and “the problem with tobacco smoking in the teenage and young adult years is that the most severe health-related consequences won’t appear for a few decades, making it easier to ignore the warnings.” When someone smokes over time, the inhaled combusted tobacco and paper damage the alveoli—tiny air sacs in the lungs that facilitate oxygen exchange—potentially leading to chronic obstructive lung disease. Smoking also significantly increases cancer risk by introducing toxic substances that suppress the immune system, allowing mutated cells that might otherwise be eliminated to grow and become cancerous. Beyond these major concerns, smoking increases risk for coronary artery disease, aortic aneurysms, peripheral vascular disease, heart attacks, and strokes. Additional health impacts include oral health problems, pregnancy complications, sexual dysfunction, and even mental health effects.

Maintaining the hard-won progress against youth smoking requires vigilance and proactive public health measures. “The reduction in tobacco use in the US is a huge advance in public health, and we should be vigilant not to slide backwards,” Dr. Schluger warns. He advocates for a comprehensive approach: banning smoking in public places, raising tobacco taxes, increasing funding for cessation programs, and cracking down on illegal advertising and sales to minors. These evidence-based interventions have proven effective in reducing smoking rates over decades. However, they must now contend with the new frontier of social media influence, where traditional regulations face implementation challenges. As the tobacco industry and cultural influencers find new ways to make smoking appear fashionable again, public health advocates, parents, educators, and policymakers must work together to counter these messages and protect the first potentially smoke-free generation in modern history. Gen Z’s remarkably low smoking rates represent a public health triumph decades in the making—one that deserves protection from calculated attempts to reverse this life-saving trend.