Smoking and the Teenage Brain: What You Need to Know
By J. Robert Headrick, MD, MBA

March 18, 2020


When it comes to teens and the dangers of smoking, there’s a lot more to consider than just the increased risk of emphysema and lung cancer later in life. Smoking leads to millions of premature deaths worldwide, and an increasing number of youth are experimenting and regularly smoking and vaping, thanks to the growing popularity of e-cigarettes. From 2018 to 2019 alone, the number of middle and high school students using e-cigarettes increased from 3.6 to 5.4 million.  


Smoking traditionally has been the most socially acceptable drug, and there’s often a casual attitude around teenage experimentation as a normal part of growing up. But a teenager’s brain is not fully developed and is fundamentally different than an adult’s, making the introduction of nicotine even more dangerous during this critical developmental stage.

The prefrontal cortex – the area of the brain responsible for cognitive and impulse control – develops more slowly than other parts of the brain. Experts believe the maturation process continues until 25 years of age. So until their brains have matured, adolescents are more likely to take risks, be influenced by their peers, and be motivated by rewards. Many teens believe they can smoke for a period of time and quit, but research suggests that’s not the case. A 2014 Surgeon General’s report found that nearly 9 out of 10 adult smokers started before age 18, and 98% began by age 26. What’s more, a teen with a parent, sibling, or friend who smokes is much more likely to try smoking or vaping and become addicted themselves.


With the increasing volume of research around nicotine’s destructive effects, we know that it’s both psychoactive and addictive and can alter emotional and cognitive processes. Nicotine exposure to the brain during adolescence is even more damaging because of the potential lasting consequences for a person’s mental health, overall cognitive ability, and personality.  

As a cardiothoracic surgeon, I regularly encounter people facing serious medical issues that are directly related to smoking. The majority started in their teenage years and couldn’t stop. Adults who pick up smoking later in life, particularly after age 18, seem to more easily give up smoking when they are experiencing negative health consequences. The younger a person begins smoking, the more likely they are to become addicted and be unable to quit, even in the face of lung cancer.

Protect Their Lungs – and Their Brains

Parents increasingly are worried about traumatic brain injuries associated with football because there’s more information and greater awareness about the dangerous long-term consequences. Smoking and vaping should be considered with the same level of seriousness. The nicotine exposure that comes from increased use of e-cigarettes in teens may lead to changes that make the brain more sensitive to other drugs and increase the likelihood of future substance abuse. Statistics show that teens who smoke are more likely to use alcohol, marijuana, and cocaine, as well assengage in other risky behaviors like fighting and unprotected sex.

In late 2019, the Food and Drug Administration officially raised the nationwide minimum age to purchase tobacco products from 18 to 21, following 19 other states that had already done so. This includes cigarettes, electronic cigarettes, and vaping products that contain nicotine. This cruuial step in saving lives hasn’t come without much discussion between lawmakers and the public about whether it impedes our civil liberties. The fact is that this change will save lives by putting more effective guardrails in place to help our youth make better decisions regarding their own health. Limiting nicotine exposure to later in life when the potential cognitive, functional, and emotional consequences are less likely is key to managing this health crisis.


Now that these regulations are in place, the next step is to have early and ongoing conversations with your kids about how their choices to smoke or vape can and will impact their lives. Teens experimenting with smoking isn’t harmless in the way it was thought about in previous generations. Smoking or vaping can lead to more than a buzz – it can fundamentally change a person’s brain and make them vulnerable to anxiety disorders, alcoholism, and drug addiction, as well as increase the risk for attention deficit disorders that negatively affect the ability to concentrate on school or work.  

Even though they may roll their eyes and scoff at these conversations, speaking the truth in clear and certain terms to your teens is your most effective tool in protecting their health.

The opinions expressed in this article are those of the author and do not necessarily reflect the views of The Society of Thoracic Surgeons.

The Society of Thoracic Surgeons

The STS mission is to advance cardiothoracic surgeons’ delivery of the highest quality patient care through collaboration, education, research, and advocacy.