Annals of Health Law
STRATEGY AGAINST SMOKING
years. 70 Both call for additional and innovative measures.
This section provides some groundwork for the development of the new
model by first outlining the critical period of smoking initiation, second
discussing the challenges of smoking cessation, third identifying relevant
insights from behavioral economics, and fourth dealing with the
fundamental question of whether paying for non-smoking is a desirable
A. Critical Period of Smoking initiation
Becoming a regular smoker is a process that usually takes time. The
initiation phase begins with early experimentation and use, which is nearly
always undertaken in a social context and progresses to a higher level of
smoking experience. 71 In HICs, the experimentation typically occurs
between the ages of ten to twenty-four years, whereas it is deemed highly
unlikely that people who never smoked start experimenting after the age of
twenty-four years. 72 In the United States, for instance, 88.2% of all adults
who had ever smoked cigarettes daily had tried their first cigarette by the
time they were eighteen years old; another 10.8% did so by age twenty-
six. 73 The chances of transitioning to a daily smoking habit after the age of
twenty-six are less than four percent. 74 The peak years for smoking
initiation appear to be between the ages of eleven and thirteen. 75 Starting
early is particularly dangerous, as adolescents tend to falsely assess the
risks of smoking. 76 Not surprisingly, the probability of ultimately becoming
70. CDC, supra note 7, at 109.
71. Won S. Choi, Elizabeth A. Gilpin, Arthur J. Farkas et al., Determining the
Probability of Future Smoking Among Adolescents, 96 ADDICTION 313 passim (2001); John
P. Pierce, Victoria M. White, Sherry L. Emery, What Public Health Strategies are Needed to
Reduce Smoking Initiation?, 21 TOBACCO CONTROL 258, 258-259 (2012) [hereinafter
Strategies]; John P. Pierce, Janet M. Distefan, Robert M. Kaplan et al., The Role of Curiosity
in Smoking Initiation, 30 ADDICT. BEHAV. 685 passim (2005)
72. Stategies, supra note 71, at 259; WORLD HEALTH ORGANIZATION, REGIONAL
STRATEGY FOR TOBACCO CONTROL 12-13 (2005). See also Thomas J. Glynn, Peter
Greenwald, Sherry M. Mills et al., Youth Tobacco use in the United States? Problems,
Progress, Goals, and Potential Solutions, 22 PREV. MED. 568, 571 (1993).
73. U.S. DEP’T. OF HEALTH AND HUMAN SERVICES, PREVENTING TOBACCO USE AMONG
YOUTH AND YOUNG ADULTS: A REPORT OF THE SURGEON GENERAL 134 (2012).
74. Id. at 134-35.
75. LLOYD D. JOHNSTON, PATRICK M. O’MALLEY, JERALD G. BACHMAN ET AL.,
MONITORING THE FUTURE – NATIONAL SURVEY RESULTS ON DRUG USE, 1975-2007, VOLUME
I – SECONDARY SCHOOL STUDENTS 271, 282 (2008).
76. SeeCOMMITTEE ONREDUCINGTOBACCOUSE:STRATEGIES,BARRIERS, AND
CONSEQUENCES, ENDING THE TOBACCO PROBLEM: A BLUEPRINT FOR THE NATION 89-93