People who do not start using tobacco by age 18 will most likely never start.[1] Nearly 9 out of 10 people who smoke (about 87 percent) started smoking by age 18, and nearly 99 percent started by age 26.^[2] However, new e-cigarette devices and other emerging tobacco products are regularly introduced and target youth. As a result, more youth are using e-cigarettes, which reverses the years of progress made to decrease youth tobacco use.

Peers Against Tobacco (PAT)

The Texas Tobacco Prevention and Control Program contracts with the University of Texas at Austin to lead PAT, which is a tobacco prevention and control initiative for colleges and universities in Texas.

PAT implements a peer-led initiative to eliminate all forms of tobacco use on college campuses across Texas. This includes, but is not limited to:

• Using curriculum and outreach campaigns.
• Creating policy implementation guides.
• Maintaining a database of all tobacco-related college policies.

The Texas College Tobacco Policy Database lists the campus tobacco policies of postsecondary institutions in Texas and rates each policy based on level of comprehensiveness.

To learn more about PAT, visit PeersAgainstTobacco.org.

Students, Adults, and Youth Working Hard Against Tobacco (Say What!)

The Texas Tobacco Prevention and Control Program contracts with the Texas School Safety Center at Texas State University to lead Say What!, the statewide tobacco prevention and control youth movement.

Say What!:

• Educates middle and high school students through mini-grant projects (free “projects in a box” that include well-designed tobacco prevention-focused materials).
• Raises awareness through social media and other campaigns.
• Convenes a statewide conference and regional summits to educate and provide youth with the experience and skills needed to become tobacco prevention and control leaders in their communities.

The Statewide Youth Advisory Board, also known as Teen Ambassadors, provide guidance on Say What! and are leaders in their community and throughout the state. They educate peers, adults, and stakeholders on the harmful effects of tobacco use.

To learn more about or join Say What!, visit TXSayWhat.com.

E-Cigarette and Tobacco Awareness Program (ETAP)

The Texas Tobacco Prevention and Control Program contracts with the Texas School Safety Center at Texas State University to lead ETAP.

ETAP offers online courses that are available statewide and at no cost to users. ETAP offerings include:

• ETAP Referral Course: This course is intended for individuals under age 21 who are cited for possession of tobacco products, including e-cigarettes (vapes), and are referred by the courts or their school. It also provides young Texans with the information and skills necessary to quit and avoid tobacco products in the future. Schools and educators are also encouraged to use the ETAP Referral Course as an alternative to school suspension or Disciplinary Alternative Education Program.
• ETAP Prevention Course: This course is designed for young Texans in grades 6-12 who are interested in learning about the harmful health effects of e-cigarettes and other tobacco products, tobacco industry marketing to young people, and how young people can build a vape free, tobacco free culture in their school. Schools and educators are encouraged to promote the ETAP Prevention Course as a way for students to receive awareness education regarding the harmful effects of tobacco use and vaping.

To learn more or enroll in an ETAP course, visit https://txssc.txstate.edu/about/programs/etap.

ETAP is the state's only Texas Department of State Health Services-approved e-cigarette and tobacco awareness program as required by Section 161.253, Texas Health and Safety Code. A certificate will be awarded after completing each ETAP course. Please be aware that the courts may not accept a certificate of completion from non-Texas Department of State Health Services approved courses, organizations, instructors, or websites.

ETAP also replaces the former Texas Youth Tobacco Awareness Program (TYTAP). Starting 9/1/25, TYTAP is no longer recognized as a Texas Department of State Health Services-approved e-cigarette and tobacco awareness program.

[1] Centers for Disease Control and Prevention. (2020). Smoking and Tobacco Use. Youth and Tobacco. https://www.cdc.gov/tobacco/php/data-statistics/youth-data-tobacco/

[2] U.S. Department of Health and Human Services. (2014). The Health Consequences of Smoking—50 Years of Progress. A Report of the Surgeon General.