Background and challenges to implementation:
Smoking initiation is a key driver to understand future trend of the tobacco epidemic. Prevalence data from the Global Adult Tobacco Survey(GATS 2009 and 2017) suggest that substantial uptake of smoking occurs after 15 years of age, including among young adult males aged 18-24 years.

Intervention or response:
We calculated the proportion of new initiation by age and compare this for 2009 and 2017. We estimate how many would become lifelong smokers by age at baseline using current quit rate by age.

Results and lessons learnt:
Initiation between 2009 and 2017 was 14.2% for 15-17 year olds, 7.0% for 18-19 years, 3.1% for 20-24 years and 1.4% for 25-34 years, with low levels of initiation (< 1.0%) among older age groups.

Conclusions and key recommendations:
Although GATS 2017 reveals an increase in the age of initiation and minor decrease in intensity of smoking and improvement in quit rates, in absolute terms the numbers have increased significantly. We find that there were strong age-related gradients in smoking initiation within these three age groups. Substantial initiation occurs among younger youth and young adults, and tapers after the age of 24. Efforts to prevent initiation of smoking should focus not only on adolescents but also on older youth and young adults. This calls for raising the age of purchase and use to 21 years, and also ensure cessation services targeted at early users.