The survey, which was conducted with the help of the Centers for Disease Control and Prevention (CDC), also measured tobacco use of middle school students for the first time and found that almost 13 percent of this group use tobacco products.

Major findings of the survey include:

• About one in 10 (9.2 percent) of middle school students and more than a quarter (28.4 percent) of high school students were current cigarette smokers.
• African-American high school students were less likely to smoke cigarettes (15.8 percent) than were white (32.8 percent) and Hispanic (25.8 percent) high school students. African-American middle school students, however, had rates of cigarette smoking that were closer (9 percent) to those for white (8.8 percent) and Hispanic (11 percent) middle school students.
• Cigars were the second most popular tobacco product used by middle and high school students. Among middle school students, 6.1 percent reported smoking cigars in the previous month, and the rate was 15.3 percent for high school students. Males were more likely to smoke cigars than were females, and African-American middle school students were significantly more likely to smoke cigars than were white students of the same age.
• The survey found use of products like bidis, flavored cigarettes from India, and kreteks, a type of clove cigarette, is an emerging public health problem among young people in the US. The use of bidis was at 5 percent and kreteks at 5.8 percent, each nearly the same rate as smokeless tobacco use (6.6 percent).

The American Legacy Foundation (ALF) and the CDC Foundation collaborated on the survey with technical assistance from the CDC. The ALF was established as a result of the 1998 settlement agreement between state attorneys general and the tobacco companies.

"The ?State of the Union? on youth tobacco use is clearly not good," said Cheryl Healton, DrPH, ALF president and CEO. "Tobacco use continues to be the leading preventable cause of premature death in the United States, and we?re committed to public-private partnerships and to working with state and local tobacco control programs and the public health community to save the lives of millions of Americans."

Michael P. Eriksen, ScD, director of the CDC Office on Smoking and Health, said, "The results provide clear evidence that teenage tobacco use continues to be a major public health problem and that states need to fully implement CDC?s ?best practice? guidelines for comprehensive tobacco prevention and control programs."

Dr. Eriksen also called for nationwide prevention efforts, enforcement of the proposed US Food and Drug Administration (FDA) rules on tobacco, increases in the excise tax on tobacco products, and greater availability of smoking cessation treatment options.

"The use of other tobacco products really does point to the fact that we need FDA regulation of all tobacco products," said Ron Todd, director of tobacco control for the American Cancer Society (ACS).

Todd added that the survey is valuable because it covers both middle school and high school students and provides baseline data. The decline in teen smoking rates is encouraging, he added. But, Todd said, "we?ll have to continue to monitor youth smoking to see if this trend continues."

The ACS estimates smoking accounts for at least 30 percent of all cancer deaths. Smoking is also a major cause of heart disease and is associated with conditions ranging from colds and gastric ulcers to chronic bronchitis and emphysema.