Tobacco use among high school students in the United States dropped 18% between 2000 and 2002, according to the latest survey reported by the Centers for Disease Control and Prevention (CDC). A significant drop was not seen among middle school students, however.

The findings of the National Youth Tobacco Survey, conducted by the American Legacy Foundation, were published in the CDC's Morbidity and Mortality Weekly Report (Vol. 52, No. 45: 1096-1098). Researchers asked more than 26,000 students in grades 6-12 about their use of cigarettes, cigars, smokeless tobacco, pipes, clove cigarettes (known as kreteks), and bidis (flavored, leaf-wrapped cigarettes from India).

Among high school students (grades 9-12), use of cigarettes, the most commonly used tobacco product, fell from 28% in 2000 to about 23% in 2002. Use of other tobacco products also dropped.

"I think this is a pretty exciting decline," said Jane Appleyard Allen, assistant director of evaluation for the American Legacy Foundation and lead author of the report. "We really have made a substantive change in tobacco use overall."

Even among younger students (grades 6-8) there was a drop in tobacco use, she noted, although it was not large enough to reach statistical significance. Cigarette smoking fell from 11% in 2000 to 10% in 2002.

Experts don't know why younger students didn't kick the tobacco habit at the same rate as older ones, but there could be many reasons, said Corinne Husten, MD, a medical officer with the CDC's Office on Smoking and Health.

Cigarette price increases, for instance, are an effective deterrent for older kids, but may not work as well on younger kids, who are less likely to spend their own money on cigarettes. Younger kids may be getting their cigarettes from older friends, or sneaking them from their parent's packs.

Younger children may also be more vulnerable to images of smoking they see around them, whether in their own families or on television and in movies.

Allen said advertising by the tobacco industry may also play a role. The six largest cigarette manufacturers spent more than $11 billion on advertising and promotions in 2001, according to the Federal Trade Commission's most recent report on cigarette sales and advertising.

"It's not technically directed at youth, but we know there's spillover," Allen said. Cigarette ads appear in newspapers, magazines, on the Internet, and at certain events sponsored by tobacco companies, like concerts, auto races, or fishing tournaments. The industry also spends significant amounts of money on in-store promotions and give-aways, according to the FTC report.

Public health experts are concerned that recent budget cuts to anti-tobacco programs could jeopardize the strides made in keeping kids off cigarettes and other tobacco products.

"We're making good progress and we can't stop now," said Husten.

"I think it's important to remember that a third of these kids who start to smoke will go on to die of a smoking-related illness," she added. "This isn't a trivial issue. We need to think about reinvigorating our commitment to what we know works."

And what works, experts said, are comprehensive programs that send kids the anti-tobacco message from many different sources: communities, schools, and the media.

A combination of initiatives can be credited with the drop seen in high school tobacco use, said the American Legacy Foundation's Allen.

"Right now we really do see a confluence of things – increased prices, smoke-free policies, restrictions on advertising, and campaigns like our national 'truth' campaign [an American Legacy Foundation initiative that combines advertising with online and grassroots anti-tobacco efforts], and also local and state campaigns," she said.

The drop in teen smoking comes as many of the most successful state campaigns are threatened by budget cuts.

A recent report presented to Congress by the Campaign for Tobacco-Free Kids found that the states have cut annual funding for tobacco prevention by 28%, or $209 million. Just four states – Maine, Delaware, Mississippi and Arkansas – provide funding for anti-tobacco programs at the levels recommended by the CDC.

Tobacco companies spend more than $20 in marketing for every $1 states put into tobacco prevention, the report said.

"It's cause for concern," Allen said. "It makes me wonder if we will continue to see declines (in youth smoking rates) or even plateaus or increases if we continue to lose funding."