Epidemiology of tobacco use among US adolescents.

Among persons in the United States under age 18 years, every day more than 6000 try cigarette smoking for the first time and more than 3000 become daily smokers. The overwhelming majority of adults who smoke began by age 18 years. Slightly more than one-third of US high school students were cigarette smokers in 1997. In recent years, males were about as likely as females to smoke. American Indians/Alaska Natives and whites were more likely to smoke than were Hispanics, African-Americans, and Asian-Americans/Pacific Islanders. Overall, cigarette smoking prevalence declined in the late 1970s or early 1980s, leveled off in the 1980s, and increased in the 1990s. The decline in prevalence among African-Americans was especially noteworthy. Among US high school students in 1997, the prevalence of cigar smoking was higher than that of smokeless tobacco use. Indicators of nicotine dependence are prevalent among adolescents who use tobacco products. Efforts to: (1) improve the validity of self-reported behaviors; (2) increase access to school dropouts and infrequent school attendees; and (3) improve school participation rates, data availability, and data linkage systems will benefit the field. Qualitative research can suggest variables to be added to survey questionnaires. Methods research should be conducted to better quantify and explain differences between survey estimates. Tracking relevant environmental variables and new tobacco products will expand the science base and facilitate appropriate public health action.