Improving the health of U.S. children: the need for early interventions in tobacco use.

Despite considerable progress, tobacco use continues to be a major public health problem in the United States, killing more U.S. citizens each year than alcohol, cocaine, crack, heroin, homicide, suicide, car accidents, fires, and AIDS combined. There is cause for particular concern about smoking and other tobacco use by children. Although adolescent smoking declined in the late 1970s and early 1980s, the combination of a now-flat daily smoking prevalence rate among high school seniors, high smoking rates among high school dropouts, and increased use of smokeless tobacco argues for renewed efforts in tobacco use prevention. The greater risk associated with tobacco use at early ages suggests the need for comprehensive interventions (i.e., involving policy change, advertising restrictions, health professionals, and comprehensive school health education) before the prime age for tobacco use initiation (i.e., 12 to 14 years old), for repeated reinforcement of these interventions through adolescence, for innovative ways of reaching underserved--particularly high-risk and minority--youth with effective tobacco use prevention efforts, and for research to determine both the short-term and the long-term effectiveness of these approaches.