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According to the Centers for Disease Control and Prevention, tobacco use among American middle school and high school students showed a slow decline from 2000 to 2011.

The report showed that in 2011, nearly 30 percent of high school males and 18 percent of high school females used some form of tobacco. More than 8 percent of middle school males and nearly 6 percent of middle school females used some form of tobacco in 2011.

Tobacco use remains the leading cause of preventable death and disease in the United States.  Cigarette use and exposure to secondhand tobacco smoke kill an estimated 443,000 Americans each year.  The health consequences of tobacco use include heart disease, multiple types of cancer, lung disease, adverse reproductive effects, and the worsening of chronic health conditions.  Yet nearly 4,000 kids under age 18 try their first cigarette every day.  In addition to the cost in human lives, cigarette smoking has been estimated to cost $193 billion annually in direct health care expenses and lost productivity.

Although the use of tobacco among high school students continued its 11-year downward trend, tobacco use remains high among high school students.

Among black high school students, cigar use increased significantly from 7.1 percent in 2009 to 11.7 percent in 2011. In 2011, cigar use among high school males (15.7 percent) was comparable to cigarette use (17.7 percent). Cigar use includes the use of cigarette-like cigars that can be packaged and smoked like typical cigarettes, but are taxed at a lower rate, making them more appealing and accessible to youth. 

Nearly 25 percent of high school males and more than 17 percent of high school females used some form of smoked tobacco product in 2011, while smokeless tobacco use among high school males (12.9 percent) was 8 times higher than among high school females (1.6 percent).

"An overall decline in tobacco use is good news, but although 4 out of 5 teens don't smoke, far too many kids start to smoke every day," CDC Director Thomas R. Frieden said. "Most tobacco use begins and becomes established during adolescence. This report is further evidence that we need to do more to prevent our nation's youth from establishing a deadly addiction to tobacco."

The study reported no significant declines in the use of any tobacco product among middle school students from 2009 to 2011.  However, cigarette use declined from 19.2 percent in 2009 to 15.8 percent among Hispanic high school students.

A 2012 Surgeon General's Report recommends making tobacco products less affordable, running hard-hitting mass media campaigns, and evidence-based tobacco control and prevention programs that work in conjunction with new restrictions on the sale, distribution, and marketing of cigarettes and other tobacco products to youth.