Cigarette smoking among US youths persists as
a critical public health problem. Notably, 80%
to 90% of adult smokers initiate smoking by
age 18 years.1---3 Trends in smoking behavior
among youths have not paralleled the steady
decline evident among adult smokers.2 Tobacco
use is related to more than 400000 US deaths
per year, and direct medical costs attributable to
smoking total more than $50 billion in the
United States annually.1,4 The public health
importance of tobacco use is underscored by the
Obama administration’s prioritization of smoking
prevention and cessation.5