• Nine percent of middle-school students and 28.4 percent of high- schoolers smoke cigarettes.

• Cigars are the second-favorite tobacco product.

• Use of "bidi" or "kretek" flavored cigarettes from India is on the rise.

The 1999 National Tobacco Youth Survey, conducted for the American Legacy Foundation in collaboration with the Centers for Disease Control, was administered to more than 15,000 students at 131 schools nationwide.

"People are really startled by the use among young kids, and also the diversity of tobacco products being used," says Cheryl Healton, president and CEO of the American Legacy Foundation, a group founded with proceeds from a $206 billion tobacco lawsuit settlement in 1998. Healton warns parents that it is projected that 5 million young people under the age of 18 will die prematurely as a result of smoking. She urges "consumer action" by parents to curb displays of cigar smoking by professional athletes.

"A lot of great work was done to get smokeless tobacco off the baseball field," Healton states. "We need to put the same energy into getting all tobacco products out of team sports."

The good news: This study shows a decline in the number of high-school students smoking cigarettes, down from 36 percent in a Centers for Disease Control study released in 1996. The drop was not unexpected, however, and is attributed to the increase in cigarette prices to pay for the tobacco lawsuit settlement.

Smoking in the Boy's Room
"You see the smoke in the bathrooms after school when the building is open for activities," says Margaret H., a parent and PTO president at her daughter's middle school. "I'm not surprised. We're seeing kids being exposed to things earlier, maturing faster."

Margaret's 12-year-old daughter Erin says smoking is not yet a big problem in her sixth-grade class, but "a lot of people do it to look cooler. They might be under pressure at home. They might feel they have to get perfect grades."

Smoking prevention specialists say no one should be surprised by the numbers of preteens who are lighting up, given the fact that this age group has been identified by peddlers of all types of products, not just tobacco, as an important demographic.

"You look at tobacco advertising. It's all image-based," says Ron Todd, director of Tobacco Prevention and Control for the American Cancer Society. "They say if you use tobacco, this is the kind of person you'll be."

Eleven- to 13-year-olds are particularly vulnerable to such media messages, prevention specialists and educators agree. With earlier studies showing even first graders identifying Joe Camel as easily as they do Mickey Mouse, helping children learn to decode the meaning of advertisements may be essential.

"They need to be taught they're being duped," says Healton. "The question needs to be raised for them: 'Is this a product that's good for you, really?' And they need to understand the nature of addiction, the notion of nicotine as biologically the most addictive drug known to man."

"The thing I've tried to stress with my kids is that to make the choice to smoke is easy," says Margaret. "To make the choice not to smoke is hard."

Schools and Prevention: What Works
Despite the growing evidence that kids are lighting up in greater numbers at earlier ages, the record on school prevention programs is decidedly mixed, experts say.

"There are multiple layers to this problem," says Healton, "And only so much time in the curriculum."

A number of states are using a comprehensive curriculum called "Life Skills" that wins high marks from both the American Cancer Society and the Centers for Disease Control. Preliminary research done in Florida, where the curriculum was introduced several years ago, shows it has had an impact in helping to curb student smoking.

Smoking prevention specialists say most states receiving money from the 1998 settlement plan to earmark a portion of the funds for improved education efforts.