Original article Patterns of Current Use of Tobacco Products Among U.S. High School Students for 2000e2012dFindings From the National Youth Tobacco Survey René A. Arrazola, M.P.H. * , Nicole M. Kuiper, M.P.H., and Shanta R. Dube, Ph.D., M.P.H. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Article history: Received May 31, 2013; Accepted August 2, 2013 Keywords: Current tobacco use; High school students; United States A B S T R A C T Purpose: The purpose of this study was to assess patterns and trends of tobacco use among high school students to better understand which products are used individually or concurrently. Methods: Data from the National Youth Tobacco Survey from 2000 through 2012 were used to assess patterns and trends of current tobacco use (cigarettes, cigars, smokeless tobacco, and other tobacco products) among U.S. high school students. We assessed use of products individually and concurrently. Results: During 2000e2012, overall linear declines were observed in current use of any tobacco product from 33.6% to 20.4% (p < .05), current use of only 1 tobacco product, from 18.8% to 10.5% (p < .05), and current poly tobacco use, from 14.7% to 9.9% (p < .05), among high school students. Overall current use of only cigarettes had both a linear decline, from 14.0% to 4.7%, as well as a quadratic trend. Conclusions: During 2000e2012, the most significant overall decline observed was for students who reported smoking only cigarettes. The results suggest that more data on the use of multiple tobacco products, not just cigarettes, is needed to guidetobacco prevention and control policies and programs. Published by Elsevier Inc. on behalf of Society for Adolescent Health and Medicine. IMPLICATIONS AND CONTRIBUTION Recent declines in current tobacco use among U.S. high school students appear to be driven by those who smoke cigarettes. To ach- ieve greater declines, poli- cies and programs focused on cigarettes may consider expanding to all tobacco products. Monitoring of all tobacco use among youth provides information to prevent initiation. Tobacco use continues to be the single leading preventable cause of death and disease in the United States [1], and most tobacco use begins before the age of 18 [2]. Cigarette smoking remains prevalent among youth, with approximately one of five high school students reporting current smoking in 2011 [3]. Although declines in youth smoking rates were observed over the past two decades, more recently, the decline in current cigarette smoking is occurring at a slower rate than was observed during 1997e2003 [4]. The rates observed for use of other tobacco products (e.g., cigars, smokeless tobacco) have not changed during this period [5]. A conclusion from the 2010 Surgeon General’s Report supports previous findings that nicotine is the key compound that produces the addictive effects of tobacco products [6], and all tobacco products contain nicotine [7]. The concurrent use of multiple tobacco products is a public health concern, especially during adolescence when young people may experiment with various tobacco products [2], which may increase their risk of nicotine dependence. Research has suggested that use of multiple tobacco products concurrently may lead to greater addiction among users of these products [2]. Furthermore, among high school students, use of tobacco in the past 30 days is associated with the use of alcohol and other illegal substances [8], and the relationship is even stronger when students report using two or more tobacco products [9]. These findings indicate a need to monitor the use of all types of tobacco products, both The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Funding Sources: There were no sources of funding, either direct or indirect, for this study. Conflicts of Interest: The authors have no conflicts of interest or financial disclosures to report. * Address correspondence to: René A. Arrazola, M.P.H., Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, N.E., MS F-79, Atlanta, GA 30341. E-mail address: RArrazola@cdc.gov (R.A. Arrazola). www.jahonline.org 1054-139X/$ e see front matter Published by Elsevier Inc. on behalf of Society for Adolescent Health and Medicine. http://dx.doi.org/10.1016/j.jadohealth.2013.08.003 Journal of Adolescent Health xxx (2013) 1e7