New data released by health authorities in the US reveals that more than one in five US high school students smoke, which increases the risk of disease and premature death in this segment of the population.
The smoking rate of 23 percent among US adolescents is higher than in the adult population, of whom 18.1 percent smoke, according to the Centers for Disease Control and Prevention.
"Nine out of ten smokers tried their first cigarette by age 18," said Tim McAfee, director of the CDC's Office on Smoking and Health.
"We must do more to prevent our youth from using tobacco products, or we will see millions of them suffer and die prematurely as adults."
Smoking accounts for one in five US deaths annually, taking more than 480,000 lives.
The CDC's Morbidity and Mortality Weekly Report said more than 90 percent of teenagers using a tobacco product were smoking cigarettes, cigars, hookahs or pipes.
About 4.5 percent said they had in the past month smoked e-cigarettes, which are devices that electrically heat a flavored nicotine liquid into a vapor that can be inhaled.
Nearly half (46 percent) of all high school students said they had used a tobacco product at least once in their lifetime. Cigars and cigarettes were the most common.
The US surgeon general said last year that unless youth smoking rates declined, 5.6 million people currently aged 0 to 17 will die early from a cigarette smoking-related illness.
According to US government data, smoking costs the economy more than $289 billion a year in medical care and lost productivity.