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The ages at which 18- to 24-year-old college students started smoking and its relationship to subsequent smoking were explored, using data from the 1995 National College Health Risk Behavior Survey. Most students (70%) had tried smoking; among those who had tried, 42% were current smokers, 19% were current frequent smokers, and 13% were current daily smokers. The majority (81%) who had ever smoked daily began doing so at age 18 years or younger, and 19% began smoking daily at age 19 years or older. Women were as likely as men to report ever having smoked a whole cigarette or ever having smoked daily. Most students (82%) who had ever smoked daily had tried to quit, but 3 in 4 were still smokers. Policies and programs designed to prevent the initiation of smoking and to help smokers quit are needed at both the high school and the college levels to reduce the proportion of young adults who smoke cigarettes.

The TNT is highly cost-effective compared with other widely accepted prevention interventions. School-based prevention programs of this type warrant careful consideration by policy makers and program planners.

Objective: To determine how US high school students who are under 18 years of age and who smoke obtain their cigarettes and whether they are asked for proof of age. Design and setting: Data from the Centers for Disease Control and Prevention's 1995 national Youth Risk Behavior Surveys which employed national probability samples of students in grades 9-12 (ages 14-18 years). Main outcome measures: Associations of usual source of cigarettes and request for proof of age with variables such as sex, race/ethnicity, grade, and frequency of smoking. Results: In 1999, among current smokers under age 18 years, 23.5% (95% confidence interval (CI), −4.5% to +4.5%) usually purchased their cigarettes in a store; among these students, 69.6% (95% CI −5.7% to +5.7%) were not asked to show proof of age. As days of past month smoking increased, reliance on buying cigarettes in a store (p < 0.001) and giving someone else money to buy cigarettes (p < 0.001) increased, and usually borrowing cigarettes decreased (p < 0.001). From 1995 to 1999, relying on store purchases significantly decreased (from 38.7% (95% CI −4.6% to + 4.6%) to 23.5% (95% CI −4.5% to +4.5%)); usually giving someone else money to buy cigarettes significantly increased (from 15.8% (95% CI −3.6% to +3.6%) to 29.9% (95% CI −4.5% to + 4.5%)). Conclusions: Stricter enforcement of tobacco access laws is needed to support other community and school efforts to reduce tobacco use among youth. Furthermore, effective interventions to reduce noncommercial sources of tobacco, including social, need to be developed and implemented.A mong adults who have ever smoked daily, more than 80% first smoked cigarettes before the age 18 years.

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