Methods: Cigarette-use categories were defined as: (1) High: smoked 100+ cigarettes and smoked everyday of the past 30, (2) High-Moderate: smoked 100+ cigarettes and smoked 20-29 days of the past 30, (3) Low-Moderate: smoked 100+ cigarettes and smoked 1-19 days of the past 30, and (4) New Smokers: smoked less than 100 cigarettes and now smoke 1 or more days of the past 30.

Results: Prevalence of current smoking among high school students in New York was 16.3%. The prevalence of High use smokers was 4.5%, High-moderate, 1.7%, Low-moderate, 3.1% and New smokers, 7.0%. Eighty-five percent of High use smokers reported experiencing craving compared with 45% of High-moderate users, 30% of Low-moderate, and 15% of New users (p<0.0001). Similar results were found for two other measures of addiction.

Conclusions: Smoking among high school youth is highly variable. Approximately 40% of high school students who report having smoked on 1+ of the past 30 days (usual definition of youth smoker) were High or High-Moderate Users by our definition. Definitions of youth smoking that incorporate both a threshold of 100 cigarettes and take into account the number of days smoked in the past 30 days, show a strong association with measures of addiction. Refining the definition of youth smoking into distinct categories could benefit programs to better focus interventions aimed at youth.