Problem/Objective: Beginning in year 2000, Washington State targeted intense prevention work among youth with a focus on cigarettes, the most frequently used tobacco product among youth at the time. Prior to 2004, cigarette smoking rates were declining and other tobacco product use, such as cigars and flavored cigarettes, remained low with no clear trend. Washington's most recent youth data showed a stalling of cigarette smoking declines among high school youth, but substantial increases among other tobacco product use.

Methods: Youth data in Washington State are collected every two years. Other tobacco product use and attitudinal data are explored and discussed to shed light on the burgeoning epidemic. Historical tax data on both cigarettes and other tobacco products, within the context of the youth prevention efforts, are also explored to better understand disturbing trends.

Results: In 2006, high school cigar smoking rates were higher than cigarette smoking rates. Flavored cigarette smoking, clove smoking and pipe smoking have also increased by 40 to 80% in the last two years. Over the same time frame, taxes on these other products were decreased from 130% of wholesale to only 75% of wholesale and youth prevention efforts (media, curriculum, etc.) focused on cigarette use and exclusively on middle school youth. Meanwhile, the tobacco industry continues to expand the variety of products and flavors to further fuel the youth experimental atmosphere.

Conclusions: In Washington, a confluence of several critical factors has created the ideal environment for epidemic levels of other tobacco use among youth.