Methods: The NYTS is administered biennially to middle and high school students and includes questions about tobacco use, environmental exposure, methods for obtaining tobacco, knowledge and attitudes about tobacco, and exposure to pro- and anti- smoking media messages. Students were selected using a three stage sample design (PSU-region, school, class). The 2000 and 2004 NYTSs were used to calculate prevalence rates for 5 stages of smoking (not susceptible to smoking, susceptible to smoking, experimenters, established smokers, and former established smokers). Two-sample t-tests were used to determine statistically significant differences between 2000 and 2004. Logistic regression models were used to identify significant correlates of susceptibility to smoking and established smoking among middle school and high school students.

Results: From 2000 to 2004, increases were seen in the earlier stages (not susceptible 41.0% to 47.2%, susceptible 10.9% to 13.3%), while decreases were seen in the later stages (experimenters 33.5% to 30.5%, established smokers 13.7% to 8.2%, former established smokers 1.6% to 0.8%). Among both middle and high school students, buying or receiving and wearing or using tobacco promotional items, and having close friends who smoke were associated with susceptibility to smoking and established smoking.

Conclusions: Further implementation of comprehensive tobacco control programs which address correlates of susceptibility to smoking and established smoking is needed to reduce youth smoking prevalence.