Substance Abuse and Mental Health Services Administration (SAMHS) report by  Rachel N. Lipari, Ph.D., and Arthur Hughes, M.S., May 18, 2015: “Cigarette smoking and exposure to secondhand smoke causes more than 443,000 deaths every year, and another 8.6 million people suffer from a serious illness related to smoking. According to the Surgeon General, if current trends continue, 5.6 million U.S. youths who are currently younger than 18 years of age will die prematurely during adulthood because oftheir smoking. Thus, cigarette smoking imposes substantial health and financial costs on our nation and its states. Preventing adolescents from starting to smoke may be the most effective way to reduce the health and economic burden of tobacco-related disease in the future. Between 1991 and 2013, there was a significant linear decrease in the prevalence of cigarette use among high school students from 27.5 to 15.7 percent. It is useful to state policymakers and prevention specialists to assess whether the decline in smoking occurred across all states among adolescents aged 12 to 17.”