Every day, nearly 4,000 children under 18 try their first cigarette, according to federal estimates. That adds up to more than 1 million new smokers every year.

According to a new report from US Surgeon General Regina Benjamin, one of every four high school seniors smokes, and the majority continue to smoke into adulthood. Nearly 90 percent of all smokers started by the age of 18, according to the report, while new research shows that smoking during adolescence and young adulthood leads to early heart disease.

Tobacco is the leading cause of preventable and premature death, killing an estimated 443,000 people a year. In addition, cigarette smoking costs the nation $96 billion in director medical expenses and $97 billion in lost productivity annually.

On Thursday, June 14, more than 200 people gathered at Kane Hall to meet with Benjamin and other public health advocates for a Youth and Tobacco Town Hall sponsored by the U.S. Department of Health and Human Services. The issues ranged from the high rate of smoking among Native Americans to making college campuses smoke-free.

Kate Cole, coordinator of the tobacco studies program at the UW and a recent MPH graduate, told Benjamin that the image of smoking in popular culture needs to be changed. She blamed the tobacco industry's well-funded PR machine as well as Hollywood for producing too many movies with smoking scenes. "When we think of youth smoking as an individual choice," Cole said, "we're ignoring everything we know about marketing. Pop culture can override rational decision-making."

Earlier, Tim McAfee, director of the Center for Disease Control and Prevention's Office on Smoking and Health, said that one third of the top-grossing children's movies in 2010 contained smoking scenes. McAfee also said cigarette companies have targeted young adults with coupons to make smoking cheaper and are using nicotine products such as "snus," dry snuff in a pouch.

For comprehensive tobacco control programs, McAfee recommended:

• 100 percent smoke-free policies
• Tobacco price increases
• Hard-hitting media campaigns, and
• Access to cessation programs.

The CDC has a series of compelling videos featuring warnings and tips from former smokers.

Another issue at the Town Hall meeting was the widespread use of tobacco among American Indians. Although the smoking rate has been cut in by half among American Indians and Alaska Natives, "the rates are still way too high," said Jan Ward Olmstead, health policy consultant for the American Indian Health Commission for Washington State.

"Tobacco use is a really big issue for Alaska Indians," said Adele Argaitchiaq Solksi, an Inupiaq Eskimo from Fairbanks. "About half of Alaska Indians use tobacco in some form." Solksi said she grew up in a family where her father and five older siblings smoked. She asked Benjamin for advice on how to approach family members on their smoking habits.

"It's hard," Benjamin responded. "I watched my mother die from lung cancer. My brother smoked as well. It's hard to talk to your family but you have to do it."

Another panel was devoted to making campuses smoke-free, and featured the challenges and successes of places such as Clark College in Vancouver, WA, which is smoke free but contains public roads and sidewalks where people still can smoke.