School zero-tolerance policies and bans on tobacco sales to minors make it tough for teenagers to buy cigarettes and hang out with friends to smoke them during the day, but many have found ways around the obstacles.
National, state and local statistics show that declines in cigarette use by teens have slowed or stopped over the past couple years, raising questions about what can be done to tackle the problem.
Health officials say federal, state and local smoking policy changes and legislation have affected teen smoking rates.
They think the entertainment industry also needs to be held accountable for the influence it has over young people and take steps to eliminate smoking scenes in videos, television and movies.
Officials at the Centers for Disease Control and Prevention in Atlanta said strategies, such as increased awareness campaigns, tobacco advertising and promotion restrictions as well as higher state taxes on tobacco products could be effective in reducing teen smoking rates.
New York's tax is more than $4. California's tax is 87 cents.
Jessica Hodgeson, who teaches youth smoking-cessation classes at the Corona-Norco Unified School District's eight high schools, meets teenage smokers when they decide to quit. Her older students have smoked as many as six years, meaning they probably started in middle school.
Hodgeson said her students identify school, family and peer stress as reasons for smoking.
"I try to reach these kids," she said. "It's hard because they're addicted. Even if they cut down, I'm proud of them."
Adrian Diaz, of Riverside, said he started smoking about two years ago after he turned 16. He said he isn't addicted to smoking. He has quit before and could do it again. Diaz is not in Hodgeson's cessation classes.
"At first, I just wanted to see what it was like," said Diaz, who averages a cigarette a day. "It feels good if I'm feeling a lot of stress. It just kind of calms it down."
Researchers at the California Department of Public Health have found that cigarette smoking among teenagers statewide has been down, up, down and stagnate since 1996, a report released earlier this year stated.
They suspect one reason might be because the average price per pack of cigarettes -- around $4.50 -- hasn't changed much since 2000, according to the report.
Nationwide, cigarette use among high school students who describe themselves as current smokers hasn't dropped as much as officials had hoped it would by this year, according to a recent report by the CDC.
The study found that decline in cigarette use among high school students slowed between 2003 and 2009. In 2003, the nation's cigarette smoking rate among high school students was 21.9 percent. The rate dropped to 19.5 percent in 2009. It had been as high as 36.4 percent in 1997, the CDC stated.
U.S. health officials had hoped the nation's teenage cigarette smoking rate would drop more dramatically and fall to 16 percent or below by this year.
In California, 14.6 percent of teenagers smoked cigarettes in 2008, the most recent year for which data was available. That year, Riverside County's rate was 12.5 percent. San Bernardino County reported a 16.6 percent rate.
Consuela Edmond, program director at the Riverside County Department of Public Health, said she believes local tobacco-retailer licensing ordinances enacted since 2005 and tobacco law enforcement has led to the county's low teen smoking rate. Twenty of the county's 26 incorporated cities have adopted tobacco-retailer licensing ordinances.
Store owners whose employees sell tobacco products to children risk losing licenses.
Programs operated by Riverside and San Bernardino counties educate store owners about the law. Some cities in both counties use covert operations involving teen volunteers to identify and ticket clerks who sell tobacco products to youths.
Edmond said the county's teen cigarette use rate was 17.4 percent before communities started enacting tobacco-retailer licensing ordinances.
"We've seen a dramatic decrease," she said. "The tobacco-retailer licensing has been very effective."
Michele Jacknik, manager of San Bernardino County's Tobacco Use Reduction Now program, said policy changes, including creation of smoke-free buildings and increased cigarette costs, have affected smoking rates by making it a publicly unacceptable activity.
Her program is part of San Bernardino County's Department of Public Health. It works with community and government groups to enforce tobacco control policies and ordinances and provide education.
Jacknik said the next step is to exert more pressure on the entertainment industry to stop using smoking in its image and character development, she said. Children will be less likely to emulate that behavior if they don't see it, they said.
"If you reduce the prominence of smoking, it will be less normal," Jacknik said. "There are adults who think it's not a big deal. But 80 percent of smokers start when they are under 18. If children see it all the time,
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