A new report by the Substance Abuse and Mental Health Services Administration (SAMHSA) shows that from 2003 to 2013, levels of past month underage cigarette smoking among those aged 12 to 17 have dropped significantly in 49 out of 50 states and in the District of Columbia.

The only state that did not experience a statistically significant decline was Utah which traditionally has one of the lowest levels of underage cigarette smoking in the nation. During this period Utah experienced a slight decline from about 6.6 percent in 2003 to 5.4 percent in 2013.  

Overall, the national level of current underage cigarette smoking dropped sharply from about 12.6 percent in 2003 to less than 6.1 percent in 2013. There still remain significant differences in the level of underage cigarette smoking occurring among the states – ranging from 4.3 percent in California to 9.5 percent in Kentucky.

The teen smoking report was debuted at SAMHSA’s National Prevention Week launch event in Washington, D.C. on Monday. “The decline in underage cigarette smoking is certainly a public health victory and it demonstrates that prevention works,” Kana Enomoto, SAMHSA’s Principal Deputy Administrator, told event attendees.

For all the good news the report offered to attendees, however, there was some bad news. Increases in e-cigarette and hookah use are offsetting declines in use of more traditional products such as cigarettes.

A recent study published by the Centers for Disease Control and Prevention shows that current e-cigarette use (use on at least 1 day in the past 30 days) among high school students increased from 4.5 percent in 2013 to 13.4 percent in 2014, rising from approximately 660,000 to 2 million students.

Among middle school students, current e-cigarette use more than tripled from 1.1 percent in 2013 to 3.9 percent in 2014—an increase from approximately 120,000 to 450,000 students. SAMHSA’s report also concludes that because the use of e-cigarettes and hookahs is on the rise among high and middle school students, it is critical that comprehensive tobacco control and prevention strategies for youth focus on all tobacco products, and not just cigarettes.

The report is based on data from SAMHSA’s National Survey on Drug Use and Health, and annual survey of 67,500 Americans aged 12 and older. Read it here.