RICHMOND, Va. (AP) ― More work needs to be done to keep young Americans from using tobacco, including creating smoking bans and increasing taxes on tobacco products, the U.S. Surgeon General’s office said in a report released Thursday.

Almost one in five high school-aged teens smokes, down from earlier decades, but the rate of decline has slowed, the report said.

It says it’s particularly important to stop young people from using tobacco because those who start smoking as teenagers can increase their chances of long-term addiction. They also quickly can experience reduced lung function, impaired lung growth, early heart disease and other health problems like asthma.

More than 80 percent of smokers begin by age 18 and 99 percent of adult smokers in the U.S. start by age 26, according to the 920-page report, which is the first comprehensive look at youth tobacco use from the surgeon general’s office in nearly two decades.

“In order to end this epidemic, we need to focus on where we can prevent it and where we can see the most effect, and that’s with young people,” Surgeon General Regina Benjamin said in an interview with The Associated Press. “We want to make our next generation tobacco-free, and I think we can.”

The report details youth tobacco use, health impacts, and tobacco marketing and prevention efforts in the U.S. Officials hope the information will reinvigorate anti-tobacco efforts and spark public activism in reducing death and disease caused by tobacco use.

The report also recommended anti-smoking campaigns and increased restrictions under the U.S. Food and Drug Administration’s authority to regulate tobacco as other ways to prevent adolescents and young adults from using tobacco products.

Benjamin did not point fingers on why youth tobacco use continues in the U.S. Instead, she wants to see how the nation as a whole can best address the issue, she said.

“I don’t want to focus on blame, I want to focus on prevention,” she said. “I want to make sure we’re doing everything that we can to prevent kids from ever starting to smoke or use tobacco products.”

The surgeon general’s office last issued a report on youth tobacco use in 1994, the first wide-ranging report on the topic by federal health officials. The new report is the 31st issued by U.S. surgeons general to warn the public about tobacco’s risks. The first report in 1964 declared tobacco to be deadly.

Since the 1994 report, smoking among high school students has declined from 27.5 percent to 19.5 percent, or about 3 million students, but the rate of decline has slowed in recent years. About 5.2 percent, or 600,000 middle school students also are current smokers. According to the report, every day in the U.S., more than 3,800 people under the age of 18 smoke their first cigarette and more than 1,000 of them become daily smokers. They replace the 1,200 people who die each day in the U.S. from smoking.

“Too many of our children are addicted, too many cannot quit, and too many go on to die far too young,” Assistant Secretary for Health Howard Koh said at a Thursday news conference.

The report also examined advertising and promotional activities by tobacco companies, which have been shown to “cause the onset and continuation of smoking among adolescents and young adults.”

Tobacco companies have spent increasing amounts of money on marketing efforts to reduce prices, which health officials said in the report could influence access to price-sensitive youth and make cigarettes more affordable.

“Far too many kids still see smoking images and messages every day that normalize this dependence,” Koh said. “Kids see smoking in the movies they watch, the video games they play, the websites they visit and in the communities where they live.”

Nearly $10 billion was spent in 2008 on cigarette marketing by the nation’s biggest tobacco companies, a 48 percent increase from what was spent in 1998, when some of the companies agreed with state attorneys general to curtail or stop some of their marketing efforts. That 25-year, $206 billion settlement also pays states for smoking-related health care costs and to support tobacco prevention and cessation programs.

“We have come a long way since the days of smoking on airplanes and in college classrooms, but we have a long way to go,” Secretary of Health and Human Resources Kathleen Sebelius said in a statement accompanying the latest report. “The prosperity and health of our nation depend on it.”

In a statement Thursday, Richmond, Va.-based Altria Group Inc., parent company of the nation’s largest cigarette maker, Philip Morris USA, which makes the top-selling Marlboro brand, said it agrees that kids shouldn’t use tobacco products and that it markets its products to adult tobacco users through age-verified direct communications and at retail stores.

“Underage tobacco use is a difficult issue, and there is not a simple solution,” the company said. “We agree there’s still more work to be done.”

In concert with the report, the surgeon general’s office is launching a contest for young people to submit videos on the report’s findings that will ultimately chosen by the public to win cash prizes.