Tobacco use, primarily in the form of cigarettes, is the leading cause of preventable morbidity and mortality in
the United States (U.S.). The adverse effects of tobacco use began to be recognized in the 1940’s and new hazards of
active smoking and secondhand smoke (SHS) exposure from cigarettes continue to be identified to this day. This has led
to a sustained and wide-ranging array of highly effective regulatory, public health, and clinical efforts that have been
informed by extensive scientific data, resulting in marked decreases in the use of cigarettes. Unfortunately, the dramatic
recent decline in cigarette use in the U.S., has been accompanied by an upsurge in adolescent and young adult use of new,
non-cigarette tobacco and nicotine-delivery products, commonly referred to as alternative tobacco products (ATPs).
Commonly used ATPs include hookah, cigars, smokeless tobacco, and electronic cigarettes. While there have been a
number of review articles that focus on adult ATP use, the purpose of this review is to provide an overview of what is, and
is not known about emerging ATP use among U.S. adolescents on a national scale; as well as to identify research gaps in
knowledge, and discuss future health and policy needs for this growing public health concern. This paper is not meant to
systemically review all published survey data, but to present clear depiction of selected ATP usage in youth populations
using national survey data.