According to the Maryland Department of Health and Mental Hygiene, tobacco use among youth in public high schools has decreased by 40% from 2000-2013, showing reduced cigarette use. Despite this overall trend, use of smokeless tobacco products among this sample has actually increased by 5%. The data indicates that the use of smokeless tobacco by youth is three times greater than adult usage and cigar use is also 2.5 times greater among youth. There is a strong correlation between the underage use of tobacco and other risky behaviors, such as substance abuse. While no significant change is evident for youth cigar use overall, there was a notable decrease since cigar use peaked in 2008. Noted declines are likely influenced by campaigns by the State and National campaigns, prevention programs supported at the local level, regulatory initiatives, and cessation intervention programs like the Maryland Tobacco Quitline.