RICHMOND, Va. — 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-age 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,” said Surgeon General Regina Benjamin 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 about 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.

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.