Arch Otolaryngol
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A sample of 5,392 students were surveyed using a 42-item, multiple-choice questionnaire from a population of 19,040 Texas school-age children. The geographic distribution was 70% urban and 30% rural, with a representative sampling of the various racial and ethnic groups within Texas. ⋯ Further, 77% perceived cigarette smoking as very harmful, while only 40% perceived smokeless tobacco as very harmful. Age of initiating use indicated that 55% of smokeless tobacco users started before the age of 13 years, whereas only 36% of cigarette smokers began that early.