Less than a third of teens say their doctors have spoken to them about tobacco use, according to a new study.

“Given that tobacco is still the number one preventable cause of death and disease in the U.S., it is surprising that more clinicians are not intervening with adolescent patients to help them avoid or quit tobacco,” lead author Gillian L. Schauer, of Carter Consulting Inc, told Reuters Health.

Every year, 400,000 U.S. youth under age 18 smoke their first cigarette, they add, with about a quarter of those becoming new daily smokers.