Children as young as nine in Brighton and Hove are regularly smoking.
More than one in five children aged nine to 11 said they had had at least one cigarette in the last seven days.
The anonymous survey was carried out by NHS Brighton and Hove in schools across the city.
An NHS report said: “Smoking seems to be much more prevalent among children in Brighton and Hove compared to other areas.”
The study revealed 4% of 11 to 16-year-olds said they were regular smokers with 7% of pupils claiming to smoke more than six cigarettes a week.
Lynn Daly, of Cancer Research Sussex, said: “Smoking in this age group is a huge problem, particularly in girls.”
In West Sussex, 65% of those aged 14 or 15 say they have tried smoking and more than 10% of girls and 8% of boys in that age group class themselves as regular smokers.
An East Sussex survey showed 15% of pupils aged 14 or 15 had smoked at least one cigarette in the past week.
Anna Kirk, of NHS Sussex, said: “We know that across Sussex young people do experiment with smoking and we also know there are influences that make smoking more attractive.”
Cancer Research figures released this week suggest more than a quarter of under-15s in the UK have tried smoking.
Jean King, of Cancer Research, said tobacco companies should introduce plain packaging to try to reduce the lure of cigarettes to youngsters.
She said: “Far too many young people start smoking every year. We must act to bring this number down.”
Child smokers can get free help and support from doctors and pharmacies.
For more information call the NHS Stop Smoking Helpline on 0300 1001823.
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