Tobacco is the largest cause of preventable death and morbidity in the world. Significant progress has been made in national tobacco control programmes, followed by a significant reduction in smoking-associated diseases. However, other populations have taken up the habit and the worldwide surge in cigarette smoking by young people is particularly worrisome. Based on our own experience as well as reported data, we examined determinants of tobacco use, at the familial, peer and societal levels as well as various prevention strategies based on legislation, health promotion and society awareness. Reasons for failures include under-enforcement of legislation, uniform approach to diverse populations and too limited means. Recommendations for future actions should include integrated policies and health programmes. Most importantly, the society outlook on tobacco should be changed, making non-smoking the norm and the objective.