As a female-dominated profession, dental hygiene has a heightened interest in women's health issues. An area of disease prevention and health promotion that merits gender specific interventions is tobacco use. Tobacco initiation, habituation, and cessation are different for men and women, and their effects on women's health also are more varied and unique. This paper addresses trends in tobacco use by women, gender specific developmental and sociocultural considerations in initiation and habituation; the pregnant tobacco user and the developing fetus; menopause, osteoporosis, heart disease, and tobacco use; the economic impact of pregnancy and tobacco use; and successful interventions with women who use tobacco. Since women present for more dental office visits than males, female patients are more accessible to the dental hygienist's tobacco intervention message, and gender specific strategies may be most successful. Dental hygienists' strong counseling and motivational abilities, along with their inherent interest in women's issues, can make prevention and cessation activities with female patients who use tobacco both challenging and rewarding.