This review summarizes recent trends and current patterns of tobacco use in the United States. Although adult smoking dropped between 1965 and 1990, from 50% to 28% of men and from 35% to 23% of women, the past decade has seen little further progress. In 2000, 25.7% of US men and 21.0% of women were smokers. Adolescent smoking has been declining since the late 1990s, but nearly 30% of high school seniors still smoke. In 2000, 4.4% of US men and 0.3% of women used snuff or chewing tobacco. Although adolescent smokeless tobacco use has declined in recent years, 14.8% of male high school students were current users in 2001. In 2001, 22.1% of male high school students and 8.5% of women students were current cigar smokers. Bidis and kreteks may be gaining popularity among young people, and more than 15% of adolescent smokers use these tobacco products. Despite recent progress, tobacco use remains prevalent in the United States. State and local governments need to invest adequate resources in the full range of tobacco control activities.