Cigarette smoking remains the primary cause of preventable death and morbidity in the United States. Smoking causes lung cancer, COPD, and CHD and contributes significantly to mortality from other conditions such as stroke. Maternal smoking during pregnancy causes low birthweight and perinatal mortality, and it may have lasting impact on the child's physical and cognitive growth. Passive exposure to ETS causes lung cancer and poses particular danger to the respiratory health of young children. Smoking cessation strategies are important, but the should be supplemented by community and policy-level interventions. Workplace or community smoking bans, statewide taxes on tobacco, and antismoking media campaigns may be effective adjuncts to individual cessation strategies. These strategies may be an even more important disincentive to smoking initiation. The expanding horizon of health consequences of smoking and its costs to American society should again challenge public health agencies to develop and implement effective strategies to prevent smoking acquisition by young people. These health effects should also motivate health professionals in other countries where smoking prevalence is increasing, rather than decreasing, to initiate more effective efforts to reverse this trend and minimize the excess morbidity and death that accompany this dangerous habit.