Despite significant change in smoking patterns among women during the 1980s, the toll in tobacco-related morbidity and mortality remains high and will continue to rise for some diseases (e.g., lung cancer). Women with lower educational attainment are at particularly high risk for smoking initiation and continuation. Advances in gender-specific knowledge regarding the processes of initiation, cessation, and relapse provide more specific opportunities for targeted intervention. Strategies for change involve media, clinical approaches, and public health efforts. Emphasis needs to be placed on tailoring the message and on utilizing innovative channels through which women can be effectively reached. Advocacy groups are targeting public policies affecting women. Ongoing gender-specific research is needed in the next decade.