Efforts to control tobacco use and tobacco related morbidity and mortality in the USA have met with reasonable success, at least through the early part of the 1990s. In the 39 years since the publication of the first Surgeon General’s Report on Tobacco and Health, adult smoking rates in the USA have declined by nearly 40%, although only a modest portion of that decline has occurred during the past decade. Nevertheless, less than a quarter of the US population now smokes and other indices of success, such as changing attitudes toward tobacco use in public places, a near universal perception of tobacco use as a health hazard, and support for laws and regulations restricting tobacco use all point to continued progress in tobacco control among the US adult population.

Controlling tobacco use among youth, however, has presented a greater challenge in recent years. Although there was considerable progress in reducing adolescent tobacco use between the early 1970s and the mid 1980s, incidence and prevalence of youth smoking began, first, to stabilise in the late 1980s and, then, alarmingly, to climb through a large portion of the 1990s. In fact, in the relatively short period between 1991 and 1997, the percentage of US high school students who were current smokers rose by nearly a third, from 27% to 36%.

The research community offered a number of …