Tobacco use contributes substantially to the burden of illness throughout the world. Significant efforts have been made to design health promotion programs for the prevention and cessation of tobacco use in North America. However, most of these programs have been planned and implemented on the basis of needs assessments conducted among the dominant cultural group. Evidence exists that lifestyle modification and tobacco cessation programs must be culturally relevant to ensure successful outcomes. A review of the literature from nursing, anthropological and epidemiological perspectives suggests that there is a paucity of data available on the largely culture-dependent values which influence the decision to use tobacco in those groups which comprise the Canadian multicultural mosaic. The interpretation of results from existing studies is limited by a number of recurrent methodological flaws. The implications of this review for future research and public health planning are discussed. The development of culturally appropriate programs directed at the prevention and cessation of tobacco use remains a significant challenge for health professionals.