In the US 20.6% of adults and 19.5% of high school students are current cigarette smokers. Smoking is responsible for 5 million deaths worldwide each year and is known to cause more and a greater variety of human disease than any other known toxin. It causes multiple cancers, significant cardiovascular, respiratory and reproductive disease, and has been linked to health problems in most organ systems of the body. The harmful effects of tobacco begin in young smokers, who experience respiratory symptoms, increased rates of infection, and evidence of cardiovascular effects soon after beginning to smoke, even at low levels of cigarette use. Declines in the rate of cigarette smoking have stalled in the developed world. In the US, the Healthy People 2010 goal of decreasing current smoking in youth to below 16% has not been met. Smoking rates are increasing in the developing world, and there is already a rise in tobacco related problems in those areas least able to cope with the increased burden of disease. Continued efforts on a global scale are needed to combat the persistent and growing problem of tobacco use.