Even with the higher socioeconomic status of this study sample, 40 % of participating adolescents identified themselves as ever smokers, having experimented with at least one puff of tobacco smoke. About half of adolescents reported having a family member who smoked including parents, stepparents, guardians, and/or siblings. Approximately one-fifth of the sample had salivary cotinine levels indicative of tobacco exposure and 10 % were current smokers. Although the US has made great strides in reducing secondhand smoke exposure through comprehensive smoke free legislation [1], many rural communities are unprotected (Klein et al. [19] and tobacco use continues to influence the lives and health of rural adolescents. This study did not measure self-reported secondhand smoke exposure. Self-reported family and peer smoking were used as a proxy for exposure to secondhand smoke. Future studies need to more accurately measure secondhand smoke exposure in adolescents from a variety of sources (e.g., homes, cars, public places, schools).