Cigarette Smoking remains the leading cause of illness, disability, and death in the United States, with young adolescents being the most likely to initiate tobacco use.1 In 2001, 64% of high school students in grades 9 through 12 reported they had smoked cigarettes at least once in their lifetime and 36% had smoked in the past 30 days. Higher cigarette smoking rates are reported by students who attend continuation or alternative high schools that serve students who are at risk for either failing or dropping out of regular school, or who have been removed from their school because of behavioral problems or illegal activity. According to the National Alternative High School Youth Risk Behavior Survey, United States, 1998,4 of the 280000 students in continuation high schools, 70% reported they had smoked cigarettes in the past 30 days.