One of the most significant challenges to our health remains the use of tobacco. Approximately one-fourth of our adults continues to smoke. 1 Tobacco use is the largest cause of preventable premature mortality in the United States with enormous associated costs. 2 The Youth Risk Behavior Surveillance for 2003 performed by the Centers for Disease Control and Prevention showed that nationwide 27.5% of students reported current cigarette use, current smokeless tobacco use, or current cigar use on one or more of the 30 days prior to the survey. 3 Reducing tobacco use and preventing its toll of acute and chronic illness and disability is a priority of Healthy People 2010, which lists 21 specific national health objectives related to tobacco. 1 This blueprint for the future of the nation's health aims at reducing tobacco use for adolescents and adults by half.

This issue of the Journal of Public Health Management and Practice (JPHMP 10:6) provides articles focusing on tobacco prevention and control illustrating the breadth and progress of this undertaking. Skeer et al and Higbee et al report on efforts that have reduced smoking in public places. Thomson et al adds to information on the controversial question of whether youth access ordinances are effective and Reichert et al examines a communication strategy aimed at adolescents. Articles by Hyland et al and Thomson et al focus on the extent to which purchasing behaviors are affected by cost and taxation of cigarettes. An innovative study by Stone et al examines the practice, characteristics, and ethics involved with community-based organizations accepting funds from the tobacco industry for public health initiatives. The Public Health Ethics and NACCHO News columns provide additional perspective on this issue.

The systematic reviews and evidence-based recommendations of the Guide to Community Preventive Services (Community Guide) are invaluable to those committed to making continued progress in this area (available at http://www.thecommunityguide.org/tobacco/). The independent task force developing the Community Guide has carefully examined the effectiveness of tobacco use and prevention and control within 3 areas: (1) preventing tobacco use initiation, (2) increasing cessation, and (3) reducing exposure to environmental tobacco smoke (ETS). For each of the interventions examined, appraisal of the strength of the evidence can result in the following designations: "recommended" (strong evidence); "recommended" (sufficient evidence); "recommended against," or "insufficient evidence to determine effectiveness."

Invaluable assistance is provided by the Community Guide for constructing community programs and developing tobacco control and prevention policies based on evidence-based recommendations. For example, recommendations with strong evidence include smoking bans and restrictions, increasing the unit price for tobacco products, and multicomponent interventions featuring media campaigns, quit-line support, or and provider reminder systems with provider education.

Public health directors, local and state legislators, and others can benefit from reviewing these recommendations to better inform program decisions and policies. Evidence for an intervention can be persuasive in working with policy makers and also helps guide our own selection of alternative program strategies. In reviewing the Community Guide findings, it is important to note that a determination that there is "insufficient evidence to determine effectiveness" does not mean that the intervention does not work, but rather indicates that additional research is needed to determine whether the intervention is effective." Further, public health practitioners must use the evidence-based recommendations, such as those from the Community Guide, in the context of their own local needs, resources, and context.

Our own experience at the Onondaga County Health Department (Syracuse, New York) is an illustrative case. Our Tobacco-Free Onondaga County Annual Action Plan is based on the Community Guide recommendations. We have provisions that closely follow the evidence-based recommendations in the areas of smoking bans and restrictions, mass media education combined with other interventions, provider reminder systems, and quit-lines. In certain areas, we do have programs where the evidence is pending (youth purchase ordinances and enforcement) or insufficient (community and school education). Our county health department staff and our Tobacco-Free Onondaga County Coalition recently had the opportunity to participate in the Public Health Grand Rounds Project, which is a collaborative effort between the University of North Carolina School of Public Health and the Centers for Disease Control and Prevention. The live satellite broadcast was aired on May 21, 2004 (available at http://www.PublicHealthGrandRounds.unc.edu).

Efforts to reduce tobacco use are succeeding. They must overcome a tobacco industry with a $5 billion annual budget dedicated to advertising and promotion. The articles in this issue of JPHMP and the Community Guide to Preventive Services will assist us in reaching our objective.

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