Tobacco use is the single most preventable cause of disease and death in the United States. The health consequences of tobacco use include heart disease, multiple types of cancer, pulmonary disease, adverse reproductive effects, and the exacerbation of chronic health conditions. Nearly one-half million Americans still die prematurely from tobacco use each year, and economic costs attributable to smoking and exposure to secondhand smoke now approach $300 billion annually. Despite these known health and financial burdens, approximately one in four American adults currently use some form of tobacco, with one in five smoking cigarettes. This public health problem is compounded by the fact that the harmful effects of tobacco use do not end with the user. Although substantial progress has been made in the adoption of comprehensive smoke free policies that prohibit smoking in all indoor areas of workplaces and public places, millions of Americans not protected by such policies remain susceptible to involuntary secondhand smoke exposure in these areas, as well as private settings such as multiunit housing. There is no risk-free level of secondhand smoke, and exposure can cause premature death and disease in nonsmoking adults and children. Nearly 90% of adult smokers begin smoking by the time they are 18 years of age. Although the prevalence of cigarette smoking among youth decreased significantly from the late 1990s to 2003, the rate of decline has slowed in recent years. In 2012, approximately 6.7% of middle school students and 23.3% of high school students reported using a tobacco product within the past 30 days. Several factors may have contributed to this lack of continued decline, including smaller annual increases in the retail price of cigarettes, decreased exposure among youth to effective mass media tobacco control campaigns, and less funding for comprehensive statewide tobacco control programs. Additionally, actions by the tobacco industry, including substantial increases in expenditures on advertising and promotion at the point of sale, may also have played a role, especially given the industry's history of deceptive advertising. In the 2006 final opinion in United States v. Philip Morris, U.S. District Judge Gladys Kessler concluded that the major tobacco companies are adjudicated racketeers that had "mounted a coordinated, well-financed, sophisticated public relations campaign to attack and distort the scientific evidence demonstrating the relationship between smoking and disease." Best Practices for Comprehensive Tobacco Control Programs - 2014 updates the guidance provided in 2007, reflecting additional state experiences in implementing comprehensive tobacco control programs, new scientific literature, and changes in state populations, inflation, and the national tobacco control landscape. This report draws upon best practices determined by evidence-based analysis of state tobacco control programs and published evidence of effective tobacco control strategies. On the basis of this analysis, experience, and evidence, CDC recommends that states establish and sustain comprehensive tobacco control programs that contain the following overarching components. This report describes an integrated budget structure for implementing interventions proven to be effective, and the minimum and recommended state investment that would be required to reduce, and ultimately eliminate, tobacco use in each state. Information for each of these components includes: Justification for the program intervention; Considerations for achieving equity to reduce tobacco-related disparities; Budget recommendations for successful implementation; References to assist with implementation.