Prevention research in tobacco control seeks to identify and test interventions to prevent the initiation of tobacco use and nicotine dependence, primarily among youth. INTRODUCTION Researchers and educators have been striving since the 1960s to develop and implement effective tobacco prevention programs for youth. Most of these programs have been school-based interventions, although programs also have been directed at community-based settings, such as clubs, youth organizations, and components of the health care system. From the mid-1970s through 1991, these efforts appeared to "pay off" in a steady decline in rates of youths beginning to smoke. Among African-American youth, for example, smoking fell to a level approximately one-fourth that of white youth. Youth smoking initiation rates have been rising steadily since 1991 among African-American and white youth. Past tobacco prevention research, much of it funded by the NCI and NIDA, has provided a solid foundation on which to build the more sophisticated interventions that are needed to address the changing mix of sociocultural and environmental factors that promote tobacco use among today's youth. For example, investigators have demonstrated convincingly that school-based prevention programs that target social influences on smoking and provide youths with the skills to resist those influences can have a short-term impact on the initiation of tobacco use during the most vulnerable junior high school period, when experimentation with tobacco is most likely to occur. A few of these programs also have demonstrated a sustained prevention effect on tobacco use throughout high school. However, the difficulties of moving these programs from the research setting to implementation in "real-world" community settings have been daunting. Therefore, while we need to support research to develop and refine tobacco prevention programs, we must simultaneously address societal and policy issues that influence the implementation and effectiveness of these programs. As discussed in a later section, such policy-related research issues include: establishing tobacco prevention as a priority in the educational curriculum; promoting environmental policies to ban tobacco use by students and teachers within and near schools; banning tobacco advertising in the vicinity of schools; and preventing minors' access to tobacco products. It is important that youth programs provide an understanding of the biological basis of addiction. Basic biologists and biobehavioral researchers should interact with prevention scientists in designing programs. We also need policy research to provide science-based answers to a number of other questions. How, for example, does tobacco marketing interact with biobehavioral factors (e.g., culture, social influences, and personality) to influence youth susceptibility to tobacco use? Research should also focus upon how price increases and youth access laws affect different segments of the population. The effect of product design, including amount of nicotine and mode of delivery, upon nicotine use and dependence among users may also be evaluated. Finally, the relative costs and benefits of mandating Medicaid coverage for nicotine addiction treatment is worthy of inquiry. Policymakers and tobacco control program planners need answers to these questions. Furthermore, the potential to link policy research to research on the state and community interventions as described below provides a unique opportunity to maximize the impact on tobacco use from both lines of research. RECOMMENDATIONS Research should be conducted to develop and evaluate novel approaches to preventing tobacco use, especially among populations at disproportionate risk. While school-based approaches that teach skills to resist social influences to smoke have had some success in preventing tobacco use among youths, major gaps remain in our understanding of the most critical elements of tobacco prevention interventions, their timing, how best to target high-risk subgroups and settings, and how to tailor prevention materials appropriately for different populations. Markers of tobacco susceptibility in early childhood could be used to develop and test targeted prevention approaches for younger children. Prevention research might also focus on family interventions to deter youth from tobacco use. Other important target groups are young people who are not in school and those who have entered the workplace. Prevention strategies are more likely to be effective if they are tailored for groups at high risk of initiating tobacco use and nicotine addiction. This includes children with attention deficit hyperactivity disorder (ADHD) and/or low academic achievement levels, depressed youth, substance-abusing youth, and "risk takers" with other health or lifestyle problem behaviors. Research on prevention programs for high-risk groups also should consider gender-specific issues, such as white female teens using cigarettes to prevent or control weight gain. Such research also should examine ethnic-specific issues, such as the apparently low smoking rates among Asian-American women and African-American girls or the very high rates of smoking among Native American children, both of which are linked to sociocultural variables. Research also is needed to develop special interventions for high-risk medical subgroups, such as young people with asthma or diabetes, pediatric cancer survivors, and children with elevated cardiovascular risk factors, for whom tobacco initiation can pose particularly damaging health consequences. Finally, we need research on prevention strategies to address individuals with a genetic susceptibility to nicotine addiction that may increase their likelihood of initiating tobacco use or moving from experimentation to regular, dependent smoking. These research initiatives should be built on the findings from biobehavioral research about the factors influencing tobacco use and addiction, which are discussed in more detail in that section. Collaborative opportunities with the National Institute of Child Health and Human Development (NICHD) and NIDA would be appropriate in these areas. OTHER RECOMMENDATIONS Prevention research should be conducted in conjunction with community and state intervention research, to explore the relative effectiveness and consequences of prevention interventions that employ single-risk versus multiple-risk strategies. Such research can determine if it is more effective to deliver a prevention intervention that focuses on tobacco use alone or to integrate tobacco prevention into a program that addresses other risk-taking behaviors, such as abusing alcohol and other drugs. Research is needed to identify the best strategies for diffusion of effective youth prevention efforts through different channels of delivery, such as schools, health centers, and other community settings. As discussed in more depth under Community and State Intervention Research, it will be critical to develop such diverse diffusion strategies to increase the impact of novel, nonschool-based approaches. THE IMPACT OF PREVENTION RESEARCH The continuing increase in the use of tobacco products by American youth during the 1990s constitutes both a pressing challenge and a unique opportunity to reduce the tobacco-related diseases in the next century. If we act now to develop and implement successful tobacco prevention interventions, we will avert a major upturn in tobacco-related cancers in the middle of the next century. Smoke-Free Kids & Soccer is an innovative collaboration of the U.S. Department of Health and Human Services (DHHS), the U.S. Women’s National Soccer Team, and U.S. Soccer. Participating DHHS agencies include the National Cancer Institute and the Centers for Disease Control and Prevention. This campaign promotes participation in soccer as a positive, healthy alternative to tobacco use; it offers free vibrant posters and tips to help teens model the success and smoke-free lifestyle of National Team members via web site: www.smokefree.gov.