It is estimated that more than 3 million American children under 18 years of age consume 947 million packs of cigarettes and 26 million containers of smokeless tobacco yearly. These tobacco products account for annual sales of $1.26 billion. Approximately 3% of tobacco industry profits ($221 million in 1988) derive directly from the sale of cigarettes to children, an activity that is illegal in 43 states. Approximately half of the tobacco industry's profits, or $3.35 billion annually, derives from sales to people who became addicted to nicotine as children. Tax revenues to the federal ($152 million) and state ($173 million) governments from cigarette sales to children dwarf governmental expenditures on smoking and health. We describe how dozens of communities have effectively enforced laws that prohibit the distribution of tobacco to children and offer some suggestions for increasing efforts to prevent nicotine addiction. (JAMA. 1990;263:2784-2787)