An estimated 57 million Americans currently smoke, putting themselves at risk of serious health problems, such as cancer, heart disease, and high blood pressure. Each year, over 430,000 deaths nationwide are attributable to smoking-related diseases, making tobacco use the leading preventable cause of death and disease in the United States. Total spending by the Department of Health and Human Services (HHS) to prevent tobacco use and dependence is estimated at $900 million for fiscal year 2001. Tobacco use, and the resulting nicotine addiction, begins predominantly in childhood and adolescence. Every day, about 3,000 young people become regular smokers. It is estimated that one-third of these youth will die from smoking-related diseases. In addition to long-term health consequences, these youth are at risk for numerous early consequences, such as a general decrease in physical fitness, early development of artery disease, and a slower rate of lung growth. If children and adolescents can be prevented from using tobacco products, however, they are likely to remain tobacco-free for the rest of their lives. In 1992, the Congress enacted legislation, referred to as the Synar amendment, to reduce the sale and distribution of tobacco products to individuals under the age of 18. HHS' Substance Abuse and Mental Health Services Administration (SAMHSA) is responsible for promulgating regulations and overseeing states' compliance with the Synar requirements. Synar and its regulation require states and territories to have and enforce laws that prohibit tobacco sales to minors, conduct random inspections of tobacco retail or distribution outlets to estimate the level of compliance with Synar requirements, and report the results of these efforts to the Secretary of HHS.