Tobacco use among children is a major public health problem that many would describe as reaching epidemic proportions. Not only are the numbers of youth who use tobacco products increasing, despite declining numbers of adult smokers, the age of initiation of this high-risk health behavior is becoming dramatically younger in certain populations. Finding potential key risk factors for these differential responses, and testing the hypothesis that patterns of resiliency to tobacco use develop prior to the child’s decision to initiate such use, are crucial to the development of tobacco use prevention policy for children.

This paper will describe how the results of the first wave of a longitudinal, repeated measures study of several child cohorts, of both elementary and middle school-aged

children from predominantly North Carolina schools, document the need for focused prevention interventions. Public health dollars have not traditionally been earmarked for prevention, in general, nor specifically tied to school-aged children’s tobacco use prevention policy. By examining patterns of resiliency in response to environmental pressures to initiate use of tobacco products, as well as the differential responses regarding use during key transitional developmental periods, these research results allow for empirically based policy decisions regarding the use of tobacco settlement funds designated for prevention. Such research-based evidence can, therefore, be utilized by both local and state education and health officials to develop the most effective interventions for the limited prevention dollar.