Tobacco use is common among children and adolescents, and about 50% who try smoking will progress to regular use and dependence. Tobacco dependence is best conceptualized as a pediatric disease that should be addressed in adolescence. This article focuses on tobacco dependence, assessment and treatment, including goals of abstinence and exposure reduction. Although more research is needed, treatment success is more likely to occur with multicomponent interventions that are tailored to the individual needs and the unique issues for this age group, including issues of parental involvement and consent for treatment, developmental issues, and patient preferences. Several school-based interventions appear promising, and many resources are available to provide education for parents, youth, and health care providers.