Tobacco use is the leading cause of premature disease and death in the United States, costing more than $170 billion each year in direct medical expenditures. More than 60 percent of spending associated with tobacco use is incurred by state and federal government purchasers of health care. States have an opportunity to improve health outcomes and reduce costs by focusing on population-wide interventions and enhancing their tobacco control programs. All states currently have tobacco control laws and programs, but most state programs could do more to implement interventions that have the proven potential to generate savings greater than their implementation costs. Health Investments That Pay Off: A Comprehensive Approach to Tobacco Control examines a multi-pronged approach states can adopt, including preventing initiation, promoting cessation and eliminating health disparities caused by tobacco use and exposure to secondhand smoke.