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This continuation of a self-destructive behaviour is, at an individual level, attributed to the fact that cigarette smoking supports nicotine/tobacco dependence: a condition in which substance use that initially is controllable becomes compulsive.1417 This change from control to compulsion is a behavioural manifestation of changes in brain physiology that accompany repeated exposure to the drug nicotine.15 ,18 ,19 Much has been written about the features of nicotine/tobacco dependence in cigarette smokers and there is some agreement regarding its indicators,14 ,16 though also continued refinement is necessary.20 ,21 Treating nicotine/tobacco dependence in current cigarette smokers is a key component in any public health programme intended to eradicate tobacco-caused morbidity and mortality.22 Unfortunately, other, non-cigarette forms of tobacco use are becoming more prevalent worldwide

Implementing a tobacco-free school policy and surveilling the prevalence of tobacco-use behaviors are fundamental to this effort

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