Abstract Although cigarette smoking has decreased significantly in the last 25 years in the United States, it continues to be a major contributor to morbidity and premature mortality. All 704 U.S.-accredited health science schools were surveyed to determine the existence and scope of smoking policies, smoking cessation programs, and related activities in these schools. The aim was to encourage health care-related organizations, institutions, and professionals to accept leadership roles in smoking prevention and cessation. Of 517 (73%) respondents, 339 reported some form of smoking policy; however, restriction was primarily prohibited in classrooms and elevators. Vending of cigarettes was reported in up to 17% of schools, and smoking-related illness complaints were reported by 31%. Smoking programs and information were minimally offered. Health science schools must be more aggressive in their approaches to dealing with smoking prevention and cessation, and assume a more proactive leadership role toward achieving a smoke-free environment.