Cigarette smoking constitutes the single largest threat to the health and longevity of American youth. Each year, almost 400,000 people die prematurely from tobacco-related diseases. Moreover, 90% of adult smokers began using tobacco before their eighteenth birthday, and each day 3,000 children and adolescents begin smoking. Smokeless tobacco use is less prevalent than cigarette smoking but has similar deleterious health effects and is often also glamorized by sports figures. This article examines the relationship between tobacco and sports and offers specific steps that physicians (specifically orthopedic surgeons and sports medicine physicians, who interact with athletes at sporting events and in schools as well as at the clinic) can take to help prevent or minimize tobacco use. Although sports have been used by the tobacco industry to promote tobacco products to young people, the authors suggest new ways to prevent its success.