This paper projects the long term consequences of the rise in youth smoking in the 1990s by updating the state estimates for projected smoking-related deaths among youth in the U.S. using information from the Behavioral Risk Factor Surveillance System (BRFSS) 2000 and the U.S. Census 2000. This analysis is similar to that from an earlier study published by the Centers for Disease Control and Prevention (CDC), Office on Smoking and Health (MMWR, 45, November 8, 1996). The 1996 analysis used young adult smoking prevalence data from 1994 and 1995; whereas, the analysis presented here represents smoking prevalence data from 2000. The overall number of potential future smoking-attributable deaths among persons aged 0-17 years in 2000 was 6,407,119 for the U.S., up from an estimated 5 million in 1995. Compared with the 1995 estimates, every state except Arizona shows increases in projected smoking-related deaths among youth for 2000. This upsurge is attributable to both increases in smoking prevalence among young adults and population aged 0-17 years from 1995 to 2000. The increase in smoking prevalence among young adults was statistically significant in nine states including Alabama, District of Columbia, Iowa, Kentucky, Nevada, North Dakota, South Carolina, South Dakota, and Vermont. With increasing attention and funding for comprehensive, research-based tobacco control programs in the U.S., one would expect smoking rates to decline over time, resulting in a reduction in projected smoking-related deaths among youth. The analysis reported here does not yet reflect this trend. This study clearly demonstrates that based on recent smoking patterns, there will continue to be a huge public health toll from tobacco. The results from this new analysis will be useful to states as they determine the overall public health benefits from increasing the state excise tax and consider funding for comprehensive tobacco control programs.