Anticipatory guidance is a traditional nursing intervention. The purpose of this study was to identify factors to serve as targets for anticipatory guidance prior to high school graduation to reduce tobacco initiation among young adults after graduation. A sample of 203 randomly selected freshmen and sophomore students at a major midwestern university completed a survey that included questions about tobacco use, drug use, mental health issues, stress, smoking environment, and other lifestyle choices. The prevalence rate for tobacco use was 32%. Multivariate analyses indicated that students who had used marijuana and alcohol were more likely to use tobacco. Implications for health promotion starting at the high school level were drawn from the study findings. (Contains 4 tables.)