Smoking is a major health problem, however the issue is even more pronounced among those incarcerated in prisons, where smoking rates are often three times that of the general population. While effective treatments have been demonstrated in the tobacco literature, research examining treatment within prisons is limited in scope. This article reviews the existing literature evaluating the extent of this problem, its demonstrated effects, and the responses by health care and correctional authorities. Overall, this problem is far reaching, and while there is trend toward curbing smoking within institutions, a great need for empirically-grounded treatments and prevention programs remains.