This paper explores adolescent preferences for the setting, timing, delivery format, provider and key elements of tobacco control programmes. The need for programme sensitivity towards urban/rural, gender and ethnic subgroups is also discussed. Schools were purposively selected from the Southern Cape-Karoo Region, South Africa. Twelve prevention and nine cessation focus group discussions were conducted with Grade 6-8 students and Grade 8-9 smokers and ex-smokers, respectively. Adolescents reported similar preferences for prevention and cessation programmes. Although they were unaware of smoking prevention or cessation programmes, they reported a willingness to participate in such programmes. Programmes should include school-based activities that are supported by out-of-school activities held over weekends and holidays. Non-judgemental and empathetic teachers and peers, as well as ex-smokers were preferred as programme providers. School-based participatory delivery formats should be supported by community-based mass media approaches. Programmes can be jointly presented to boys and girls of diverse ethnic backgrounds with some gender-sensitive sessions. Programme participation and sustainability would be enhanced if it were exciting, fun filled and integrated into their daily lives. School-based programmes must be embedded within comprehensive approaches that involve community- and policy-level interventions.