BACKGROUND In 1999, North Carolina first conducted the Youth Tobacco Survey (YTS) among middle and high school students and found current smoking rates higher than the national average. In 2003, school and community grants across the state were funded to prevent and reduce youth tobacco use. METHODS The North Carolina YTS has been conducted every other year since 1999 with high response rates by schools and students. The YTS is a written survey administered during the school day. It is voluntary and anonymous. RESULTS In 2007 middle and high school student tobacco use rates reached their lowest point in the last decade. Nineteen percent of high school students reported current cigarette smoking, while 4.5% of middle school students said that they currently smoke. Almost every type of tobacco product use (cigarette, cigar, pipe, and bidi) has decreased since the 1999 YTS, with increasing rates of decline in cigarette use from 2003-2007 compared to 1999-2003. CONCLUSIONS This is a cross-sectional survey conducted every other year where students self-report use, attitudes, and perceptions. CONCLUSIONS North Carolina's youth tobacco use rates have declined more steeply since 2003 when the tobacco initiatives started by the North Carolina Health and Wellness Trust Fund (HWTF) began to mobilize communities statewide. Continuing to fund and expand evidence-based tobacco prevention strategies is likely necessary in order to sustain steady declines in youth smoking rates.