Tobacco use among youths in the Central American and neighboring countries is a serious health problem. Research has found a significant association between family interaction patterns and tobacco smoking among adolescents. This association was tested among 5,549 adolescent students in 5 Central American countries, Panama, and the Dominican Republic that participated in the Drug Use Screening Inventory (DUSI) survey in 1994. Anonymous self-report questionnaires, in a Spanish version, were administered to the students. Five items regarding “family attention” were assessed using a dichotomous Yes or No response format. The questions pertained to parents being aware of student’s likes and dislikes, clear rules of the household, parental awareness of things that are important to student, parental awareness of student’s whereabouts, and whether the student feels important to his/her parents. Results show that, when considering students in the entire region, those with the highest level of family attention had approximately one-fourth lower odds of tobacco smoking than students at the lowest level. Evidence that the occurrence of tobacco use varied across the lowest and the intermediate level of family attention was not found. It was not found that the relationship between tobacco use and family attention varied across subgroups by gender, age, or by any other domains studied by the DUSI. These findings indicate that there is a moderate-to-strong association between highest and lowest levels of family attention and occurrence of tobacco smoking, among the youths sampled for the entire region as a whole, and in five countries in the country-specific analyses. Dominican Republic, Nicaragua, and Panama were the exceptions. This variation is suggestive of potentially interesting cultural and regional differences that remain to be identified. 1 figure, 2 tables, 38 references