The primary purpose of this study was to describe tobacco control policy in secondary schools in South Carolina, and sanctions imposed on students for violation of these policies; and to explore potential associations between policies and sanctions. A secondary purpose was to explore the use of tobacco education curricula in the state. This study employed a cross-sectional design in which two surveys were mailed to all secondary schools in South Carolina (n = 437): the School Principal Questionnaire (SPQ) and the Lead Health Education Teacher Questionnaire (LHETQ). The SPQ elicited information about tobacco control policies and the sanctions imposed on violators of such policies. The LHETQ was sent to lead health education teachers to elicit information about use of packaged curricula addressing tobacco use and prevention. Over 95% of respondents reported having school policies that prohibited use of tobacco inside buildings, and explicitly prohibited the use of cigarettes for students anywhere on school grounds. Sanctions imposed for violation of tobacco policy were severe. For a second offense, nearly 68% of students were suspended out-of-school or expelled, and for a third offense, almost 28% of students were expelled. There is some evidence to suggest that more stringent policies were associated with more severe sanctions. Cessation from tobacco programs were rarely used as a sanction, and in fact, tobacco education curricula were rarely used by health education teachers. In South Carolina secondary schools, tobacco policies are prevalent. Student violators of such policies are punished by means that potentially detract from their educational experience (e.g., out-of-school suspension, expulsion). It is recommended that school administrators and school health education teachers implement tobacco cessation programs as part of appropriate sanctions for violations of school tobacco use policy.