As many as 30% of all coronary heart disease (CHD) deaths in the United States each year are attributable to cigarette smoking, with the risk being strongly dose-related.1 2 Smoking also nearly doubles the risk of ischemic stroke.3 Smoking acts synergistically with other risk factors, substantially increasing the risk of CHD.4 Smokers are also at increased risk for peripheral vascular disease, cancer, chronic lung disease, and many other chronic diseases. Cigarette smoking is the single most alterable risk factor contributing to premature morbidity and mortality in the United States, accounting for approximately 430 000 deaths annually.5 Numerous prospective investigations have demonstrated a substantial decrease in CHD mortality for former smokers compared with continuing smokers.6 This diminution in risk occurs relatively soon after cessation of smoking, and increasing intervals since the last cigarette smoked are associated with progressively lower mortality rates from CHD.7 Similar rapid decreases in risk with smoking cessation are also seen for ischemic stroke.8 9 Benefits from quitting are seen in former smokers even after many years of heavy smoking.2 Investigations also have demonstrated benefits from cessation for smokers who have already developed smoking-related diseases or symptoms. Persons with diagnosed CHD experience as much as a 50% reduction in risk of reinfarction, sudden cardiac death, and total mortality if they quit smoking after the initial infarction.10 11 Furthermore, the patient who has recently developed a clinical illness is very motivated to change, and several studies have shown that intervention in this “teachable moment” can be very effective. Thus, the provision of smoking cessation advice is associated with a 50% long-term (more than 1 year) smoking cessation rate in patients who have been hospitalized with a coronary event, and even modest telephone-based counseling can increase this percentage to ≥70% in …