The reality that emergency departments (EDs) have become the default site of care for the 46 million uninsured Americans, the millions more resident uninsured foreigners, and surprisingly large numbers of insured patients is a mixed blessing. On the down side, it means that EDs are being asked to remedy fundamental problems in the organization and financing of medical services—problems for which they have responsibility but no authority. On the up side, EDs have the potential to address important health problems in our society. One such problem, tobacco use, is the subject of an article by Vokes et al in this issue of Annals. The facts about the damage from smoking are grim. More than 44 million smokers exist in the United States. Each year, 440,000 patients die from smoking-related causes, including cancer, heart disease, and lung disease. Smoking shortens a lifespan by 8 to 12 years, and those last few years can be miserable, especially for patients with end-stage pulmonary obstructive disease or metastatic cancer. Furthermore, the health of nonsmokers is imperiled by exposure to second-hand smoke, leading to a host of medical complications among children and adults. But not all the news about smoking is grim. Fewer people are starting to smoke, and more smokers are quitting. Adult smoking rates are at a modern low (20.9%), and youth smoking is at a 30-year trough. There are now more ex-smokers than current smokers. And there is mounting evidence that intervention by physicians and other clinicians—by giving advice, counseling, and pharmacotherapy—can improve the chances of quitting smoking. Notwithstanding the press of their other responsibilities, EDs are uniquely situated to help smokers quit, as asserted by Vokes et al and in a recent statement of emergency medicine organizations. This uniqueness stems from 2 facts. First, smokers are disproportionately represented among ED users, accounting for 40% of all such visits. Second, EDs are the primary source of care for about a third of all Americans, and these patients have unusually high rates of smoking, possibly as great as 50%. Vokes et al report on smoking cessation practices in 2 ED settings—1 urban and 1 suburban—within the same emergency medicine residency training program. The study analyzed audiotape encounters for 871 adult (aged 18 to 65 years) nonemergency women in the 2 sites for all conversations about