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In 1991,70% of smokers in the United States had at least one outpatient visit with a physician or other health professional during the previous year (59). Sixty to 70% of current smokers want to stop; 70 to 80% feel that a physician intervention would help them in quitting. There is a natural window of opportunity for physicians to intervene with smok ers, and the effectiveness of physician advice is cost-effective and has been examined in trials of smokers in general practice (60).

However, simple advice by the physician to quit smoking compared to no advice, results in only an additional 5% of smokers quitting in 1 year. Physicians are not unaware of this low rate of success, and unfortunately it has resulted in many physicians not systematically addressing smoking with their patients. Having a more effective yet practical smoking cessation protocol is likely to increase physician attention to this issue.

The following clinical practice guideline for smoking cessation is based on the guidelines recommended by the United States Public Health Service (58). It suggests that every patient who smokes be offered an intervention for smoking. Patients who are willing to quit now should be provided with effective treatment; patients who are unwilling to quit now should be provided with a brief intervention designed to increase their motivation and readiness to quit.

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