Smoking is one of the leading causes of heart disease and stroke, accounting for 32% of coronary heart disease deaths. Although the proportion of U.S. adults who smoke cigarettes has steadily decreased over the past 50 years, to approximately 17% in 2014, large disparities in smoking rates remain across racial/ethnic groups, socioeconomic statuses, and geographic areas and among people with mental health and substance use disorders. About 36.5 million U.S. adults continue to smoke cigarettes, resulting in about 480,000 smoking-related deaths each year in the United States. At least 70% of cigarette smokers see a clinician annually, and most want to quit. However, fewer than 25% of tobacco users leave a health care visit with evidence-based counseling and medication.

The purpose of this document is to provide evidence-based, tested tobacco use identification
and intervention strategies for busy clinicians. These strategies were gathered from the published scientific literature, including the U.S. Public Health Service–sponsored Clinical Practice Guideline Treating Tobacco Use and Dependence: 2008 Update.

The strategies are organized into two categories of actions: Improve delivery system design and increase evidence-based brief, and interventions for patients who use tobacco. This document concludes with additional resources and references where more detailed information can be found.

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