Smoking cessation

Tobacco use is the leading attributable health risk in the United States today, and smoking cessation by patients should be a major concern of all practicing physicians. A history and physical examination with emphasis on the consequences of tobacco use can open up the subject, while the nonsmoking behavior of physician and office personnel and the office setting itself reinforce the nonsmoking advice. When a patient has decided to quit, the physician can implement several strategies: provide a positive orientation toward quitting, discuss the pros and cons of gradual versus sudden cessation, identify triggers to smoking, anticipate withdrawal symptoms, and set up a reinforcement system.