Post-discharge support is a key component of effective treatment for hospitalized smokers, but very few hospitals provide it. Linking hospitalized smokers with free, proactive tobacco quitlines is an ideal way to provide supportive contact at discharge, because quitlines are effective and cost effective for smoking cessation. Many hospitals are beginning to fax-refer smokers to quitlines at discharge. Fax referral is convenient and is part of the current culture of medical communication channels. However, less than half of fax-referred smokers are successfully contacted and enrolled in quitline services. "Warm hand-off" is a novel approach to care transitions in which health care providers directly link patients that have substance abuse and mental health problems with specialists, using face-to-face or phone transfer. Warm hand-off achieves very high rates of treatment enrollment for these highly vulnerable groups.

The objective if this application is to determine the relative effectiveness, and cost-effectiveness, of warm hand-off versus fax referral for linking hospitalized smokers with tobacco quitlines. This study employs a two-arm, individually randomized design. It is set in two large Kansas hospitals that have dedicated tobacco treatment interventionists on staff.

Inclusion Criteria:

• Inclusion criteria include being residents of Kansas,
• aged 18 years and older,
• have smoked at least 1 cigarette in the 30 days prior to admission,
• speak Spanish or English,
• and wish to remain abstinent after they are discharged
• Patients who are discharged to another facility (for long term care or rehabilitation) will be included in the trial.

Exclusion Criteria:

• Exclusion criteria include lacking access to a telephone post-discharge,
• acute life-threatening medical conditions (for example, cardiac arrest, acute respiratory failure, septic shock),
• communication barriers (intubation, unable to speak or hear),
• altered mental status,
• severe unstable psychiatric disorder (acute psychosis),
• terminal illness with less than a 12 month life expectancy
• non-Kansans because residents of other states may receive quitline services from a different vendor which would confound intervention effects and make it difficult to obtain quitline adherence data