Physician advice to stop smoking, referral to state Quitline, and physician considers prescribing nicotine replacement therapy.

Physician will follow their institution's standard of care for smoking cessation.

Physician advice to stop smoking, referral to state Quitline, and physician considers prescribing nicotine replacement therapy.

To assess the efficacy of the "Offer and Report" protocol (standardized (1) "very brief advice," (2) referral to telephone-based smoking cessation counseling, and (3) consideration of prescribing nicotine replacement therapy (NRT)) as compared to usual smoking cessation care by vascular physicians in biochemically-validated 3 month smoking cessation rates. A questionnaire will be completed by the patient at the Baseline visit and another questionnaire will be completed at the 3 month visit to assess the change in smoking status.