Clinicians should provide tobacco use cessation counseling at every clinical encounter. The counseling should be personal, medically oriented, clear, and strong. Nonsmokers may be encouraged to remain abstinent. Patients who use tobacco products may be identified through office and medical record systems, such as including smoking status as part of the vital signs. Or using a stamp on the front of the patient record identifying the patient as a smoker. Tobacco users may be counseled on the health effects of tobacco use, and may receive personal advice and encouragement to quit at every visit. Recommendations regarding NRT may be offered. Specific recommendations include: (1) Tobacco usage history should be obtained at all patient visits, (2) Nonsmokers, especially children and adolescents, should be encouraged not to start, (3) Office and medical record systems to identify patients who use tobacco should be employed, (4) Physicians and other office staff should advise all tobacco users to quit, (5) Physicians and other office staff should identify and assist smokers who are willing to quit, (6) Physicians and other office staff should provide motivational interventions for smokers who are not willing to quit.

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Tobacco cessation counseling on a regular basis is recommended for all persons who use tobacco products. Pregnant women and parents with children living at home also should be counseled on the potentially harmful effects of smoking on fetal and child health. The prescription of nicotine patches or gum is recommended as an adjunct for selected patients. Anti-tobacco messages are recommended for inclusion in health promotion counseling of children, adolescents, and young adults (see Clinical Intervention).