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A Resource from the American College of Preventive Medicine


Despite the overwhelming evidence of the harms of smoking, especially the damage to the cardiovascular system -- about one in five Americans continue to smoke.   Most of them know the risks.  Most would like to quit, have tried to quit.  But only about 1 in 20 who try to quit on their own are successful.  Many give up, at least until they are forced to quit by a cardiovascular event.  We underestimate the addictive power of nicotine.   Quitting is extremely difficult without a doctor’s assistance.  There are more effective ways to stop smoking that combine behavior counseling and medications.   The irony is that a doctor’s advice to quit is one of the most powerful stimulants to make a quit attempt, but few doctors "prescribe” an optimal quit plan after they advise patients to quit.  There are many reasons for the lack of comprehensive smoking cessation services in primary care, but there are also many solutions. 

The Cardiovascular Health and Tobacco Use Time Tool developed by the American College of Preventive Medicine is one of these solutions -- an innovative educational tool designed to assist physicians in transforming their office systems to facilitate smoking cessation interventions for smoking patients.   It provides a guide to the physician’s role, the counseling and follow-up provided by nurses and other staff, and the many resources available to meet the needs of the practice. 

The tool includes a practical approach for a clinical visit, along with a robust clinical reference document delineating the epidemiology, clinical evidence, guidelines and recommendations, along with additional tools and resources, as well as a patient handout. 

This educational activity is intended for primary care physicians. 

After completing this program, physician participants should be able to:

  • Describe the 5A model for counseling on smoking cessation

  • Describe the practice changes needed to enhance smoking cessation interventions

  • Assess the readiness to quit of a patient

  • Understand the barriers that physicians must overcome to improve cessation protocols

  • Discuss the role of medications in a quit plan

  • Develop a referral network, including quitline, online, local resources

  • Reference the guidelines for further assistance in developing their practice protocols

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME). The American College of Preventive Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The American College of Preventive Medicine designates this Enduring Material for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The estimated time to complete this activity is 1.0 hour. 

To earn CME credit for this educational activity:

  1. Read the CME information on this page.
  2. Read the Time Tool and Clinical Reference.
  3. Complete the CME post-test exam with a score of at least 70%.
  4. Complete the CME evaluation survey.
  5. Your CME certificate will be sent to you via email.


2009 through October 2011. Original release date: October 2009


These materials have been reviewed by the members of the American College of Preventive Medicine to ensure the continued scientific accuracy and medical relevance of information presented and its independence from commercial bias.

  • David Goldberg, MD
    Rush University Medical Center
    Chicago, Illinois

  • Michael C. Fiore, MD, MPH, MBA
    University of Wisconsin School of Medicine
    Madison, Wisconsin

  • Tom Houston, MD
    The Ohio State University
    Columbus, Ohio

In the interest of providing an educational experience free of commercial bias, and as the accredited provider of CME for this activity, the American College of Preventive Medicine was responsible for decisions regarding educational content and allocation of funds.  All individuals involved in the planning, development, and delivery of educational activities are required to sign a conflict of interest statement in which they disclose any relevant financial interests or other affiliations with industry or other associations which may have direct and substantial interest in the subject matter of the CME activity. Such disclosure allows program participants to better evaluate the objectivity of the information presented in the program.

  • David Goldberg, MD has disclosed no financial relationships.
  • Michael C. Fiore, MD, MPH, MBA has disclosed financial relationships with NABI Pharmaceutical, GlaxoSmithLine and Pfizer.
  • Tom Houston, MD has disclosed a financial relationship with Pfizer.
  • Larry Mattson, Medical Writer, has disclosed no financial relationships.


These pages may be viewed using standard Internet browser applications (e.g. Internet Explorer). They may also be downloaded as PDFs and read using standard PDF reader applications (e.g. Adobe Acrobat Reader).

The American College of Preventive Medicine collects personal information from participants in this online activity for purposes of assigning CME credit only.  We will not share or sell your contact information, and your answers to quizzes and feedback forms will be kept confidential.

This material is copyright of the American College of Preventive Medicine.


If you have questions regarding this CME activity, please contact Jennifer Edwards at jedwards@acpm.org.

Cardiovascular Health and Tobacco Use Patient Guide




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