 Primary: To test whether the delivery of A3-5 smoking cessation counseling Assess, Assist, Arrange in primary care offices is enhanced by a system that couples 1 an expanded vital sign intervention with 2 fax referral of preparation-stage patients for telephone counseling and 3 feedback to the provider. The question will be examined in a randomized trial, with practices as the unit of analysis and with a control intervention consisting of a conventional vital sign intervention. The experiment will therefore compare what intervention and control practices accomplish beyond simply identifying patients who use tobacco. 