CHAPTER9·T○ BACCO∪SE237 TABLE 9. 1(Continued) Other Effe Cataract Hip fractures Increased absenteeism Increased health services usage Low bone density Peptic ulcer disease(Helicobacter pylori positive) Poor surgical outcomes Poor wound healin Adapted from U.S. Centers for Disease Control and Prevention. The health consequences of smoking report of the surgeon general. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. 2004: 2-6 the national smoking rate is slowly declining, it is still well above the national goals set in Healthy People 2010: less than 12% for adults and 16% for adolescents (9). This chapter provides clinicians and their associates with the necessary information to institute effective smoking cessation techniques in their practices. Although this chapter emphasizes smoking cessation, these interventions may be used to help smokeless tobacco users quit as well The interventions described are based on the u. S. Public Health Service (PHS) guidelines, with additional emphasis on the role of telephone"quit lines, now available in every state in the United States. Although one option for clinicians is to deliver intensive counseling as the primary focus of a series of clinic visits, an alternative is to offer simple advice to quit coupled with referral to a quit line, a 30-second option that many clinicians may find easier to incorporate into their daily practice. BACKGROUND Many clinicians recognize smoking as a major threat to a patient's health but do not feel confident in their ability to intervene effectively. Most clinicians have not experienced success in helping paticnts to stop smoking.Most have treated patients with significant tobacco-related diseases who have been unable to stop despite multiple attempts, even as they became sicker. Repeated failures to help patients stop smoking frequently cause clinicians to become discouraged and reinforce the belief that nothing can be done