Approximately 4.5 million Americans visit the emergency department each year with symptoms of chest pain. Over 90% are eventually ruled out for myocardial infarction and other acute cardiovascular events. Three serial blood tests taken at 8 hour intervals are needed to rule out MI, requiring a 24-hour stay in the emergency department Observation Unit (OU). During most of this time patients are at bed rest. While approximately 25% of these patients are smokers, nothing is currently being done to address smoking cessation with these patients. The experience of hospitalization for chest pain is intense, but transient. The long term impact of this experience on smoking cessation and motivation to quit is unknown. The effects of this experience on the individual's perception of risk from smoking, and how personal coping style may interact with the OU experience are also unknown. We will recruit 722 smokers and randomly assign them to either (a) Usual Treatment, or (b) Enhanced Treatment for smoking cessation. Enhanced Treatment consists of a brief intervention by the attending physician, a 30 minute motivationally tailored cognitive behavioral interview with a trained health educator, nicotine replacement when appropriate, and scheduled follow-up phone contacts. Data will be collected on smoking attitudes, motivation and behaviors, nicotine dependence, risk perception, psychological coping style. Follow- up assessments will be conducted at l, 3, and 6 months after recruitment. An implementation index of the amount and duration of all smoking interventions delivered in both conditions will be created statistically, and analyzed for effects on smoking outcomes and interactions with coping style and risk perception, and determination of optimal cost-benefit ratios. Primary outcome analyses will examine 7-day point prevalence abstinence at each follow-up and survival analysis (time to 1st relapse). We hypothesize that; (1)smokers given the Enhanced Treatment will show significantly higher abstinence rates at 6 months post-tx, and (2) greater improvement variables mediating readiness to quit (ie., decision making, self-efficacy), compared to Usual Care and, (3) coping style and risk perception will moderate the efficacy of the intervention for all subjects. Information provided by this study is needed to develop specific smoking interventions targeted to this population. Broad application of these findings should reach over l million smokers per year.