Over a 2-year period (October 2007�CNovember 2009), 52,952 cognitively and physically capable patients awaiting care for any reason throughout eight San Diego county emergency and trauma units participated in screening for their use of various substances. Screenings were face-to-face interviews conducted in the EDs by trained bilingual/bicultural health educators (HEs) fluent in both English and Cisplatin mw Spanish languages. More than 25 paraprofessional HEs received extensive manualized training on building rapport with patients and administering the screening tool. HEs were present in most EDs 7 days a week, with coverage from 7 a.m. to 11 p.m. (this schedule was chosen because very few patients come into the ED between the hours of 11 p.m.�C7 a.m.).

While our sample is large and we estimate that we were able to approach at least 70% of capable patients, the sample was not a census of the total ED population and was not a probability sample and, therefore, must be considered a convenience sample. A private area, usually the room in which the patient was waiting to receive care, was used to conduct the screening interviews. Screenings were conducted at various times during the patient��s visit and were frequently interrupted for medical care and resumed later in the visit. Adult patients, 18 years of age and older, were asked to participate in the screening regardless of the reason for their ED visit, with the exception of patients with severe illness/injury, acutely intoxicated patients, and patients who were not competent or capable to give consent.

Participation was voluntary, and consent was secured for all patients who agreed to be screened. Typically, the screening process took about 10 min. Approximately 30% of patients were estimated to be incapable or too sick to participate. Refusals among those able to be screened were rare, with about 1.5% of patients refusing. Measures ED Patient Tobacco Use Prevalence Measures Patients�� lifetime and past three-month tobacco use and problems associated with tobacco use were assessed with a brief screening questionnaire, the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), developed by the World Health Organization (WHO) in 1997. The ASSIST was specially designed for use by health care workers as a valid and simple method of screening for hazardous, harmful, and dependent use of a variety of substances, including tobacco (WHO ASSIST Working Group, 2002).

Lifetime use was based on the ASSIST question, Anacetrapib ��In your lifetime, have you ever used tobacco products?�� An additional ASSIST item assessed the frequency of tobacco use in the past three months using the response options of never, once or twice, monthly, weekly, or daily/almost daily. The response options have numerical scores associated with them: 0 (never), 2 (once or twice), 3 (monthly), 4 (weekly), and 6 (daily).