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BACKGROUND: It has been well established that smoking is one of the primary causes of not only cardiovascular disease but many chronic diseases associated with both high morbidity and mortality. Smoking cessation is one of the few areas in which physician counseling has shown to be effective in eliciting patient lifestyle modifications.11, 12 However, physicians have been shown to do a very poor job of assessing a patients willingness to quit, counseling or assisting them in quitting, and arranging for follow up21 yet, it is not well documented why that is the case. We are interested the perceived barriers to smoking cessation counseling for physicians in New Mexico and whether or not there is a difference in those perceived barriers for rural and urban physicians. METHODS AND RESULTS: We conducted a survey by mail of rural and urban family practice and internal medicine physicians selected at random in the State of New Mexico to determine if frequencies of perceived barriers are different for urban and rural family practice physicians. The survey included a choice of five possible barriers a physician can encounter in counseling patients on smoking cessation. Survey forms were sent to 500 physicians, 101 urban and 98 rural surveys were returned. No statistically significant difference was found between the rural and urban groups for any of the barriers. However, the study was only powered to detect up to a 19% difference between the groups. Based on our calculated Confidence Intervals (ranging from -21-26%), up to a 26% difference could have been missed. Our study did show that for both rural and urban physicians 'Lack of Time' and 'Patient's Unwillingness to Change' are central barriers to smoking cessation counseling. CONCLUSIONS: While the study was not powered to detect differences based on the response rate, there were actual differences between the groups as reported in percentages. These were very interesting and could indeed be important. Also, lack of time and patient's unwillingness to change are central barriers to smoking cessation counseling for New Mexico physicians. More research is needed on ways to assist primary care physicians to overcome these identified barriers in order to implement effective smoking cessation interventions.'