Background: Although national clinical practice guidelines exist for treatment of tobacco use, little is known about the extent to which they are used in daily practice. Methods: Nine hundred Alabama family physicians and internists were surveyed to measure self-reported knowledge and use of guideline elements as well as past participation and future interest in continuing medical education (CME). Results: Of 215 physicians responding (24%), 67% reported they routinely ask patients about tobacco use. Most (81%) advise quitting, but less than half (45%) assess willingness to quit or assist with quit attempts, and fewer (41 %) arrange follow-up. One in four (25%) had previously participated in CME; one in five (22%) were familiar with the guideline; four out of five (81%) were interested in CME on the subject. Conclusions: Analysis revealed a correlation between experiencing CME and utilisation of guideline elements. In response, a CME programme and PDA-based protocol were developed to facilitate integration of the recommended 5-A intervention into daily practice. © 2005 Radcliffe Publishing.