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However, tobacco use accounts for half a million annual deaths in the United States and worsens the prognosis for nearly any medical diagnosis.33 Furthermore, tobacco use has been shown to exacerbate the symptoms of common presenting concerns in primary care13 such as chronic pain34 and insomnia35 and is associated with higher levels of psychiatric symptomatology and dysfunction.30 Finally, in the present study, we found that BHPs in primary care settings are delivering brief interventions for at-risk drinking less than half of the time and brief interventions for tobacco use less than a third of the time when patients are positive for at-risk drinking and tobacco use, respectively

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