Background: Secondhand smoke exposure increases morbidity and mortality in children. Thirty-one percent of caregivers who accompany their children to the Ochsner Health Center for Children smoke, and none uses the services of the Smoking Cessation Trust (SCT), a free smoking cessation program for eligible Louisiana residents who began smoking before 1988. The objective of this study was 2-fold: first, to assess and compare pediatricians' confidence and behaviors in regard to smoking cessation promotion with caregivers, and second, to determine pediatricians' knowledge and comfort level with the SCT