This study was designed to assess the capability of the Doctors Helping Smokers (DHS) model to produce an increase in smoking cessation over controls within four urban Indian Health clinics. A total of 601 Native American smokers were enrolled, surveyed, and measured for cardiovascular risk factors. Of those present in treatment clinics at 1-year follow-up, 7.1% reported being abstinent vs. 4.9% in the control group. Of those who made at least one visit to the clinic during the treatment year, 9.4% self-reported being abstinent in the treatment sites vs. 3.9% in the control group (p = .04). Cotinine validated quits for all enrollees, regardless of whether they attended the clinic during the intervention, are 6.7% (intervention) and 6.8% (control). Number of quit attempts and future quit intentions were greater in the intervention group. Recommendations for future intervention efforts include earlier contact with clinicians, clinic involvement in preplanning, developing the program around the principles and realities of each site, building in more extensive components, and utilizing additional community resources.