This study examined physician attitudes and practices pertaining to patient counseling about smoking in Belgrade, Serbia. Data were collected using a cross-sectional survey of 86 physicians at multiple health care facilities. Approximately 74% of physicians agreed that they should routinely ask patients about their smoking habits and 79% agreed that physicians should routinely advise their smoking patients to quit smoking. However, only 35% of the physicians regularly counseled with their patients about smoking. Previous tobacco-cessation counseling training and being female both directly increased the likelihood of physicians regularly counseling patients about smoking, but age and smoking status did not significantly influence physician counseling about smoking. Physicians who received previous training were 3.3 (95% CI = 1.7-6.4) times more likely to regularly counsel their patients about smoking than those who had not received training; and female physicians were 6.8 (95% CI = 2.2-20.7) times more likely than male physicians to regularly counsel their patients about smoking. Previous tobacco-cessation counseling training was associated with a greater likelihood of feeling well-prepared to assist patients to quit smoking (49% vs. 20%; P less than 0.0001). In turn, the likelihood of regularly counseling their patients about smoking was 81% for those who felt well-prepared, 39% for those who felt somewhat prepared, and 2% for those who felt unprepared (P less than 0.0001). Hence, tobacco-cessation counseling training increases confidence, which, in turn, increases patient counseling about smoking. (Contains 2 tables.)