Combination Medications vs. Patch Alone for Medically-Ill Smokers

Inclusion Criteria: * currently smoking at least 10 cigarettes per day (confirmed by high exhaled carbon-monoxide (CO)) * 18 years or older * interested in quitting within the next 30 days * one or more pre-defined medical illnesses (including cardiovascular disease, other vascular disease, chronic pulmonary disease, cancer, hypertension, diabetes, hyperlipidemia, and recurrent pulmonary infections) Exclusion Criteria: * contraindications to pharmacotherapy (including unstable angina, myocardial infarction within 2 months, severe arrhythmia, seizure disorder, serious mental illness requiring antipsychotic medications) * current use of other tobacco products (smokeless tobacco, cigars, pipes, etc.), bupropion, clonidine, nortriptyline, or nicotine replacement medications * unable to give consent