PURPOSE: To increase use of fax referral services to a state smokers' quitline. DESIGN: Program evaluation. SETTING: A populous urban county. SUBJECTS: Smokers older than 17 years. INTERVENTION: In January 2005, a state-funded smoking cessation center began to offer training and technical assistance to clinical sites to expand tobacco control services. MEASURES: Proportion of each county's smokers referred to quitline. RESULTS: Prior to program onset, only one Bronx provider had made a fax referral to the quitline. In 2006, 943 fax referrals were made, representing 0.5% of all smokers in the county. This was a higher proportion than any other state county with an adult population exceeding 250,000. Bronx smokers are 2.47 times more likely to be fax-referred to the quitline than other smokers in New York. CONCLUSION: A program consisting of training and technical assistance, and emphasizing systems change, can markedly increase providers' use of quitline referral services.