OBJECTIVES: To learn the prevalence of smoking among physicians in the province of Azuay, Ecuador, as well as their attitudes toward the habit. METHODS: This descriptive cross-sectional study was conducted using a survey that was based on models used in previous research. The survey consisted of 14 questions on the physicians' sociodemographic characteristics, issues related to the use of tobacco, and the physicians' attitudes toward smoking among their patients. The survey was delivered to 884 physicians and answered by 687 of them (77.7%). The results were entered into an electronic database, and multivariate analysis was carried out with the SPSS version 7.5 software package. Subgroups were compared using stratified analysis. Even though the study was descriptive, parametric statistical tests were applied with the quantitative variables, and Pearson's chi-square test was used to compare associations between discrete variables. A P level < 0.05 was considered statistically significant. RESULTS: Of the 687 physicians who responded to the survey, 8 of them did not answer all the questions and so were excluded from the sample. Of the remaining 679, 509 of them (75%) were men and 170 (25%) were women. Their average age was 43, and the prevalence of smoking for the group overall was 32.4%. The large majority of the smokers were between 36 and 55 years old. The male physician smokers smoked more cigarettes per day than did the female physician smokers (P < 0.05). Of the physician smokers, 68% of the men had been smoking for more than 10 years, but this was true for only 46% of the women. In terms of when the smokers began smoking, 47.1% of the men started when they were between 16 and 20 years old, while the single largest group of women smokers (40.5%) began when they were between 21 and 25 years old. Of the physicians who smoked, 60% of them said they did so in the workplace, and 67.6% of them said they had tried to quit smoking at some point. The physician smokers were less critical of smoking than were the physician nonsmokers, and the smokers also less frequently advised their patients to stop smoking (53.2% vs. 71.6%; P < 0.01). CONCLUSIONS: The prevalence of smoking among the physicians in the province of Azuay, Ecuador, is one of the highest among physicians in Latin America, and it is also similar to the overall rate for adults in Ecuador. These patterns make it difficult to expect a reduction in smoking in the province. There is an urgent need to implement preventive and therapeutic actions to control this scourge.