Background. Smoking is the Leading cause of premature death in Europe yet there are still many countries in which there is little information on its patterns and determinants. Albania is one such country. Methods. A survey of health and lifestyle, including questions on smoking practice and attitudes, and its determinants was undertaken in Tirana, the capital of Albania in mid 2001. Subjects. One thousand one hundred and twenty adults aged 25 years and over (response rate 72.7%). Results. Forty-one percent of the study population (61% mate and 24% female) were current or ex-smokers-28% were current smokers (37.6% of mates and 19.3% of females) and 13% were ex-smokers (23.4% of mates and 4.7% of females). Age-standardized (to the European standard population) prevalence of smoking for the adult population of Tirana was 31.2% (42.8% in mates and 21.2% in females). Smoking was most common among those aged 25-34 years (59% of mates and 30% of females in this age group). Of the current smokers, 16.5% smoked more than 20 cigarettes/day, and 67.3% smoked the first cigarette within 30 min of waking. Only 11% of current smokers had tried to quit smoking once during their life. Concern about health was the most common reason for quitting cited by ex-smokers (44%). In men, smoking was inversely associated with educational achievement. While the probability of smoking decreases with age, there was no consistent association with employment or income. Conclusion. The prevalence of smoking in Albania is comparable with other Western societies. The high rates of smoking among young men and women suggest that tobacco will make an increasingly Large contribution to premature morbidity and mortality in the future. The high rate of smoking among young women in Albania, while a common phenomenon in post-communist countries, is especially worrying. This study emphasizes the need for a robust, evidence-based strategy for tobacco control in Albania. (C) 2003 The Royal Institute of Public Health. Published by Elsevier Science Ltd. ALL rights reserved.