Purpose: This study aims to examine whether, in the opinion of patients selected in 13 hospitals of Hubei province, China, hospitals are smoke free. Patients were also asked whether their physicians had inquired about their smoking status. Design/methodology/approach: Patients were recruited through an intercept method (i.e. stopped by the interviewer while in the hospital); data were collected through interviews, with a response rate of 96.1 percent. Findings: Among the intercepted patients, 48.3 percent reported having seen people smoking in hospitals; 22.3 percent had seen a doctor and/or nurse smoking; 23.8 percent had smelled tobacco in hospitals; 68.4 percent reported having seen "no-smoking" signs in hospital settings; 42.6 percent reported having been asked about smoking status in their latest visit to a doctor and 23.8 percent reported receiving tobacco cessation counseling. Compared to hospitals in large cities, patients from medium/small city hospitals reported significantly higher levels of cigarette smoking among physicians, and poorer implementation of regulations for a smoking-free hospital, and less smoking cessation counseling by physicians. Originality/value: Findings of this study point to the need for greater efforts to be made in promoting a smoke free environment in hospitals, as well as encouraging physicians to provide more smoking cessation counseling to smoking patients, particularly physicians in small and medium hospitals. (Contains 4 tables.)