While the harmful health effects of carbon monoxide, nicotine, tar, irritants and other noxious gases that are present in tobacco smoke are well known, those due to heavy metals and other toxic mineral elements in tobacco smoke are not sufficiently emphasized. Tobacco smoking influences the concentrations of several elements in some organs. This review summarizes the known effects of some trace elements and other biochemically important elements (Al, As, Cd, Cr, Cu, Pb, Mn, Hg, Ni, Po-210, Se, and Zn) which are linked with smoking. Cigarette smoking may be a substantial source of intake of these hazardous elements not only to the smoker but also, through passive smoking, to nonsmokers. The adverse health effects of these toxic elements on the fetus through maternal smoking, and on infants through parental smoking, are of special concern.