This study examined mortality attributed to active and passive smoking in Taiwan for the years 1981 and 1990. It was estimated that 19,283 deaths, representing 19% of the total number of deaths in 1990 (almost one out of five deaths in Taiwan), were smoking related. On an average day, 53 people died as a result of cigarette smoking, including 13 deaths from passive smoking. More men died (14,140 deaths) from smoking-related causes than from all cancer deaths combined (13,161 deaths); 91% of lung cancer and 30% of all cancers were due to smoking. In comparison, the smoking attributable mortality was much less for women, with 5,143 deaths. In addition, almost 5,000 deaths can be attributed to passive smoking every year in Taiwan with more deaths from women than from men. The overall prevalence rates for cigarette smoking has changed little in the last 20 years; approximately 60% for men and 4% for women although a consistent increase of one million new smokers was added every decade. Among younger people, the rate increased substantially, while it dropped 10-15% among middle-aged and older persons. Smoking is the largest single source of health risk in Taiwan. It is crucial that strategies to prevent smoking initiation among young people be developed so that the most vulnerable group can receive immediate attention. Despite the recent aggressive smoking cessation campaign by the Department of Health, much work remains. In order to facilitate this work, it is therefore recommended that the government commit to a goal of smoke-free nation by the year 2010.