A cross-sectional survey on tobacco use in the city of Alexandria, Egypt, used an interview questionnaire based on World Health Organization guidelines. The study in 2000 included 2120 participants aged 15 to 86 years. More than a quarter (27.2%) were current smokers (25.5% daily smokers and 1.7% occasional smokers) and 3.5% were ex-smokers. Current smokers spent 23.1% of their family income on tobacco. The prevalence of current smoking was significantly higher among men (48.5%) than women (1.5%) and the mean age of initiation of smoking was lower among men (18.1 years) than women (22.6 years). The high prevalence of tobacco use among men is of concern, so too is the likelihood that tobacco use will increase among women. Further research is needed into factors that prevent people from starting smoking and assist them stopping smoking.