This study was designed to determine the prevalence of active smoking and environmental tobacco smoke (ETS) exposure among medical students in Riyadh, Saudi Arabia, and to examine their attitudes and beliefs towards tobacco control programs. The investigation was a cross-sectional study conducted during the first semester of 2013 at King Saud University School of Medicine located in Riyadh, Saudi Arabia. Invited to participate in this study were 1,789 medical students. A descriptive data analysis was performed. A total of 805 medical students completed the questionnaire. The prevalence of experimentation with cigarette smoking was 11.3%. The estimated prevalence of current smoking among the study participants was 4.7%. The majority of the students held positive attitudes toward tobacco control and approximately 93.1% of the students felt that health care professionals should be required to receive training for cessation counseling while only 36.8% of the students reported having received any training in this area. Over the study's duration 57.7% of participants reported that ETS exposure was much higher in public places, while 13.9% reported exposure at home. This investigation revealed that ETS exposure among medical students in Riyadh is at an alarmingly high rate. The data suggests a need for a more robust smoke-free policy and a commitment to greater enforcement in public places. The results of the study also demonstrate a positive attitude among participants for tobacco control. It also indicates a need for cessation counseling and training which could be incorporated into medical school curriculum.