Background. The study aimed to (1) determine the current routine smoking care that smoke-free public hospitals in New South Wales (NSW), Australia, provide to inpatients who are smokers; (2) determine current strategies supporting such care; and (3) examine the association between smoking care provision and hospital characteristics and support strategies. Method. A cross-sectional survey of 169 senior hospital managers was undertaken. Survey items included smoking care practices such as identification of smoking status and provision of nicotine replacement therapy as well as hospital activities such as existence of policies and staff training. Hospital characteristics such as size and geographic location were also collected. Results. Twenty percent of respondents reported provision of minimally 'adequate' smoking care, defined as providing five or more smoking care items to 80% or more of patients. Larger hospitals were significantly less likely to provide adequate smoking care. Nurse training, the existence of signs indicating a smoke-free site and signs indicating location of designated smoking areas were also associated with smoking care provision. The existence of three or more support strategies was associated with smoking care provision. Conclusion. Even in the context of a smoke-free hospital site, the majority of inpatients who are smokers receive inadequate smoking care. Considered investment is required for hospitals to implement strategies to institutionalise the routine provision of appropriate smoking care. (c) 2004 Elsevier Inc. All rights reserved.