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Background and objective It is unknown which factors are associated with smoking cessation interventions initiated by hospital chest physicians in China. We examined physicians' awareness of negative effects of smoking on smoking cessation advice given. Methods A cluster randomized cross-sectional survey was conducted from July to August 2011 in hospital chest physicians ( n = 354) in Guangzhou, China. Results Of those who responded ( n = 354, 92%), 63.8% were aware of negative effects of smoking and 64.5% initiated smoking cessation programmes with their patients. Awareness differed among physicians depending on their hospital affiliation (χ2 = 54.7, P > 0.001), that is, primary (44.9%), secondary (55.1%) and tertiary hospitals (87.0%), (odds ratio = 1.732, 95% confidence interval: 1.072-2.797, P < 0.05). Physicians with less awareness prescribed smoking cessation medication less frequently (χ2 = 137.71, P < 0.001). Smoking cessation practice by physicians also depended on hospital affiliation (χ2 = 5.7, P > 0.001), (odds ratio = 4.074, 95% confidence interval: 1.399-11.860, P = 0.010). Smoking status of physicians was related to smoking cessation practice. Conclusions Physicians more aware of the health hazards of smoking provided more smoking cessation advice. Awareness correlated with hospital levels and smoking status. Physician's advice correlated with their smoking status and educational background, but not with the levels of hospital, position or department affiliation. [ABSTRACT FROM AUTHOR]