Smoking is a major cause of mortality in Spain. Tobacco smoking by health care workers has a negative influence on the general population. In Spain, the prevalence of smoking is high and is increasing among women. The aim of this study was to identify tobacco consumption among female physicians and nurses in the Community of Madrid, as well as to determine their knowledge about smoking and whether smoke-free areas are available in health centers. A cross-sectional, descriptive study was performed in 1998 and 2001 through survey of smoking habits in the female medical staff in the Community of Madrid. Multi-stage sampling with conglomerates was used. We studied 1235 health professionals (435 doctors and 800 nurses) in 1998 and 1000 in 2001 (400 doctors and 600 nurses); 43.1% were smokers in 1998 and 43% were smokers in 2001. In both years smoking was more prevalent among nurses (47.6% and 47%) than doctors (34.7% and 37%). Smoking was also more prevalent among health professionals working in hospitals (46.6% and 46.7%) than in those working in primary care (35.3% and 37.3%). When both years were compared, no significant differences in smoking prevalence according to profession were found. In both surveys, the prevalence of smoking was lowest among younger (< 30 years) doctors (22.9% and 23.6%). A similar situation was found in 2001 among nurses (43.8% of those aged < 30 years smoked). The percentage of exsmokers was higher in 2001 (18.9% vs. 27.8%). The percentage of health workers who smoked in front of patients decreased (2.9% vs. 1%) as did the percentage of those who thought smoking should be allowed smoke in waiting rooms (14.9% vs. 7.4%). The percentage of workers who smoked in staff rooms decreased (90.6% vs. 87.1%) and that of health professionals who worked in centers with a specific smoking area increased (30.4% vs. 59.4%). The prevalence of smoking among female physicians and nurses in the Community of Madrid is very high, and in the case of nurses, it higher than among the general population. No substantial changes were observed between the two surveys. Smoking is more frequent among nurses than among doctors, and is more frequent in hospitals than in primary care. In the second survey, those who smoked less were the younger members of both professions, which allows a certain optimism. Although it has improved, observance of current legislation in health centers continues to be very low.