Abstract: Objective The study was conducted to investigate the prevalence of smoking among middle school students in Zhejiang Province and their understanding of the hazards of smoking, providing scientific evidence for tobacco control and health education. Methods Multi-stage random cluster sampling was conducted in 249 classes from 221 schools in 30 counties of Zhejiang Province. The selected 11 638 students from junior grade one to senior grade three were investigated using self-management questionnaires. Results The rate of attempts at smoking was 30.30%, 27.77% in urban areas and 31.88% in rural areas, the rural rate significantly higher than the urban one. The rate among boys was 42.99% and girls 17.19%, boys' rate significantly higher than girls'. The current smoking rate was 7.88%, 6.59% in urban areas and 8.68% in rural areas, boys' rate 13.58% and girls' 1.99%. The report rate of whole cigarette smoking was 16.12%, 14.13% in urban areas and 17.37% in rural areas, boys' rate 27.01% and girls' 4.87%. The rate of passive smoking was 16.65%, 20.69% in urban areas and 14.07% in rural areas, boys' rate 16.22% and girls' 17.04%. Conclusion Smoking is widespread among secondary school students in Zhejiang Province, for who live with the students have a significant impact on them about their smoking behavior. Prompt health education as well as positive and effective control measures should be delivered to the students.