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INTRODUCTION Trust and satisfaction play vital roles in how smokers react to smoking cessation treatment delivered by physicians. This paper aims to ascertain whether smoking status and pack-years of smoking affect trust in physicians and satisfaction with the health system in China. METHODS The current study used the ordered probit model to evaluate how smoking status affects trust in physicians and satisfaction with the health system in China. Data from the China Family Panel Studies (CFPS) 2018 were used for the analysis, and the final sample consisted of 29500 adults. The CFPS is a nationally representative, comprehensive, high-quality, biennial longitudinal survey of Chinese communities, families, and individuals. The survey was conducted in 25 provinces and their administrative equivalents. The population of 25 provinces represents 95% of the total population in Mainland China. RESULTS According to the ordered probit model, the results showed that current smokers were significantly negatively associated with trust in physicians, and more cigarette smoking was associated with decreased trust in physicians. Moreover, current smokers were also significantly negatively related to satisfaction with the health system. CONCLUSIONS The present study found that current smokers would be more likely to rate trust in physicians lower, and less likely to rate greater satisfaction with the health system, than never smokers. These results may have important implications for regaining trust in physicians from smokers and supporting health-system reform for tobacco treatment. [ABSTRACT FROM AUTHOR]