The number of smokers in developing countries is expected to increase as markets in high income countries begin to decline and multinational tobacco companies shift their marketing efforts to lower income countries. We determined the prevalence and distribution of smoking in a cross-sectional study of 1,015 urban civil servants in Accra, Ghana (82.7% participation rate) in 2006. The results were compared to the findings from a previous study in 1976 of civil servants in Accra to estimate the changes in smoking patterns over a 30 year period. In our 2006 study, the smoking prevalence rate was 6.1% (95% CI: 4.8–8.9) and 0.3% (95% CI: 0.006–1.4) in men and women respectively. These figures were dramatically lower than the rates of 32% and 5.9% reported for men and women respectively in the previous study. Knowledge of the health risks associated with smoking may have contributed to the lower rates.