Objectives: Following the first case in Hong Kong in 1998, the method of committing suicide by charcoal burning has spread to other communities. This aim of this study was to examine the impact of charcoal burning suicides on both overall suicide rates and older-method suicide rates in Hong Kong and urban Taiwan. Design: Trend analysis of the overall and method-specific suicide rates between 1997 and 2002. Comparison of age and gender profiles of those who committed suicide by charcoal burning and other methods of suicide. Setting: Hong Kong and Urban Taiwan. Main results: Suicides by charcoal burning increased rapidly within five years in both Hong Kong and urban Taiwan. This increase was not paralleled by decreases in suicides by older methods and led to an increase of more than 20% in the overall suicide rates. Those in the 24-39 age range were more likely to choose charcoal burning than other methods. Conclusions: The lack of parallel decreases in the suicides rates of older methods with the rise of charcoal burning suicides suggests limited substitution between the methods. The preponderance of the rise in suicide deaths associated with charcoal burning suggests that its invention, followed by wide media dissemination, may have specifically contributed to the increase in suicides in both regions. As a similar increase was found in urban Taiwan as in Hong Kong, charcoal burning suicide should not be viewed as merely a local health problem and has the potential to become a major public health threat in other countries. 1 To prevent such tragic deaths, restriction of lethal means and responsible media reporting have been proposed to be two important measures.2 The well-known findings of decreased suicide rates after the detoxification of domestic gas in the UK 3 and the reduction of subway suicides and suicide attempts after the change in media reporting in Vienna 4 have demonstrated the effectiveness of these two prevention strategies.Although existing studies 3 5 6-10 on method availability and suicide provide valuable information on prevention strategies, they have primarily focused on the effect on suicide rates when a specific method was restricted. It is also crucial, however, to examine the effect on suicide rates when a new method appears, if the emergence of its use can be clearly demarcated. Existing studies have not defined a clear distinction between the potential effects on suicide rates when a method is restricted (potentially leading to reduced rates or seeking alternative methods for suicide) and when an apparently new method is used by individuals to attempt suicide. The conceptual difference between these two scenarios is potentially significant: means restrictions can limit the range of choices but it should have no apparent impact on the size of the population actively seeking to undertake lethal suicidal acts. The emergence of a new method, however, may increase the size of that population at risk through the high availability and desirability 11 inherent in this new method. The potential ...