Purpose: To examine smoking initiation in a group of adolescents at risk for developing substance abuse. Methods: Fifty-nine adolescents (25 control and 34 at risk adolescents) participated in a longitudinal study of behavioral and cognitive predictors of development of substance abuse. Aggression, conduct problems, hyperactivity, impulsivity, inattention, anxiety/depression, social difficulties, and somatic complaints were assessed at study entry, and tested as predictors for smoking. Results: At the last follow-up (mean 15 months), 41 (69.5%) adolescents had not smoked, 10 (17%) had experimented with cigarettes, and 8 (13.5%) had smoked regularly. Aggression, hyperactivity, and somatic complaints significantly predicted smoking initiation (p less than 0.05). Smoking status was similar across psychiatric diagnostic groups. Conclusions: These adolescents warrant close monitoring as they are at risk for nicotine dependence and/or psychiatric problems. Preventive measures should be targeted to these at risk adolescents in both primary care and community settings.