The aim of this study was to ascertain the rate of smoking among adolescent (13-17 years old) psychiatric inpatients and to examine factors related to smoking status in this population. The medical records of all adolescents admitted to a private psychiatric hospital during a 1-year period were reviewed. The rate of current smoking was 59.8%. Of the adolescents who reported smoking, 40% smoked at least 140 cigarettes per week, and 44.7% smoked 7 days a week. Smokers were more likely to be Caucasian, fall within the 13-year age group, and meet criteria for substance abuse/dependence. Adolescents who used no alcohol or illicit substances were least likely to report current smoking, followed by those who used alcohol only, followed by those who used illicit substances. Results of the current study suggest the need for both thorough assessment of smoking and specialized smoking interventions in this population, who are likely to mature into heavily dependent, recalcitrant adult smokers in the absence of intervention.