Design Inception cohort of adolescents sampled from the community and followed up for 4 years (Teenage Attitudes and Practices Survey [TAPS]). Setting USA. Participants 7885 adolescents (51% boys) who were 10-18 years of age at baseline and lived in households selected for the US National Health Interview Survey (last 2 quarters of 1988 and the first 2 quarters of 1989). 5828 adolescents (53% boys) without baseline depressive symptoms and 1228 adolescents (60% girls) with baseline depressive

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... ptoms were analysed for smoking initiation; 576 smokers (59% boys) without baseline depressive symptoms and 253 smokers (62% girls) with baseline depressive symptoms were analysed for smoking cessation. Non-smokers included puff smokers (had smoked 1 but not 100 cigarettes), former or experimental smokers (had smoked >100 cigarettes but had not smoked in the previous month), and occasional smokers (had smoked 1 cigarette and had smoked < 5 days in the previous month). Assessment of prognostic factors Race, school performance, risk taking behaviour, presence of smokers in the household, age, and parental education were assessed for potential confounding effects. Main outcome measures Number of non-smokers who began smoking regularly (smoked >5 cigarettes in the previous month) and number of regular smokers who stopped smoking (did not smoke in the previous 30 days and did not think they would be smoking 1 year later). Main results After adjustment for race, school performance, risk taking, and presence of smokers in the household, depressed adolescents were more likely than non-depressed adolescents to start smoking regularly (table). No association between depressive symptoms and smoking cessation rates was seen after further adjustment for age and parental education (table). Conclusions Adolescents with baseline depressive symptoms were more likely than those without depressive symptoms to start smoking regularly. No association was seen between baseline depressive symptoms in adolescent smokers and cessation rates for smoking 4 years later.