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The objective of this study was to determine the prevalence and determinants of the current smoking status among secondary school students in Al-Hassa, Saudi Arabia. A total of 1,652 secondary school adolescents were selected by multistage proportionate sampling method. Data collection was carried out through self-administered anonymous questionnaire including: Arabic version of the Global Youth Tobacco Survey, modified Fagerstrom Test for Nicotine Dependence and Patient Health Questionnaire to asses for anxiety and depressive disorders. This study revealed that the prevalence of current smokers was 21.7. Seventy-one percent of current cigarette smokers were minimally nicotine dependent. Major depressive and anxiety disorders were significantly higher among current smokers. Hierarchical regression analysis shows that, male, older age, smoking of close relatives and friends, anxiety disorders and socializing motives were statistically significant determinants of current smoking status among the included adolescents. Family members should be made aware of the detrimental influence their smoking behavior has on their youth. Counseling and preventive psychiatric services should be an integral part of the clinical facilities caring for secondary school students.