BackgroundSeveral studies worldwide have pointed to depression and anxiety symptoms as being related to adolescent smoking. The aim of this study was to investigate, the potential link of cigarette smoking with depression, anxiety, and suicidal ideation and the influence of gender on these relationships in Brazilian adolescents.MethodsAssociations of smoking with Children Depressive Inventory version 2 (CDI2) scores, Hamilton Anxiety Scale (HAM-A) scores, and poor school performance (i.e., grade retention) were examined in 988 Brazilian students (age range, 11–17 years) enrolled in 82 public and private schools. Logistic regression modeling was employed and the resultant odds ratios (ORs) are reported with 95% CIs.ResultsOf 988 participants, 240 (24.3%) were smokers. Mean (±standard error) HAM-A scores were higher for smokers (21.1 ± 9.7) than nonsmokers (15.4 ± 8.6; p < 0.0001). Relative to nonsmokers, smokers had higher total CDI2 scores (p = 0.033), and higher scores for the CDI2 domains of Emotional Problems (p = 0.023), Negative Self-esteem (p < 0.001), and Functional Problems (p = 0.046). Suicidal ideation was common among smokers with depressive symptoms (54.2%). Smoking was associated with being held back three grades (p < 0.001). Female smokers were more likely to report suicidal ideation than male smokers (p = 0.020). Logistic regression modeling revealed significant associations of suicidal ideation with being female (OR, 1.81; 95% CI, 1.38–2.37), being a female smoker (OR, 2.05; 95% CI, 1.51–2.80), and having a HAM-A score > 16 (OR, 2.18; 95% CI, 1.66–2.86).ConclusionSmoking was found to be associated with anxiety symptoms, depressive symptoms, and poor school performance in Brazilian adolescents; and female smokers reported more suicidal ideation than male smokers.