This study tested the feasibility and efficacy of a brief smoking intervention for adolescents in a hospital setting. Forty adolescent patients were randomized to receive either brief advice or a motivational interview, a nonconfrontational therapeutic intervention. Feasibility of brief smoking interventions with teen patients was supported by high rates of recruitment, retention, and quit attempts, and long periods of continuous abstinence. Although between-groups differences on smoking measures were not significant at 3-month follow-up, an effect size of h = .28 was noted. The sample showed significant decreases in smoking dependence and number of days smoked. Baseline stage of change, smoking rate, and depression were significant prospective predictors of smoking outcome. Implications for smoking intervention research with adolescents are discussed.