| Summary: | <i>Background and Objective</i>: Although smoking and the physical activity level (PAL) are important determinants of health status in adolescence, there is a lack of information on the relationship between smoking and PAL in early adolescence. The objective of this study was to evaluate the gender-specific relationship between smoking and PAL in 14-to-16-year-old adolescents. <i>Materials and Methods</i>: The sample included 650 adolescents (337 girls, 14.7 ± 0.5 years at first testing wave) from Bosnia and Herzegovina. During the first testing wave, participants were tested using structured questionnaires. Second testing was commenced after approximately 20 months (16.4 ± 0.6 years). The variables were age, gender, socioeconomic status, living environment, cigarette smoking (predictors), and PAL (criterion). Predictors were measured at the first wave, and criterion at the first-wave and second-wave. <i>Results</i>: For girls, smoking was negatively correlated to PAL at the first-wave (OR: 0.75, 95% CI: 0.55–0.95) and at the second-wave (OR: 0.73, 95% CI: 0.71–0.96). No significant association between smoking and PAL was found for boys. Results suggest that adolescent boys and girls do not follow the equal trajectories when it comes to relationships between smoking and PAL. <i>Conclusions</i>: In developing promotional public health actions related to a decrease of smoking and increase of PAL, a gender-specific approach is highly recommended. Further studies analyzing the cause–effect relationship between consumption of other types of psychoactive substances and PAL in this age group are warranted.
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