||Chronic musculoskeletal complaints (MSCs) are among the major health problems, and cross-sectional studies suggest an association between smoking and MSCs. The causal relationship, however, is not known. The present study is designed to assess the association between smoking and chronic MSCs, and is based on data from a large longitudinal cohort study of all inhabitants 20years in Nord-Trondelag County (Helse Undersokelsen i Nord-Trondelag -HUNT), conducted in 1995-97 (HUNT 2) and 2006-08 (HUNT 3). The study population consisted of 15,134 subjects without chronic MSCs and valid exposure data on smoking at baseline (HUNT 2). The outcome was defined as presence of chronic MSCs at follow-up (HUNT 3). The results show that smoking at baseline represents a 20% increased risk (IRR=1.20, 95% CI 1.14-1.27, P=0.0001) for chronic MSCs at follow-up. The risk for chronic MSCs by daily smoking decreased with increasing age up to 50years; after this, there was no significant association. The results show that modifiable risk factors like smoking should be included in public health intervention programs for MSCs.