Depression, anxiety, and smoking initiation: a prospective study over 3 years.

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Abstract

This report considers the extent to which depression and anxiety predict smoking onset in adolescence. A 6-wave cohort design was used to study a sample of 14- and 15-year-old students (n = 2032) drawn from 44 secondary schools in the state of Victoria, Australia. The students were surveyed between 1992 and 1995 with a computerized questionnaire that included a 7-day retrospective diary for tobacco use and a structured psychiatric interview. Experimental smokers were 29 times more likely than non-smokers to make a transition into daily use in the subsequent 6 months. Depression and anxiety, along with peer smoking, predicted initiation of experimental smoking. Specifically, depression and anxiety accentuated risks associated with peer smoking and predicted experimentation only in the presence of peer smoking. The finding that experimental smoking is an overwhelmingly strong predictor of later daily smoking focuses attention on smoking initiation. Depressive and anxiety symptoms are associated with higher risks for initiation through an increased susceptibility to peer smoking influences. Promoting the psychological well-being of adolescents and addressing perceived interpersonal benefits of smoking may play a role in the prevention of adolescent tobacco use.

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Most cited references 17

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Why children start smoking cigarettes: predictors of onset.

K M Conrad, B R Flay, D. Hill (1992)

We review findings from 27 prospective studies of the onset of cigarette smoking conducted since 1980. Almost 300 measures of predictors of smoking onset were examined, and 74% of them provided multivariate support for predictors of onset derived from theory and previous empirical findings. Expected relationships were strongly supported for (a) socioeconomic status, with students with compromised status being more likely to try smoking; (b) social bonding variables, particularly peer and school bonding, with less support for family bonding; (c) social learning variables, especially peer smoking and approval, prevalence estimates, and offers/availability, with less consistent support for parent smoking and approval; (d) refusal skills self efficacy; (e) knowledge, attitudes and intentions, with the expected stronger predictions from intentions than from attitudes than from knowledge; and (f) broad indicators of self-esteem. The few investigators who analyzed their data separately by age, gender, or ethnicity found many differences by these factors, though there were too few of them to detect any pattern with confidence. Though the 27 studies are far from perfect, we believe that they confirm the importance of many well-accepted predictors and raise some questions about others. In particular, family smoking, bonding and approval each received unexpectedly low support. It is not clear whether this lack of support reflects reality as it has always been, is due to a changing reality, reflects developmental changes, either in the age of subjects or the stage of onset, or is due to poor measurement and too few tests. Future prospective studies need to be theory-driven, use measures of known reliability and validity, report analyses of scale properties, and use statistical methods appropriate to the hypotheses or theories under study. Finally, we encourage more investigations of the potentially different predictors of transitions to experimental or regular cigarette smoking. This will require multi-wave studies and careful measurement of changes in smoking behavior.

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Cigarette smoking, major depression, and other psychiatric disorders among adolescents.

R A Brown, P M Lewinsohn, J R Seeley … (1996)

To examine cross-sectionally and prospectively relationships of cigarette smoking with major depressive disorder (MDD), controlling for comorbidity in a community sample of adolescents. A representative sample of 1,709 adolescents (aged 14 through 18 years) was assessed by using semistructured diagnostic interviews on two occasions, approximately 1 year apart. Logistic regression analyses were used to examine cross-sectionally and prospectively the relationships between smoking and each psychiatric disorder, while statistically controlling for the other disorders. Cross-sectional analyses revealed significant relationships of drug abuse/dependence and disruptive behavior disorders with adolescent smoking, even after the co-occurrence of all other disorders was controlled. Prospectively, smoking was found to increase the risk of developing an episode of MDD and drug abuse/dependence, after adjusting for other disorders. Finally, only lifetime prevalence of MDD remained a significant predictor of smoking onset, after controlling for other disorders. Gender did not moderate any of the relationships between psychopathology and smoking. The results suggest important relationships between cigarette smoking and psychiatric disorders among adolescents, particularly with regard to MDD, drug abuse/dependence, and disruptive behavior disorders. These findings have important clinical implications, both for psychiatric care and for smoking prevention and cessation efforts with adolescents.

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Peer group structure and adolescent cigarette smoking: a social network analysis.

S T Ennett, K E Bauman (1993)

Social network theory and analysis are applied to examine whether adolescents who fill various social positions that characterize peer group structure differ in prevalence of current smoking. One thousand and ninety-two (1,092) ninth graders in one school system named their three best friends, allowing the identification of each adolescent as clique member, clique liaison, or isolate. At four of five schools, the odds of being a current smoker were significantly higher for isolates than for clique members and liaisons. The relationship was not explained by demographic variables or by the number of friends who smoke.

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Author and article information

Journal

Title: American Journal of Public Health

Abbreviated Title: Am J Public Health

Publisher: American Public Health Association

ISSN (Print): 0090-0036

ISSN (Electronic): 1541-0048

Publication date Created: October 1998

Publication date (Print): October 1998

Volume: 88

Issue: 10

Pages: 1518-1522

Article

DOI: 10.2105/AJPH.88.10.1518

PMC ID: 1508459

PubMed ID: 9772855

SO-VID: 43f1da3d-586b-42a6-a8cf-2035a56780a8

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