The Relationship between Depression and Smoking in Adolescents

Article excerpt

Despite research indicating that cigarette smoking is the number one preventable cause of premature death in the United States (e.g., Bartecchi, MacKenzie, & Schrier, 1995), smoking continues at a high rate. Adolescent smoking rates actually increased in the 1990s (Centers for Disease Control and Prevention, 1998). This trend might continue, as marketing practices by the tobacco industry have been linked with smoking uptake among adolescents (Sargent et al., 2000). Given that most smokers begin smoking at an early age (Bartecchi, MacKenzie, & Schrier, 1995) and that early onset is associated with heavier smoking in later years (Everett et al., 1999), there is a great need to understand factors associated with the initial decision to begin smoking as well as its maintenance. Numerous theories have been proposed to explain the initiation and maintenance of smoking behavior in both adolescents and adults. For example, Perry, Murray, and Klepp (1987) have suggested that adolescent smoking serves a number of purpo ses, often associated with specific developmental tasks. They noted that smoking may be a coping mechanism for dealing with boredom and frustration; a transition marker or a claim on a more mature, adult status; a way of gaining admission to a peer group; and a way to have fun, reduce stress, or maintain and increase one's personal energy.

Research on the maintenance of smoking behavior has found that smokers see their habit as having a calming effect (Leventhal & Avis, 1976), and pleasurable relaxation is the most frequently cited motive for smoking, particularly for younger smokers (Klitzke, Irwin, Loinbardo, & Christoff, 1990). Smoking can also be a quick and easy coping strategy for students who have low self-image or who experience frequent dysphoric states (Semmer, Cleary, Dwyer, Fuchs, & Lippert, 1987). Personality factors, such as neuroticism, negative affect, hopelessness, and general psychological disarray, have also been found to be integral in the maintenance of smoking (Breslau, Kilbey, & Andreski, 1993). Jackson (1998) has suggested that some children show a propensity for later, adolescent smoking as early as third grade by being cognitively susceptible, or lacking a firm commitment toward not smoking. Others have suggested that depression plays an important role in both the initiation (Kandel & Davies, 1986) and maintenance (And a et al., 1990) of smoking.

Depression and Smoking

Depression has been found to have a strong association with cigarette smoking (see Covey, Glassman, & Stetner, 1998, for a review). Adults who are depressed are 40% to 50% more likely to smoke than adults who are not depressed (Schoenborn & Horm, 1993). Depressive symptoms have also been found to predict continued smoking in adolescents (Zhu, Sun, Billings, Choi, & Malarcher, 1999). Dalack, Glassman, Rivelli, Covey, and Stetner (1995) found that even after a recovery from major depression (diagnosed), smokers often remained symptomatically depressed. Interestingly, smokers who are depressed tend to smoke more cigarettes than more emotionally stable individuals who smoke (Spielberger, 1986). In addition, depressed individuals are less successful in their efforts to stop smoking (Curtin, Brown, & Sales, 2000; Vazquez & Becona, 1999) and more prone to depression following smoking cessation (Covey, Glassman, & Stetner, 1998). According to the DSM-IV, "depressive symptoms post cessation may be associated with a re lapse to smoking" (American Psychiatric Association, 1994, p. 246).

Despite the significant body of literature associating depression with smoking, the nature of this relationship remains unclear, and theories attempting to explain the observed correlation are sometimes contradictory. Proposed theories include both noncausal and causal relationships between depression and smoking. A noncausal relationship suggests that a predisposition of common factors, such as psychological vulnerabilities, contributes to the observed correlation between smoking and depression for adults (Breslau, 1995) and adolescents (Koval, Pederson, Mills, McGrady, & Carvajal, 2000). …