Categorizing adolescent smokers may help with treatment

June 24, 2000

Adolescents smokers are not all alike, contrary to common stereotypes. Several dimensions or categories of adolescent smokers exist, according to a study of adolescents.

"The fact that an adolescent smoker may be a persistent smoker, an experimenter, an intermittent smoker, or an attempted quitter should be taken into account when developing smoking prevention and treatment programs," said lead author Peter M. Lewinsohn, PhD, of the Oregon Research Institute in Eugene, OR.

Previous studies have noted an association between adolescent smoking and problem behavior, but few have looked at the difference between adolescents who persist in smoking rather than those just experimenting with it, for example.

"Clearly, understanding the determinants or factors related to onset of smoking, progression to regular use, and persistence of smoking during adolescence is both theoretically and clinically important," said Lewinsohn.

Approximately 90 percent of adult smokers began at age 18 or earlier. Moreover, many adolescent smokers try to quit, but nearly 80 percent are unsuccessful, according to the study.

Lewinsohn and colleagues looked at a pool of approximately 1,500 adolescents that included never-smokers, experimenters, former intermittent smokers, current intermittent smokers, former daily smokers, and current daily smokers.

Compared to never-smokers, smokers as a whole had more stressful environments, more academic problems, more impulsive behavior, and poorer coping skills, the researchers found. They reported their results in the current issue of the journal Nicotine & Tobacco Research.

When they examined smokers by category, the researchers found little difference between never-smokers and experimenters (who had smoked fewer than six lifetime cigarettes), except that experimenters had higher levels of problematic academic behavior. "While these differences are relatively small in magnitude, they suggest that in some ways even a seemingly trivial use of cigarettes is associated with an elevated level of behavioral problems," said Lewinsohn.

Compared to those who quit smoking, persistent smokers reported more problematic academic behavior, greater conflict with parents, and more friends who smoked. "Consistent with our hypothesis, persistence of smoking was found to be associated with a problematic environment," said Lewinsohn.

When they compared persistent daily smokers with intermittent smokers, the researchers found that persistent smokers had higher levels of psychiatric problems, such as depression and conduct disorders, higher levels of substance abuse and impulsive behaviors, and more friends who smoked.

"It appears that in addition to having substance abuse problems, those who progress to daily smoking also are more likely to have other psychiatric problems, and this presence of psychiatric problems may need to be taken into account in the design of interventions," said Lewinsohn.

The implications of their study with regards to prevention need to be clarified by future studies, according to the researchers. Such studies should consider factors such as beliefs about the connection between body weight and smoking, health beliefs about smoking, and the influence of parental disapproval of smoking.
Nicotine & Tobacco Research is the official peer-reviewed quarterly journal of the Society for Research on Nicotine and Tobacco. For information about the journal, contact Gary E. Swan, PhD, at 650-859-5322.

Posted by the Center for the Advancement of Health . For information about the Center, call Petrina Chong, 202-387-2829.

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