Smoking among teen-agers increases risk for anxiety disorders

November 07, 2000

New York, New York - In a longitudinal study published in the November 8 issue of the Journal of the American Medical Association, Dr. Jeffrey Johnson and colleagues at Columbia-Presbyterian, the New York Psychiatric Institute, and Mount Sinai Medical Center provide evidence that teen smoking may lead to anxiety disorders in late adolescence and early adulthood.

An association of teen smoking with anxiety disorders has been known for some time, but whether anxious teens are simply more likely to become hooked on cigarettes or smoking itself increases the likelihood of developing an anxiety disorder has been unclear. "Some previous studies have suggested that anxious individuals may be more likely than others to begin smoking," Dr. Johnson, assistant professor of clinical psychology, explains, "Our findings clearly indicated that anxiety disorders during adolescence were not associated with increased risk for initiation of cigarette smoking during early adulthood."

The study has important implications for young people. In keeping with previous findings, Dr. Johnson observes: "Teens who smoke a pack of cigarettes per day or more are likely to experience difficulty quitting smoking. Many youths who smoke heavily as teen-agers continue to smoke well into adulthood." And, Dr. Johnson points out, "It appears that individuals who continue to smoke heavily during adulthood remain at high risk for onset of certain types of anxiety disorders." Therefore, preventing teens from getting hooked on cigarettes can promote mental as well as physical health into adulthood.

Many teens begin smoking to identify with an image of smokers as "cool," well-adjusted, and popular. Because of this tendency, replacing this attractive image with a portrayal of smokers as overly prone to panic attacks, anxiety, or agoraphobia might change teens' minds about taking up the habit. In their paper, Dr. Johnson and colleagues suggest that letting teens know about this risk "may increase the effectiveness of interventions that are designed to persuade young people to stop smoking cigarettes and to avoid initiating cigarette use."

Interviewing mothers as well as the adolescents themselves, Dr. Johnson and colleagues tracked the development of smoking habits and anxiety disorders such as panic disorder, generalized anxiety disorder, and agoraphobia among teens. When taking into account age, childhood temperament, depression, and the adolescent's alcohol and drug use, as well as the education, smoking habits, and mental health of the youth's parents, Dr. Johnson and colleagues found a strong association between smoking during adolescence and anxiety disorders during early adulthood, but not between adolescent anxiety disorders and cigarette smoking during early adulthood.

The longitudinal study helps answer a controversy about what comes first, heavy smoking or anxiety disorders, suggesting that the former may contribute to the onset of the latter. Previous studies demonstrated an association between smoking and anxiety problems among adolescents and adults. Hypothesizing that anxious teens might be more likely to succumb to peer pressure or to seek out the calming effects of nicotine, some researchers found that anxious and depressed teens were more likely to start smoking. On the other hand, other researchers reported that cigarette smoking seemed to keep anxiety levels high, and that daily smoking was associated with panic attacks in young adults. Consistent with this evidence, the current study suggests that heavy cigarette smoking may contribute to the development of certain types of anxiety disorders.

According to the study, how much a teen smokes seems to makes a difference. Says Dr. Johnson, "Our findings suggest that risk for onset of certain types of anxiety disorders during early adulthood tends to increase as the quantity and frequency of cigarette smoking during adolescence increases." However, because most teens who smoke heavily continue to do so as adults, it is not yet certain whether smoking cessation can completely reverse the trend toward developing certain anxiety disorders in young adulthood.
The study was supported by National Institute of Mental Health and the National Institute on Drug Abuse.

Columbia University Medical Center

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