From Our 2007 Archives

Report Links Teen Smoking, Depression

Teenage Smokers May Also Be at Greater Risk for Alcohol and Drug Abuse

By Salynn Boyles
WebMD Health News

Reviewed By Louise Chang, MD

Oct. 23, 2007 -- Smoking cigarettes may make teens more susceptible to depression, alcohol abuse, and illegal drug use, a new report states.

Based on data from a government drug use survey, researchers concluded that teens who smoke are nine times more likely to abuse alcohol and 13 times more likely to abuse illegal drugs than teens who don't smoke.

The report "Tobacco: The Smoking Gun" was released today by the Columbia University's National Center on Addiction and Substance Abuse (CASA), led by former U.S. Health, Education and Welfare commissioner Joseph A. Califano Jr.

The report was funded by the anti-tobacco group Citizen's Commission to Protect the Truth.

"The message is clear," Califano tells WebMD. "If your kid is smoking, you better be alert to the much greater likelihood that he or she also may be abusing alcohol or illegal drugs."

Teen Smokers at Risk

Despite decades of warnings about the dangers of smoking, every day an estimated 4,000 teens in the United States light up a cigarette for the first time.

Califano says the report was issued to make parents, teachers, and physicians aware that the dangers of teen smoking are immediate as well as long-term.

According to the CASA analysis, twice as many teen smokers as nonsmokers suffer symptoms of depression.

Smoking at a young age has also been linked to panic attacks and general anxiety disorders in some studies, the report notes.

While the research falls short of proving that smoking is a cause of depression and other mental illness, Califano says the evidence is pointing in that direction.

"Smoking is clearly linked to substance abuse and depression, and this report shows that the statistical relationship is very powerful," he says.

Based on the government's 2005 National Survey on Drug Use and Health, the CASA analysis shows that:

  • Teenage smokers between the ages of 12 and 17 are five times more likely to drink alcohol and nine times more likely to meet the medical criteria for alcohol abuse or dependence as teens who don't smoke.
  • Teens who smoke are 13 times more likely to use marijuana than nonsmoking teens.
  • Teens who smoke are more than twice as likely to have suffered from symptoms of depression over the course of a year.

The earlier a child begins smoking, the greater the risk, Califano says. Compared to children who never smoked, children who start smoking before age 13 are three times as likely to binge drink, 15 times as likely to use marijuana, and seven times more likely to use other illegal drugs such as heroin or cocaine.

Teens, Smoking, and Depression

Califano says there is growing evidence from animal and brain imaging studies that the nicotine has a more profound effect on young brains than on the brains of adults, increasing their vulnerability to cigarettes and possibly other addictive substances.

Specifically, adolescents may exhibit more nicotine-driven changes in brain chemistry associated with addiction. Animal studies suggest that teens may become nicotine dependent more quickly than adults.

While most of the research has involved animals, at least one study of teenagers suggests that teen smoking leads to depression, and not the other way around.

The report, released in October 2000, showed a link between smoking and depression, but it seemed to contradict the idea that teens smoke because they are depressed.

Rather, the study showed that current cigarette use was a strong predictor of developing serious symptoms of depression within a year.

Elizabeth Goodman, MD, who led the study team, says the message that smoking has an immediate, detrimental effect on health is a very powerful one for young people to hear.

"When you tell teens that smoking will lead to lung cancer in 50 years or even 30 years, they don't hear it," she tells WebMD. "But telling them that when they smoke it can make them feel bad is a message they understand."

The CASA report calls for greater restrictions on the advertising and marketing of all types of tobacco products.

Califano tells WebMD that tobacco companies have found ways around existing restrictions and are still actively marketing their products to children.

He cites R.J. Reynolds' introduction of a line of flavored cigarettes under the Camel brand -- such as the citrus flavored "Twista Lime" and the pineapple and coconut-flavored "Kauai Kolada" -- as among the most egregious examples of this.

Following complaints from federal lawmakers and attorneys general from no fewer than 40 states, R.J. Reynolds agreed to stop selling most of its flavored cigarettes in October 2006.

"No matter how you cut it, selling candy-flavored cigarettes is targeting children," Califano says. "Things really haven't changed all that much since the days of 'Joe Camel.'"

SOURCES: Tobacco: The Smoking Gun, National Center of Addiction and Substance Abuse report," Oct. 23, 2007. Joseph A. Califano Jr., president, National Center on Addiction and Substance Abuse, Columbia University, New York City. Ellen Goodman, MD, professor of pediatrics; director, Child and Adolescent Obesity Program, Tufts New England Medical Center, Boston. Attorneys General agreement with R.J. Reynolds Tobacco, Oct. 11, 2006. National Survey on Drug Use and Health, NIH. Goodman, E. Pediatrics, Oct. 1, 2000; vol 106.

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