Psychological and Familial Factors of Depression in Relation to Adolescent Smoking Behavior

Document Type : Original Article


1 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

2 Isfahan Province Health Center, Isfahan University of Medical Sciences, Isfahan, Iran

3 Student Research Committee, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran

4 Deputy of Prevention, Isfahan Province Welfare Organization, Isfahan University of Medical Sciences, Isfahan, Iran

5 Department of Social Injury Prevention, Isfahan Province Education Organization, Isfahan University of Medical Sciences, Isfahan, Iran

6 Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

7 Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Several common factors have been identified for smoking and depression. The The present study explores the relation of psychological and familial factors with depression, by student smoking behavior. Materials and Methods: A total of 5500 middle- and high-school students were selected in Isfahan province in 2010. A self-administered questionnaire collected data on background characteristics, smoking status, depression, and risk factors. Univariate analysis multiple logistic regressions were conducted to compare between depressed and nondepressed people by adolescent smoking status. Odds ratios and the corresponding 95% confidence intervals (CIs) were reported. Results: Fathers lower education attainment was accompanied adolescents higher depression prevalence. Parental smoking and sibling smoking increased the depression likelihood by 1.41 (95% CI: 1.18, 1.68) and 1.43 folds (95% CI: 1.04–1.94) for never-smokers. Positive attitude toward smoking increased the probability of depression by 1.18 among never-smokers. Never-smokers lacking refusal skill had 1.23 (1.03–1.47) higher chance of depression. A higher level of self-efficacy related to lower chance of depression. Taking risky behavior, increased the depression likelihood by 1.56 (95% CI: 1.29–1.89) in never-smokers, by 1.85 (95% CI: 1.37–2.44) in experimental smokers, and by 1.14 times (95% CI: 1.01–1.72) in current smokers. Family conflict increased depression chance by 2.25 times (95% CI: 1.89–2.66) in never-smokers, by 1.95 (95% CI: 1.46–2.61) in experimental smokers, and by 2.06 times (95% CI: 1.38–3.08) in current smokers. Conclusions: Targeting self-efficacy level, risky behavior, and family conflict can drop the comorbidity of smoking and depression simultaneously. This may help public health practitioners and policymakers to develop common strategies in reducing adolescents smoking and depression comorbidity.


Brown RA, Lewinsohn PM, Seeley JR, Wagner EF. Cigarette smoking, major depression, and other psychiatric disorders among adolescents. J Am Acad Child Adolesc Psychiatry 1996;35:1602-10.  Back to cited text no. 1
Weitzman M, Cook S, Auinger P, Florin TA, Daniels S, Nguyen M, et al. Tobacco smoke exposure is associated with the metabolic syndrome in adolescents. Circulation 2005;112:862-9.  Back to cited text no. 2
Unger JB, Johnson CA, Stoddard JL, Nezami E, Chou CP. Identification of adolescents at risk for smoking initiation: Validation of a measure of susceptibility. Addict Behav 1997;22:81-91.  Back to cited text no. 3
Boden JM, Fergusson DM, Horwood LJ. Cigarette smoking and depression: Tests of causal linkages using a longitudinal birth cohort. Br J Psychiatry 2010;196:440-6.  Back to cited text no. 4
Gilbert DG. Paradoxical tranquilizing and emotion-reducing effects of nicotine. Psychol Bull 1979;86:643-61.  Back to cited text no. 5
Henningfield JE, Miyasato K, Jasinski DR. Abuse liability and pharmacodynamic characteristics of intravenous and inhaled nicotine. J Pharmacol Exp Ther 1985;234:1-12.  Back to cited text no. 6
Munafò MR, Araya R. Cigarette smoking and depression: A question of causation. Br J Psychiatry 2010;196:425-6.  Back to cited text no. 7
Fergusson DM, Lynskey MT, Horwood LJ. Comorbidity between depressive disorders and nicotine dependence in a cohort of 16-year-olds. Arch Gen Psychiatry 1996;53:1043-7.  Back to cited text no. 8
Johnson EO, Rhee SH, Chase GA, Breslau N. Comorbidity of depression with levels of smoking: An exploration of the shared familial risk hypothesis. Nicotine Tob Res 2004;6:1029-38.  Back to cited text no. 9
Breslau N, Kilbey MM, Andreski P. Nicotine dependence and major depression. New evidence from a prospective investigation. Arch Gen Psychiatry 1993;50:31-5.  Back to cited text no. 10
Tyas SL, Pederson LL. Psychosocial factors related to adolescent smoking: A critical review of the literature. Tob Control 1998;7:409-20.  Back to cited text no. 11
Mahabee-Gittens EM, Ding L, Gordon JS, Huang B. Agreement between parents and youth on measures of anti-smoking socialization. J Child Adolesc Subst Abuse 2010;19:158-170.  Back to cited text no. 12
Fleming CB, Kim H, Harachi TW, Catalano RF. Family processes for children in early elementary school as predictors of smoking initiation. J Adolesc Health 2002;30:184-9.  Back to cited text no. 13
Odukoya OO, Odeyemi KA, Oyeyemi AS, Upadhyay RP. Determinants of smoking initiation and susceptibility to future smoking among school-going adolescents in Lagos State, Nigeria. Asian Pac J Cancer Prev 2013;14:1747-53.  Back to cited text no. 14
Chang FC, Lee CM, Lai HR, Chiang JT, Lee PH, Chen WJ. Social influences and self-efficacy as predictors of youth smoking initiation and cessation: A 3-year longitudinal study of vocational high school students in Taiwan. Addiction 2006;101:1645-55.  Back to cited text no. 15
Ellickson PL, Tucker JS, Klein DJ. High-risk behaviors associated with early smoking: Results from a 5-year follow-up. J Adolesc Health 2001;28:465-73.  Back to cited text no. 16
Mazur J, Dzielska A, Malkowska-Szkutnik A. The relationship between tobacco smoking and risk behaviour syndrome among 15-year-old adolescents in Poland and other European countries. Przegl Lek 2009;66:768-72.  Back to cited text no. 17
Tanskanen A, Tuomilehto J, Viinamäki H, Vartiainen E, Lehtonen J, Puska P. Smoking and the risk of suicide. Acta Psychiatr Scand 2000;101:243-5.  Back to cited text no. 18
Okoli CT, Richardson CG, Ratner PA, Johnson JL. Non-smoking youths' “perceived” addiction to tobacco is associated with their susceptibility to future smoking. Addict Behav 2009;34:1010-6.  Back to cited text no. 19
Yu F, Nehl EJ, Zheng T, He N, Berg CJ, Lemieux AF, et al. A syndemic including cigarette smoking and sexual risk behaviors among a sample of MSM in Shanghai, China. Drug Alcohol Depend 2013;132:265-70.  Back to cited text no. 20
Stice E, Ragan J, Randall P. Prospective relations between social support and depression: Differential direction of effects for parent and peer support? J Abnorm Psychol 2004;113:155-9.  Back to cited text no. 21
Saluja G, Iachan R, Scheidt PC, Overpeck MD, Sun W, Giedd JN. Prevalence of and risk factors for depressive symptoms among young adolescents. Arch Pediatr Adolesc Med 2004;158:760-5.  Back to cited text no. 22
Schwarzer R JM. Generalized Self-Efficacy scale. In J. Weinman, S. Wright, and M. Johnston, Measures in health psychology: A user's portfolio. Causal and control beliefs Windsor, England: NFER-NELSON. 1995:35-7.  Back to cited text no. 23
Piko B. Smoking in adolescence do attitudes matter? Addict Behav 2001;26:201-17.  Back to cited text no. 24
Castrucci BC, Gerlach KK, Kaufman NJ, Orleans CT. The association among adolescents' tobacco use, their beliefs and attitudes, and friends' and parents' opinions of smoking. Matern Child Health J 2002;6:159-67.  Back to cited text no. 25
Simons-Morton BG. The protective effect of parental expectations against early adolescent smoking initiation. Health Educ Res 2004;19:561-9.  Back to cited text no. 26
Elder JP, Sallis JF, Woodruff SI, Wildey MB. Tobacco-refusal skills and tobacco use among high-risk adolescents. J Behav Med 1993;16:629-42.  Back to cited text no. 27
Bandura A, Pastorelli C, Barbaranelli C, Caprara GV. Self-efficacy pathways to childhood depression. J Pers Soc Psychol 1999;76:258-69.  Back to cited text no. 28
McFarlane AH, Bellissimo A, Norman GR. The role of family and peers in social self-efficacy: Links to depression in adolescence. Am J Orthopsychiatry 1995;65:402-10.  Back to cited text no. 29
Ulgen H, Ozturk C, Armstrong M. Effect of self-efficacy on Turkish children's perceptions of the advantages/disadvantages of smoking. Asian Pac J Cancer Prev 2012;13:795-8.  Back to cited text no. 30
Kann L, Kinchen S, Shanklin SL, Flint KH, Kawkins J, Harris WA, et al. Youth risk behavior surveillance – United States, 2013. MMWR Surveill Summ 2014;63:1-68.  Back to cited text no. 31
Hill KG, Hawkins JD, Catalano RF, Abbott RD, Guo J. Family influences on the risk of daily smoking initiation. J Adolesc Health 2005;37:202-10.  Back to cited text no. 32
Yang WS, Leatherdale ST, Ahmed R. Smoking susceptibility among never-smokers: Data from the 2006-07 National Youth Smoking Survey. Can J Public Health 2011;102:254-7.  Back to cited text no. 33
Mistry R, Babu GR, Mahapatra T, McCarthy WJ. Cognitive mediators and disparities in the relation between teen depressiveness and smoking. Drug Alcohol Depend 2014;140:56-62.  Back to cited text no. 34