But no indication found that teens with anxiety disorders are more likely to become chronic smokers in early adulthood
CHICAGO -- Teenagers who smoke at least one pack of cigarettes a day are at greater risk of developing agoraphobia, generalized anxiety disorder, and panic disorder in young adulthood, according to an article in the November 8 issue of The Journal of the American Medical Association.
Jeffrey G. Johnson, Ph.D., of Columbia University and the New York State Psychiatric Institute, New York, and colleagues investigated the association between cigarette smoking and anxiety disorders among adolescents and young adults. The research was based on the Children in the Community Study, which included a total of 976 randomly sampled families from upstate New York. The study participants were 688 teenagers interviewed in 1985-1986, when they were a mean age of 16 years. The participants were interviewed again in 1991-1993, when they were a mean age of 22 years.
According to background information cited in the study, previous research has demonstrated that cigarette smoking is associated with psychiatric disorders among adolescents and adults in the general population. One hypothesis is that anxious people are at elevated risk to start smoking due to factors such as peer pressure, facilitation of social interaction, and the presumed calming effects of smoking. Another hypothesis is that cigarette smoking contributes to the development of anxiety disorders due to factors such as impaired respiration and the presumed anxiety generating effects of nicotine.
Among the 688 teenagers interviewed for the Children in the Community Study, 39 (6 percent) smoked at least 20 cigarettes per day, and 44 (6 percent) had anxiety disorders. At the mean age of 22, 104 young adults (15 percent) smoked at least 20 cigarettes per day, and 68 (10 percent) had anxiety disorders. The researchers factored in age, sex, difficult childhood temperament, alcohol and drug use, anxiety and depressive disorders during adolescence, and parental smoking, educational level, and psychopathology.
"After controlling for covariates, adolescents who smoked 20 cigarettes or more per day were at elevated risk for agoraphobia [6.8 times greater risk], generalized anxiety disorder (GAD) [5.5 times greater risk], or panic disorder [15.6 times greater risk] during early adulthood," the authors write.
Among the 39 young adults who had smoked 20 or more cigarettes per day during adolescence, 10.3 percent experienced agoraphobia (the fear of going into open spaces and public places), 20.5 percent suffered from generalized anxiety disorder, and 7.7 percent experienced panic disorder. Among the 649 adolescents who were not chronic smokers, the prevalence was 1.8 percent for agoraphobia, 3.7 percent for GAD, and 0.6 percent for panic disorder.
Although previous studies have suggested some types of anxiety symptoms during adolescence may be associated with the risk for initiation of cigarette smoking or nicotine dependence, the authors report their findings suggest teenagers with anxiety disorders may not be at higher risk for chronic smoking as young adults. "Anxiety disorders during adolescence were not significantly associated with cigarette smoking during early adulthood," they write. "Six (14 percent) of the 44 adolescents with anxiety disorders and 98 (15 percent) of the 644 adolescents without anxiety disorders smoked at least 20 cigarettes per day during early adulthood."
The authors urge further research to learn more about the association between smoking and anxiety disorders. "It will be of interest for future research to investigate whether different mechanisms, including impaired respiration, and the potentially anxiogenic effects of sustained nicotine intake may underlie the associations between cigarette smoking and agoraphobia, GAD, and panic disorder," they write. "It will also be important to investigate possible biological or psychological vulnerability factors that may increase risk for both cigarette smoking and certain anxiety disorders."
"Our findings provide health care professionals with additional evidence regarding the harmful consequences of cigarette smoking," they conclude. "By providing adolescents with information indicating that cigarette smoking may increase risk for the onset of anxiety disorders, it may be possible to increase the effectiveness of interventions that are designed to persuade young people to stop smoking cigarettes and to avoid initiating cigarette use."
(JAMA. 2000; 284:2348-2351)
Editor's Note: This study was supported by grants to co-authors Patricia Cohen, Ph.D., and Daniel S. Pine, M.D., from the National Institute of Mental Health, and by a grant to co-author Judith S. Brook, Ph.D., from the National Institute on Drug Abuse.
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