Child and adolescent psychopathology as risk factors for subsequent tobacco use

A growing body of research suggests that a number of types of psychopathology that occur during childhood and adolescence are also associated with an increased risk for tobacco use. This paper assesses the relationship between several types of child and adolescent psychopathology and subsequent tobacco use. The types of psychopathology that are discussed include 'externalizing' disorders such as conduct problems and attention-deficit/hyperactivity disorder (ADHD), and 'internalizing' disorders such as depression and anxiety disorders. The strongest evidence for connections between child and adolescent psychopathology and subsequent tobacco use is for conduct problems, ADHD, and depression. There is much weaker support for a connection between anxiety disorders and tobacco use. The relationships between conduct problems and ADHD (which frequently co-occur) and subsequent tobacco use are quite robust. Possible explanations of the relationships between conduct problems, ADHD, and tobacco use are presented. There appears to be a bidirectional relationship between depression and tobacco use; i.e., each has a comparable probability of preceding the other. Areas of particular importance are: (a) the effects of various psychopathologies on various aspects of tobacco use; (b) the role of comorbid psychopathologies; (c) identification of protective factors; (d) the effects of moderators (e.g., gender, ethnicity); (e) mechanisms and processes ('active ingredients') associated with various psychopathologies; (f) implications for intervention; and (g) possible cohort effects.