The association of behavioural and emotional problems with tobacco use in adolescence

Smoking is a highly addictive behaviour, often initiated during adolescence. It is suggested that smoking is associated with behavioural and emotional problems. This study aims to assess the impact of psychosocial problems on smoking initiation and vice versa.

We obtained data on self-reported psychosocial problems and smoking of adolescents at the age of 13 years and 2 years later. The baseline questionnaire was completed by 1789 students. 68% of the baseline questionnaire could be linked to a questionnaire of the second measurement.

15% smoked at baseline and 29% two years later. Respectively 8% and 9% had a clinical Externalizing problem score or a clinical Internalizing problem score at baseline, 14% had these problems two years later. Externalizing problems at baseline predicted the onset of smoking two years later. Internalizing problems only predicted smoking among girls. This association between psychosocial problems and smoking is most obvious for the onset of regularly smoking and less for the onset of experimenting. Reversibly smoking at baseline is only associated with the onset of externalizing problems two years later.

Clinical Externalizing and Internalizing problems make the initiation of regular smoking more likely. The effects on experimental smoking are less obvious.