Smoking and mental health - NCSCT

Smoking and mental health
between passive smoking and hyperactivity, inattention and conduct
disorders. 162 Passive smoking in children has also been linked to
neurocognitive testing deficits 163 and behavioural and emotional problems
in general. 164
7.6.3 Smoking and child and adolescent mental disorders
It is well recognised that smoking is particularly common among young people
with mental disorders, especially emotional and behavioural disorders. Crosssectional
data indicate that, in Australia, 72% of young people with a conduct
disorder had smoked within the past 30 days, as had 46% of those with
depression and 38% of those with ADHD, compared with 21% of those with no
mental health diagnosis. 165 In the 2004 Child and Adolescent Mental Health
Survey of Great Britain, 19% of young people with an emotional disorder were
classed as regular smokers, as were 15% of those with hyperkinetic disorder and
30% of those with conduct disorder, compared with around 6% in children
without these disorders. Depression in adolescence has been associated with
smoking in adulthood, whereas young people who smoke appear to be more
likely to become depressed. 166 Adolescents with ADHD are more likely to smoke
than their peers, to have started smoking younger 167 and to have more severe
nicotine dependence. 168
Theories underpinning the association with ADHD include nicotine selfmedication,
whereby young people smoke to alleviate ADHD symptoms by
exploiting the central nervous stimulant effects of nicotine to improve attention
and cognition. 168 This theory is supported by evidence that adolescents with
ADHD who are not treated with stimulant medication are more likely to
smoke, 169,170 and that children with greater levels of inattention and
hyperactive–impulsive symptoms are more likely to be smokers. 169 Alternative
hypotheses or potential confounders include the possibility that the
impulsiveness, impaired inhibition and other cognitive deficits of adolescents
with ADHD make it more difficult for them to resist initiating and continuing
smoking, 168 or that the social disadvantages of ADHD result in greater exposure
to peer smoking as a result of a higher likelihood of associating with deviant
peers who are themselves more likely to smoke. 171
Smoking is also more common among young people with eating disorders. The
American National Longitudinal Study of Youth found that adolescent girls with
a high body mass index, who reported that they were trying to lose weight, were
more likely to initiate smoking than other females. 172 This association between
smoking and dieting behaviours, and with disordered eating symptoms and some
aspects of general weight concerns, may be more marked among females. 173
Similarly, although adolescents with anorexic-restrictive eating patterns did not
use smoking as a weight control strategy, body image concerns were more
prevalent in girls who smoked than in those who did not. 174
150 © Royal College of Physicians 2013