Depression and nicotine dependence from adolescence to young adulthood
Introduction
Depression is one of the most consistent risk factors implicated in both the etiology of smoking behavior as well as the subsequent developmental course of nicotine dependence. Supporting evidence for this relationship comes from longitudinal investigations in which both depression symptoms (McKenzie, Olsson, Jorm, Romaniuk, & Patton, 2010) as well as a diagnosis of major depression (Breslau et al., 1993, Breslau et al., 1998, Dierker et al., 2001) have been shown to be associated with increased risk of future smoking, the progression to nicotine dependence among adolescents (Fergusson, Lynskey, & Horwood, 1996) and adults (Breslau, Scott, & Kessler, 2004) and a decreased likelihood of successful smoking cessation (McClave et al., 2009).
Though it is consistently linked to several smoking related outcomes, one line of emerging evidence suggests that depression may in fact be uniquely associated with symptoms of nicotine dependence rather than with one's level of smoking per se. For example, evidence from a family study following adolescent smokers through the age of risk for smoking initiation and escalation showed that depression, as well as several other psychiatric disorders, was associated with the progression to nicotine dependence, but not with experimental or regular smoking in the absence of dependence (Dierker et al., 2001). More recently, an investigation of young adult smokers from the National Epidemiologic Study of Alcohol and Related Conditions (NESARC) demonstrated that daily smokers with depression were at increased risk for nicotine dependence both after controlling for level of smoking and also when examining rates of nicotine dependence across the continuum of daily smoking behaviors (Dierker & Donny, 2008). That is, individuals with a lifetime diagnosis of depression showed higher rates of nicotine dependence at each level of daily smoking, ranging from 1 to 5 cigarettes per day to well over a pack per day, compared to individuals without a history of depression.
A discussion of the mechanism that may help to explain the association between depression and nicotine dependence has, to date, largely focused on the role of depression (either through causal or shared effects) in elevating one's probability of smoking (i.e. increasing the likelihood of initiation, promoting earlier onset, and/or influencing the number of cigarettes or persistence of smoking), suggesting that it is the increased exposure that then causes physiological adaptations that lead to dependence symptoms (Pomerleau, 1995). The aforementioned evidence independently linking depression to nicotine dependence, however, supports an alternate hypothesis that recognizes depression as a sign or signal for nicotine dependence across a potentially wide range of smoking behaviors (Dierker & Donny, 2008).
Yet, how wide might this range be? For example, is it inclusive of even the very first experiences with cigarettes? Further, does depression as a signal of nicotine dependence sensitivity necessarily function consistently across time and developmental stage? Available research has largely documented static, between-subjects relationships rather than exploring the developmental growth and change in the association between depression and nicotine dependence within individuals and across the period of greatest risk for both smoking initiation and escalation. The present study sought to begin to fill this gap by examining the dynamic, longitudinal relationships between depression and nicotine dependence. Specifically, we investigate whether there are time and smoking exposure variations in the association between symptoms of depression and emerging nicotine dependence from the earliest experiences with cigarettes through increasing levels of smoking exposure, and from adolescence into young adulthood. We ask: (McKenzie et al., 2010) Are symptoms of depression independently associated with emerging nicotine dependence after accounting for smoking exposure? (Breslau et al., 1993) Does this relationship vary across levels of smoking from the earliest exposures through higher levels of smoking quantity and regularity? (Breslau et al., 1998) Does the relationship vary across the transition from adolescence to young adulthood? To address these questions, we rely on data from an ongoing longitudinal sample recruited during adolescence and followed for 6 years through the transition to young adulthood.
Section snippets
Participants
The sample was drawn from the Social and Emotional Contexts of Adolescent Smoking Patterns (SECASP) Study, which has been described elsewhere (Dierker & Mermelstein, 2010). All 9th and 10th grade students at 16 Chicago-area high schools completed a brief screener survey of smoking behavior (N = 12,970). All students who reported 1) smoking in the past 90 days and smoking < 100 cigarettes/lifetime, 2) smoking in the past 30 days and smoking > 100 cigarettes/lifetime, or 3) smoking < 100
Results
More than half of the sample (58.5%, n = 550) started the study having smoked fewer than 100 cigarettes in their lifetime and increased their smoking behavior to reach 100 or more cigarettes by the 72 month follow-up assessment; 22.1% (n = 208) increased their smoking but did not reach 100 cigarettes by 72 months; 8.5% (n = 80) started the study having smoked 100 or more cigarettes and increased their smoking to over 500 cigarettes; and the remaining 10.9% (n = 103) did not increase their smoking during
Discussion
Despite considerable evidence supporting a depression-smoking link, the mechanisms underlying this association remain relatively unclear. The present study sought to investigate this relationship from the perspective of emerging nicotine dependence symptoms and within a developmental context including both the transition from adolescence to young adulthood as well as increasing lifetime cigarette exposure. Three major findings emerged. First, after statistical control for nicotine exposure
Role of funding sources
The project described was supported by Award Number P01CA098262 from the National Cancer Institute, grants DA029834 and DA033742 from the National Institute on Drug Abuse, and a Center Grant DA010075 awarded to the Methodology Center, Penn State University.
Contributors
Dr. Lisa Dierker conducted the initial analyses, drafted the initial manuscript, and approved the final manuscript as submitted. Dr. Donald Hedeker, Dr. Jennifer Rose and Dr. Arielle Selya contributed to the analyses, reviewed and revised the manuscript, and approved the final manuscript as submitted. Dr. Thomas Piasecki reviewed and revised the manuscript, and approved the final manuscript as submitted. Dr. Robin Mermelstein conceptualized and designed the study, reviewed and revised the
Conflict of interest
The authors have no conflicts of interest relevant to this article to disclose.
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