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Association of tobacco experimentation with anxiety and depression: findings from a representative sample of Tunisian adolescents

  • Amel Amara ORCID logo , Nihel Omri , Rania Bannour ORCID logo EMAIL logo , Manel Limam , Meriam El Ghardallou , Menel Mellouli , Jihene Sahli and Ali Mtiraoui
Published/Copyright: February 28, 2024
International Journal of Adolescent Medicine and Health
From the journal International Journal of Adolescent Medicine and Health Volume 36 Issue 1

Abstract

Objectives

Emerging evidence points to tobacco experimentation being associated with a vast array of mental disorders, particularly anxiety and depression. We aimed to assess the prevalence of tobacco experimentation, its predictive factors and its potential links with anxiety and depressive disorders among in school adolescents in a Tunisian delegation.

Methods

We carried out a cross sectional study among adolescents schooling in middle and high schools in the delegation of Nfidha, Sousse, Tunisia, during the period from January to March of the 2019–2020 school year using an anonymous questionnaire self-administered to a representative sample of 1,353 randomly selected pupils. Data were collected using the Arabic versions of the Beck Depression Inventory short form (13 items) and the Screen for Child Anxiety Related Disorders (SCARED-C) and a socio-demographic questionnaire with reference to the literature.

Results

Tobacco was experimented by (17.5 %; CI 95 %: 14.8–18.8 %) of pupils. Almost three out of four pupils (73.2 %; CI 95 %: 70.8–75.6 %) reported experiencing depressive symptoms and (65 %; CI 95 %: 62.5–67.5 %) anxiety symptoms. Pupils who exhibited depressive disorder indicators were significantly more prone to experiment with tobacco (20.2 vs. 9.9 %, p<0.001; crude OR=2.301 CI 95 %: 1.74–3.58). Similarly, the prevalence of tobacco experimentation was found to be higher among pupils who reported having experienced anxiety disorders (21.0 vs. 14.5 %, p<0.001; crude OR=1.56 CI 95 %: 1.06–2.27). Being a male pupil (AOR=5.48 95 % CI: 3.62–8.31), being be enrolled in a high school (AOR=2.86, 95 % CI: 1.92–4.26), tobacco use by father and siblings (respectively AOR=1.76, 95 % CI: 1.19–2.60; AOR=2.47, 95 % CI: 1.52–4.02) and experiencing depressive disorders (AOR=2.69, 95 % CI: 1.60–4.53) were the determinants of tobacco experimentation in the multivariate analysis.

Conclusions

Tobacco experimentation in adolescence has been shown to be significantly associated with anxiety and depression. National smoking prevention strategies should be reinforced with a focus on mental health disorders.

Keywords: tobacco; experimentation; anxiety; depression; mental health; adolescent
Corresponding author: Rania Bannour, Department of Community and Family Medicine, Sousse, Tunisia; Research Laboratory LR12ES03, Sousse, Tunisia; and Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia, E-mail:

Acknowledgments

The authors would like to acknowledge the study staff and study participants.

  1. Research ethics: Not applicable.

  2. Author contributions: The authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: The authors states no conflict of interest.

  4. Research funding: None declared.

  5. Data availability: Not applicable.

References

1. Soleimani, MA, Sharif, SP, Bahrami, N, Yaghoobzadeh, A, Allen, KA, Mohammadi, S. The relationship between anxiety, depression and risk behaviors in adolescents. Int J Adolesc Med Health 2019 [cité 1 août 2023];31. Disponible sur: https://www.degruyter.com/document/doi/10.1515/ijamh-2016-0148/html.10.1515/ijamh-2016-0148Search in Google Scholar PubMed

2. Sendi, I, Chouikh, A, Ammar, A, Bouafia, N. Depression in a sample of Tunisian adolescents: prevalence, associated factors and comorbidity with anxiety disorders. Int J Adolesc Med Health 2021;33:20180068. https://doi.org/10.1515/ijamh-2018-0068.Search in Google Scholar PubMed

3. Zammit, N, Maatoug, J, Ghammam, R, Fredj, SB, Dhouib, W, Ayouni, I, et al.. Surveillance of tobacco use among young adolescents: trends and predictors across three years in Sousse, Tunisia. BMC Publ Health 2022;22:2022. https://doi.org/10.1186/s12889-022-14416-x.Search in Google Scholar PubMed PubMed Central

4. Slomp, FM, Bara, TS, Picharski, GL, Cordeiro, ML. Association of cigarette smoking with anxiety, depression, and suicidal ideation among Brazilian adolescents. Neuropsychiatric Dis Treat 2019;15:2799–808. https://doi.org/10.2147/ndt.s217069.Search in Google Scholar

5. Goldade, K, Choi, K, Bernat, DH, Klein, EG, Okuyemi, KS, Forster, J. Multilevel predictors of smoking initiation among adolescents: findings from the Minnesota Adolescent Community Cohort (MACC) study. Prev Med 2012;54:242–6. https://doi.org/10.1016/j.ypmed.2011.12.029.Search in Google Scholar PubMed PubMed Central

6. Talati, A, Wickramaratne, PJ, Keyes, KM, Hasin, DS, Levin, FR, Weissman, MM. Smoking and psychopathology increasingly associated in recent birth cohorts. Drug Alcohol Depend 2013;133:724–32. https://doi.org/10.1016/j.drugalcdep.2013.08.025.Search in Google Scholar PubMed PubMed Central

7. Bhandari, M. Anxiety and depression among adolescent students at higher secondary school. Bibechana 2017;14:103–9. https://doi.org/10.3126/bibechana.v14i0.16019.Search in Google Scholar

8. Mental health of adolescents. Accessed February 13, 2024. https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health.Search in Google Scholar

9. Taylor, S, Landry, CA, Rachor, GS, Paluszek, MM, Asmundson, GJG. Fear and avoidance of healthcare workers: an important, under-recognized form of stigmatization during the COVID-19 pandemic. J Anxiety Disord 2020;75:102289. https://doi.org/10.1016/j.janxdis.2020.102289.Search in Google Scholar PubMed PubMed Central

10. Peltzer, K. Early smoking initiation and associated factors among in-school male and female adolescents in seven African countries. Afr Health Sci 2011 [cité 31 juill 2023];11. Disponible sur: https://www.ajol.info/index.php/ahs/article/view/73385.Search in Google Scholar

11. Morissette, SB, Tull, MT, Gulliver, SB, Kamholz, BW, Zimering, RT. Anxiety, anxiety disorders, tobacco use, and nicotine: a critical review of interrelationships. Psychol Bull 2007;133:245–72. https://doi.org/10.1037/0033-2909.133.2.245.Search in Google Scholar PubMed

12. Farrell, M, Howes, S, Taylor, C, Lewis, G, Jenkins, R, Bebbington, P, et al.. Substance misuse and psychiatric comorbidity: an overview of the OPCS national psychiatric morbidity survey. Addict Behav 1998;23:909–18. https://doi.org/10.1016/s0306-4603(98)00075-6.Search in Google Scholar PubMed

13. Fluharty, M, Taylor, AE, Grabski, M, Munafò, MR. The association of cigarette smoking with depression and anxiety: a systematic review. Nicotine Tob Res 2017;19:3–13. https://doi.org/10.1093/ntr/ntw140.Search in Google Scholar PubMed PubMed Central

14. Mykletun, A, Overland, S, Aarø, LE, Liabø, HM, Stewart, R. Smoking in relation to anxiety and depression: evidence from a large population survey: the HUNT study. Eur Psychiatry 2008;23:77–84. https://doi.org/10.1016/j.eurpsy.2007.10.005.Search in Google Scholar PubMed

15. Ghali, H, Rejeb, OB, Fredj, SB, Khéfacha, S, Dhidah, L, Rejeb, MB, et al.. Smoking dependence and anxio-depressive disorders in Tunisian smokers attending the smoking cessation clinic in a university hospital. J Egypt Public Health Assoc 2019;94:9. https://doi.org/10.1186/s42506-019-0012-y.Search in Google Scholar PubMed PubMed Central

16. Feldner, MT, Babson, KA, Zvolensky, MJ. Smoking, traumatic event exposure, and post-traumatic stress: a critical review of the empirical literature. Clin Psychol Rev 2007;27:14–45. https://doi.org/10.1016/j.cpr.2006.08.004.Search in Google Scholar PubMed PubMed Central

17. Major depression and stages of smoking: a longitudinal investigation | depressive disorders | JAMA psychiatry | JAMA network [Internet]. [cité 2 août 2023]. Disponible sur: https://jamanetwork.com/journals/jamapsychiatry/article-abstract/190815.Search in Google Scholar

18. Glassman, AH. Cigarette smoking: implications for psychiatric illness. Am J Psychiatry 1993;150:546–53. https://doi.org/10.1176/ajp.150.4.546.Search in Google Scholar PubMed

19. Glassman, AH, Covey, LS, Stetner, F, Rivelli, S. Smoking cessation and the course of major depression: a follow-up study. Lancet 2001;357:1929–32. https://doi.org/10.1016/s0140-6736(00)05064-9.Search in Google Scholar

20. McKenzie, M, Olsson, CA, Jorm, AF, Romaniuk, H, Patton, GC. Association of adolescent symptoms of depression and anxiety with daily smoking and nicotine dependence in young adulthood: findings from a 10-year longitudinal study: teen depression and young adult smoking. Addiction 2010;105:1652–9. https://doi.org/10.1111/j.1360-0443.2010.03002.x.Search in Google Scholar PubMed

21. Chaiton, MO, Cohen, JE, O’Loughlin, J, Rehm, J. A systematic review of longitudinal studies on the association between depression and smoking in adolescents. BMC Publ Health 2009;9:356. https://doi.org/10.1186/1471-2458-9-356.Search in Google Scholar PubMed PubMed Central

22. Munafò, MR, Hitsman, B, Rende, R, Metcalfe, C, Niaura, R. Effects of progression to cigarette smoking on depressed mood in adolescents: evidence from the National Longitudinal Study of Adolescent Health. Addiction 2008;103:162–71. https://doi.org/10.1111/j.1360-0443.2007.02052.x.Search in Google Scholar PubMed

23. Taylor, AE, Fluharty, ME, Bjørngaard, JH, Gabrielsen, ME, Skorpen, F, Marioni, RE, et al.. Investigating the possible causal association of smoking with depression and anxiety using Mendelian randomisation meta-analysis: the CARTA consortium. BMJ Open 2014;4:e006141. https://doi.org/10.1136/bmjopen-2014-006141.Search in Google Scholar PubMed PubMed Central

24. Pengpid, S, Peltzer, K. Prevalence and associated factors of psychological distress among a national sample of in-school adolescents in Morocco. BMC Psychiatr 2020;20:475. https://doi.org/10.1186/s12888-020-02888-3.Search in Google Scholar PubMed PubMed Central

25. El Achhab, Y, El Ammari, A, El Kazdouh, H, Najdi, A, Berraho, M, Tachfouti, N, et al.. Health risk behaviours amongst school adolescents: protocol for a mixed methods study. BMC Publ Health 2016;16:1209. https://doi.org/10.1186/s12889-016-3873-4.Search in Google Scholar PubMed PubMed Central

26. GLANZ, Karen, RIMER, Barbara K, et VISWANATH, Kasisomayajula. (ed.). Health behavior: Theory, research, and practice. John Wiley & Sons, 2015.Search in Google Scholar

27. Fakhfakh, R, Jaidane, I, Hsairi, M, Ben Hamida, AM. Les facteurs de risque et de protection de l’initiation à la cigarette chez les adolescents tunisiens. Revue d’Épidémiologie et de Santé Publique, 2015, vol. 63, no 6, p. 369–379. https://doi.org/10.1016/j.respe.2015.09.005.Search in Google Scholar PubMed

28. Ayedi, Y, Harizi, C, Skhiri, A, Fakhfakh, R. Linking global youth tobacco survey (GYTS) data to the WHO framework convention on tobacco control (FCTC): the case for Tunisia. Tob Induc Dis 2022;20:07. https://doi.org/10.18332/tid/143994.Search in Google Scholar PubMed PubMed Central

29. Ayed, HB, Yaich, S, Hmida, MB, Jemaa, MB, Trigui, M, Karray, R, et al.. Prevalence and factors associated with smoking among Tunisian secondary school-adolescents. Int J Adolesc Med Health 2021;33:379–87. https://doi.org/10.1515/ijamh-2019-0088.Search in Google Scholar PubMed

30. 1680a2c810.pdf [Internet]. [cité 13 août 2022]. Disponible sur: https://rm.coe.int/p-pg-mednet-2021-8-medspad-guidelines-2020-2021-fr/1680a2c810.Search in Google Scholar

31. 16808cbf44.pdf [Internet]. [cité 6 août 2022]. Disponible sur: https://rm.coe.int/2017-ppg-med-41-medspad-tunisia-report-fra/16808cbf44.Search in Google Scholar

32. Beck, AT, Beck, RW. Screening depressed patients in family practice. A rapid technic. Postgrad Med 1972;52:81–5. https://doi.org/10.1080/00325481.1972.11713319.Search in Google Scholar PubMed

33. An Arabic validation of a depression inventory – Julia West 1985 [Internet]. [cité 17 juill 2023]. Disponible sur: https://journals.sagepub.com/doi/10.1177/002076408503100406.Search in Google Scholar

34. Dadfar, M, Kalibatseva, Z. Psychometric properties of the Persian version of the short Beck depression inventory with Iranian psychiatric outpatients. Scientifica 2016;2016:8196463. https://doi.org/10.1155/2016/8196463.Search in Google Scholar PubMed PubMed Central

35. Behrens, B, Swetlitz, C, Pine, DS, Pagliaccio, D. The screen for child anxiety related emotional disorders (SCARED): informant discrepancy, measurement invariance, and test-retest reliability. Child Psychiatry Hum Dev 2019;50:473–82. https://doi.org/10.1007/s10578-018-0854-0.Search in Google Scholar PubMed PubMed Central

36. Birmaher, B, Khetarpal, S, Brent, D, Cully, M, Balach, L, Kaufman, J, et al.. The screen for child anxiety related emotional disorders (SCARED): scale construction and psychometric characteristics. J Am Acad Child Adolesc Psychiatry 1997;36:545–53. https://doi.org/10.1097/00004583-199704000-00018.Search in Google Scholar PubMed

37. Hariz, N, Bawab, S, Atwi, M, Tavitian, L, Zeinoun, P, Khani, M, et al.. Reliability and validity of the Arabic screen for child anxiety related emotional disorders (SCARED) in a clinical sample. Psychiatry Res 2013;209:222–8. https://doi.org/10.1016/j.psychres.2012.12.002.Search in Google Scholar PubMed

38. Beal, AC, Ausiello, J, Perrin, JM. Social influences on health-risk behaviors among minority middle school students. J Adolesc Health 2001;28:474–80. https://doi.org/10.1016/s1054-139x(01)00194-x.Search in Google Scholar PubMed

39. Suicidal ideation and suicide attempts among Tunisian adolescents: prevalence and associated factors [Internet]. [cité 29 juill 2023]. Disponible sur: https://www.panafrican-med-journal.com/content/article/34/105/full/.Search in Google Scholar

40. Enquête MedSPAD en Tunisie. PDF free download [Internet]. [cité 21 juill 2022]. Disponible sur: https://docplayer.fr/24795864-Enquete-medspad-en-tunisie.html.Search in Google Scholar

41. eftxssw9.pdf [Internet]. [cité 7 août 2022]. Disponible sur: https://www.ofdt.fr/BDD/publications/docs/eftxssw9.pdf.Search in Google Scholar

42. Jesus, M, Braga, V, Lins, E, Jesus, R, Freitas, F, Silva, M, et al.. Factors associated with tobacco experimentation among adolescents students. J Nurs UFPE on line, 2020, vol. 14, p. e244043.Search in Google Scholar

43. Freitas, EAO, Martins, MSAS, Espinosa, MM. Alcohol and tobacco experimentation among adolescents of the Midwest Region/Brazil. Cien Saude Colet 2019;24:1347–57. https://doi.org/10.1590/1413-81232018244.15582017.Search in Google Scholar PubMed

44. Bonilha, AG, Ruffino-Netto, A, Sicchieri, MP, Achcar, JA, Rodrigues-Júnior, AL, Baddini-Martinez, J. Correlates of experimentation with smoking and current cigarette consumption among adolescents. J Bras Pneumol 2014;40:634–42. https://doi.org/10.1590/s1806-37132014000600007.Search in Google Scholar PubMed PubMed Central

45. Charfi, N, Turki, M, Smaoui, N, Maâlej Bouali, M, Omri, S, Zouari, L, et al.. Alcohol use and associated environmental factors among middle and high school students in Sfax (Tunisia). Int J Ment Health Addiction 2020;18:658–73. https://doi.org/10.1007/s11469-018-9969-6.Search in Google Scholar

46. Ansari-Moghaddam, A, Rakhshani, F, Shahraki-Sanavi, F, Mohammadi, M, Miri-Bonjar, M, Bakhshani, NM. Prevalence and patterns of tobacco, alcohol, and drug use among Iranian adolescents: a meta-analysis of 58 studies. Child Youth Serv Rev 2016;60:68–79. https://doi.org/10.1016/j.childyouth.2015.11.018.Search in Google Scholar

47. Al-Gelban, KS, Al-Amri, HS, Mostafa, OA. Prevalence of depression, anxiety and stress as measured by the depression, anxiety, and stress scale (DASS-42) among secondary school girls in Abha, Saudi Arabia. Sultan Qaboos Univ Med J 2009;9:140–7.Search in Google Scholar

48. Jha, KK, Singh, SK, Nirala, SK, Kumar, C, Kumar, P, Aggrawal, N. Prevalence of depression among school-going adolescents in an urban area of Bihar, India. Indian J Psychol Med 2017;39:287–92. https://doi.org/10.4103/0253-7176.207326.Search in Google Scholar PubMed PubMed Central

49. Rofo, S, Gelyana, L, Moramarco, S, Alhanabadi, LHH, Basa, FB, Dellagiulia, A, et al.. Prevalence and risk factors of posttraumatic stress symptoms among internally displaced christian couples in Erbil, Iraq. Front Public Health 2023;11:1129031. https://doi.org/10.3389/fpubh.2023.1129031.Search in Google Scholar PubMed PubMed Central

50. Dardas, LA, Silva, SG, Smoski, MJ, Noonan, D, Simmons, LA. Personal and perceived depression stigma among Arab adolescents: associations with depression severity and personal characteristics. Arch Psychiatr Nurs 2017;31:499–506. https://doi.org/10.1016/j.apnu.2017.06.005.Search in Google Scholar PubMed

51. Fatiregun, AA, Kumapayi, TE. Prevalence and correlates of depressive symptoms among in-school adolescents in a rural district in southwest Nigeria. J Adolesc 2014;37:197–203. https://doi.org/10.1016/j.adolescence.2013.12.003.Search in Google Scholar PubMed

52. Fröjd, SA, Nissinen, ES, Pelkonen, MUI, Marttunen, MJ, Koivisto, AM, Kaltiala-Heino, R. Depression and school performance in middle adolescent boys and girls. J Adolesc 2008;31:485–98. https://doi.org/10.1016/j.adolescence.2007.08.006.Search in Google Scholar PubMed

53. Bhattarai, D, Shrestha, N, Paudel, S. Prevalence and factors associated with depression among higher secondary school adolescents of Pokhara Metropolitan, Nepal: a cross-sectional study. BMJ Open 2020;10:e044042. https://doi.org/10.1136/bmjopen-2020-044042.Search in Google Scholar PubMed PubMed Central

54. Escobedo, LG, Reddy, M, Giovino, GA. The relationship between and cigarette smoking in depressive symptoms US adolescents. Addiction 1998;93:433–40. https://doi.org/10.1046/j.1360-0443.1998.93343311.x.Search in Google Scholar PubMed

55. Lakhdar, NEY, Lamri, D, Ouahidi, ML. Activité physique, dépression, anxiété et obésité chez les adolescents scolarisés de Béni Tadjit, Est du Maroc.Search in Google Scholar

56. Quello, SB, Brady, KT, Sonne, SC. Mood disorders and substance use disorder: a complex comorbidity. Sci Pract Perspect 2005;3:13–21. https://doi.org/10.1151/spp053113.Search in Google Scholar PubMed PubMed Central

57. Zammit, N, Amara, A, Ghammam, R, Ben Fredj, S, Boujebha, S, Maatouk, A, et al.. Monitoring tobacco use among a sample of Tunisian high school pupils. Eur J Publ Health 2022;32:ckac131.570. https://doi.org/10.1093/eurpub/ckac131.570.Search in Google Scholar

58. Global Youth Tobacco Survey Collaborating Group. Differences in worldwide tobacco use by gender: findings from the global youth tobacco survey. J Sch Health 2003;73:207–15. https://doi.org/10.1111/j.1746-1561.2003.tb06562.x.Search in Google Scholar PubMed

59. The influence of peer behavior as a function of social and cultural closeness: a meta-analysis of normative influence on adolescent smoking initiation and continuation. PsycNET [Internet]. [cité 6 août 2022]. Disponible sur: https://psycnet.apa.org/doiLanding?doi=10.1037%2Fbul0000113.Search in Google Scholar

60. Byeon, H. Association among smoking, depression, and anxiety: findings from a representative sample of Korean adolescents. PeerJ 2015;3:e1288. https://doi.org/10.7717/peerj.1288.Search in Google Scholar PubMed PubMed Central

Received: 2023-12-15
Accepted: 2024-01-28
Published Online: 2024-02-28

© 2024 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/ijamh-2023-0197
Keywords for this article
tobacco; experimentation; anxiety; depression; mental health; adolescent

Articles in the same Issue

  1. Frontmatter
  2. Reviews
  3. Efficacy of behavioral interventions to increase engagement in sexual health services among LatinX youth in the United States: A meta-analysis for post-pandemic implications
  4. Electronic nicotine delivery system: a narrative review on growing threat to tobacco control and health of the young Indian population
  5. Original Articles
  6. Mindful awareness and resilience skills for adolescents (MARS-A): a mixed-methods study of a mindfulness-based intervention for a heterogeneous adolescent clinical population
  7. Adolescent health care and perceptions in a provincial hospital in Papua New Guinea
  8. Adolescents on an inpatient unit and their healthcare providers: what’s working and what’s not
  9. Adolescent and young adult long-acting reversible contraception post-insertion visit attendance before and after COVID-19
  10. Knowledge and beliefs of Greek parents towards HPV infection and vaccination – are they willing to vaccinate their sons?
  11. Prevalence and correlates of unintentional nonfatal injuries among school-going adolescents in Central America
  12. Prevention starts here: effectiveness of substance abuse prevention module among adolescent students in Bengaluru – a quasi experimental study
  13. Association of tobacco experimentation with anxiety and depression: findings from a representative sample of Tunisian adolescents
  14. Knowledge of smoking and influencing factors among school-going adolescents in Timor-Leste
  15. Tobacco use and oral health related quality of life among Indian adolescents
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