Jeffrey Johnson, Ph.D., Patricia Cohen, Ph.D., Daniel Pine, M.D., and colleagues
Journal of the American Medical Association
November 8, 2000, Vol. 284, No. 18, pp. 2348-2351
Available free from (212) 543-5523.
Does smoking cause anxiety or does anxiety cause smoking? Smokers say smoking calms them, but this study finds that adolescents who smoke are more likely to suffer from phobias, panic attacks and other serious anxiety problems as young adults.
The study started with interviews of almost 700 young teens (an average age of 14) in 1983 and followed them for 10 years. They lived in upstate New York; most were white and Catholic.
When these teens were about 16 years of age, only 6 percent smoked at least 20 cigarettes per day. At the age of 22, 15 percent smoked at least 20 cigarettes per day and 10 percent (of all those studied) had anxiety disorders. Smoking habits changed over time, and so did anxiety: Only 3 percent smoked at least 20 cigarettes per day as adolescents and young adults, and only 2 percent had anxiety disorders both as adolescents and as young adults.
Since smokers say smoking calms them down, it would be logical to expect that kids who were anxious became adults who smoked. According to the author, the opposite was true: The kids who smoked were more likely to have agoraphobia (fear of open places), panic disorder, or general anxiety as young adults.
In this kind of study, where you can't control who smokes and who doesn't, there is always concern that the smokers differed from nonsmokers in some important ways, and that anxiety was really caused by these other unknown factors, rather than the smoking. In this study, the researchers statistically controlled for all the other possible influences they could: age, sex, teen drinking and drug use, depression during adolescence, difficult temperament during childhood, parents' education and psychiatric problems, and parents' smoking habits. By eliminating those influences from the statistical analysis, they were able to conclude that smoking was the likely culprit.
Jeffrey Johnson, the senior author, offers two possible explanations for the findings. First, smoking can impair respiration, which can contribute to panic attacks (and panic attacks are one symptom of phobias). Second, there is evidence that nicotine itself increases anxiety, despite the claims of smokers. Although anxiety increases when a person stops smoking, a few weeks later that person's anxiety level will be lower than it was when he or she smoked. This suggests that the nicotine itself causes increased symptoms of anxiety, even though withdrawal initially also increases anxiety.
Johnson hopes that youth workers will use this information to help teens become more motivated to quit smoking, or not to start. He acknowledges that fear of cancer in the distant future does not always help, but predicts that teens may be more motivated to avoid anxiety problems that could start in just a few years.