C-C4-03: Teen Tobacco Use and Depression in Primary Care

Abstract

Background/Aims: Tobacco use is the number one cause of preventable morbidity and death in the nation. Despite the ever growing list of harmful effects associated with smoking, tobacco use is common among children and adolescents and approximately half who try smoking will progress to regular use and dependence. Of concern, the great progress achieved between 1997 and 2003 in reducing teen smoking has stalled with overall rates near 20%. There is only limited evidence of the effectiveness of smoking cessation interventions in teen populations, and the low probability that adolescents will stop smoking on their own highlights the importance of prevention and early detection. Depressive disorders occur in approximately one in five youth by age 18 and are associated with a broad range of negative effects on health, as well as academic and social functioning. Methods: We examined the association of smoking and depression in a large, diverse population of teens seeking primary care from 7 health care organizations in Los Angeles and Washington, D.C. Subjects and their parents were recruited from January, 2005 through March, 2006 to participate in the Teen Depression Awareness Project (TDAP). Among the 4722 teens eligible and interested in participation, 4529 completed a structured telephone interview which assessed depression using the Diagnostic Interview Schedule for Children and queried smoking status. Results: Smoking prevalence varied significantly among teens who scored “non-depressed,” “sub-threshold depressed,” and “depressed” (3.2%, 9.3%, and 15%, respectively). Multivariable analyses controlling for gender, race/ethnicity, age, BMI percentile, and health care site found that compared with non-depressed teens, teens with sub-threshold depression were almost three times as likely to smoke (OR=2.9, CI=1.6, 5.2) and depressed teens were more than 5 times as likely to smoke (OR=5.4, CI=3.4,8.7). Among teens who smoked, 25% suffered depressive symptoms. Conclusions: Primary care visits represent an important opportunity to identify teens at risk for and from depression and smoking. Effective treatments for smoking and depression need to address the co-occurrence and interaction of these serious threats to adolescent health.