Teens who smoke daily are more likely to report health complaints

"Teens who smoke report significantly higher levels of health complaints than nonsmoking teens, and we found that this gap has widened over the years, even as the overall prevalence of teen smoking has dropped," said Marc Braverman a professor, lead author and Extension specialist in the College of Public Health and Human Sciences at Oregon State University, who worked with collaborators in Norway.

"Some adolescents smoke as an attempt to cope with their health problems, and that subgroup may represent a growing proportion of teen smokers, as fewer teenagers are taking up smoking for social reasons."

The researchers believe it is the first time that this shifting relationship between daily smoking and health complaints in adolescence has been reported. The results were published recently in the journal Nicotine and Tobacco Research.

Smoking is on the decline among adults and adolescents in most places around the world, which is very welcome news, said Braverman, whose research expertise includes smoking prevention and tobacco control policy.

But as smoking rates decline, reducing them further becomes more challenging. Some tobacco researchers believe that the remaining smokers tend to be more "hard-core" smokers, who have been smoking for long periods and either do not wish to quit or believe they would not be successful if they tried, he said.

"Many public health officials are asking what kinds of new strategies might be needed to reduce smoking prevalence, to say, the low single digits, and what kinds of resources that might require," Braverman said. "Some smokers are more addicted to or dependent on cigarettes than others."

Understanding the links between health and smoking among teens will help public health officials determine better smoking cessation strategies for that age group, particularly those who smoke on a daily basis, Braverman said.

For the study, researchers used data from the Health Behavior in School-Aged Children Study, an international collaborative project sponsored by the World Health Organization that began in the 1980s and currently includes 43 countries. Surveys of 11-, 13- and 15-year-olds are conducted every four years in participating countries.

The researchers examined smoking behavior and health problems among 15-year-olds in Norway over five waves of the survey, from 1993-94 to 2009-10. They focused on Norway in part because that country experienced dramatic declines in smoking rates over that time period, which allows for investigation of how smoking populations have changed, Braverman said.

As part of the survey, the students were asked about their smoking behavior and how often they experienced subjective physical and psychological health complaints such as headache, stomachache, backache, dizziness, irritability, nervousness, feeling "low" and sleep difficulties.

In addition to the changes in health complaints over time, the researchers found important differences in health complaints related to gender. Girls, in general, reported more health complaints than boys, but the difference between the sexes was significantly larger among smoking teens than nonsmoking teens. In particular, girls who smoked daily reported higher levels of health complaints than any other subgroup, Braverman said.

The data collected did not allow for an explanation of the reason for the finding, but the study raises concerns that adolescent girls might be at especially high risk for health problems associated with smoking, he said.

If teens are smoking as a coping mechanism for physical or psychological problems, they may be at greater risk for dependence and addiction than their peers who are smoking because of peer or social influences, Braverman said.

"And for those teens who smoke to cope with health problems, getting them to stop will likely require different strategies and more intensive intervention efforts than those that are commonly used," Braverman said. "A 'stop smoking' media campaign probably won't be enough."