title: Anxiety and depressive disorders are associated with smoking in adolescents with asthma.
abstract: OBJECTIVE
  To evaluate the association between mental health indicators (including meeting criteria for one or more DSM-IV [Diagnostic and Statistical Manual of Mental Disorders-fourth edition] anxiety or depressive disorders) and susceptibility to smoking or current smoking among youth with asthma and to evaluate the impact of smoking on asthma symptoms and self-management.
  
  
  METHODS
  We conducted telephone interviews with a population-based sample of 11- to 17-year-old youth and their parents (n = 769). Interview content included questions on smoking behaviors, asthma symptoms and treatment, externalizing behavior, and a structured psychiatric interview to assess DSM-IV anxiety and depressive disorders.
  
  
  RESULTS
  Five percent of youth were smokers and 10.6% indicated that they were "susceptible to smoking." Smoking was more common among youth with mental health disorders. Anxiety/depressive disorders were present in 14.5% of nonsmokers, 19.8% of susceptible nonsmokers, and 37.8% of smokers. After controlling for important covariates, youth with more than one anxiety and depressive disorder were at over twofold increased risk for being a smoker. Similarly, for each one-point increase in externalizing disorder symptoms, youth had a 10% increase in likelihood of being a smoker and a 4% increase in risk for "susceptibility to smoking." Youth who were smokers reported more asthma symptoms, reduced functioning due to asthma, less use of controller medicines, and more use of rescue medications.
  
  
  CONCLUSIONS
  Comorbid mental health disorders are associated with increased risk of smoking in youth with asthma. Smoking is associated with increased asthma symptom burden and decreased controller medication use. Interventions for youth with asthma should consider screening for and targeting these behavioral concerns.
authors: Center for Health Studies, Group Health Cooperative, Seattle, Washington 98101-1448, USA. bush.t@ghc.org
authors: Terry
authors: T
authors: Bush
authors: Laura
authors: L
authors: Richardson
authors: Wayne
authors: W
authors: Katon
authors: Joan
authors: J
authors: Russo
authors: Paula
authors: P
authors: Lozano
authors: Elizabeth
authors: E
authors: McCauley
authors: Malia
authors: M
authors: Oliver
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D017677:Age Distribution; D000704:Analysis of Variance; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D001249:Asthma / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D002648:Child; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D004198:Disease Susceptibility / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D011336:Probability; D012016:Reference Values; D012309:Risk-Taking; D012720:Severity of Illness Index; D017678:Sex Distribution; D011795:Surveys and Questionnaires