title: Cigarette smoking and mood disorders in U.S. adolescents: sex-specific associations with symptoms, diagnoses, impairment and health services use.
abstract: OBJECTIVE
  To report sex-specific associations between cigarette smoking and DSM-IV disorders, symptoms, and mental health services use related to depression and anxiety in a nationally representative sample of U.S. adolescents.
  
  
  METHODS
  Data on two samples were drawn from the 1999-2004 National Health and Nutrition Examination Surveys to examine the association of ever smoking (versus never smoking) with depression (n=1884 12-15 year-olds) and anxiety (n=6336 12-19 year-olds). Sex-specific associations between smoking and DSM-IV diagnoses, subthreshold and severe disorder, symptoms, impairment and mental health services use were assessed using logistic regression modeling.
  
  
  RESULTS
  Rates of DSM-IV depression and anxiety were increased in adolescent female ever smokers as compared to never smokers (OR=3.9, 95% CI: 1.3-11.3 and OR=10.6, 95% CI: 3.1-37.0, respectively). Females also showed statistically significant increases in severe disorder, subthreshold disorder, all symptoms of major depressive disorder, most symptoms of panic disorder, and increases in severe impairment, especially those related to schoolwork and teachers. Male adolescents showed smaller variations in depression and anxiety by smoking status, but were more likely to seek mental health services.
  
  
  CONCLUSIONS
  Smoking prevention efforts may benefit from specifically targeting female youth who show signs of depression or anxiety diagnoses through a school-based program, while greater benefits with males may be evident through programs integrated into mental health services.
authors.affiliation: Legacy, Washington, DC, USA. arichardson@legacyforhealth.org
authors.forename: Amanda
authors.initials: A
authors.lastname: Richardson
authors.forename: Jian-Ping
authors.initials: JP
authors.lastname: He
authors.forename: Laurel
authors.initials: L
authors.lastname: Curry
authors.forename: Kathleen
authors.initials: K
authors.lastname: Merikangas
mesh_terms: D000293:Adolescent; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D002648:Child; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D009749:Nutrition Surveys; D016584:Panic Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012737:Sex Factors; D012803:Sick Role; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology*; D000074606:Smoking Prevention; D013001:Somatoform Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D014481:United States; D014600:Utilization Review