Cognitive mediators and disparities in the relation between teen depressiveness and smoking.
BACKGROUND
Depressiveness and tobacco use in adolescents are linked, however, there is limited evidence about the cognitive mediators involved and how the role of mediators may differ by gender and racial/ethnic subgroups.


METHODS
We used a racially/ethnically diverse population-based cross-sectional sample of middle and high school students (n=24,350). Logistic regression models measured the associations of depressiveness with tobacco smoking status, and whether smoking-related knowledge and attitudes (KA) and smoking refusal self-efficacy (SE) attenuated the associations indicating preliminary evidence of mediation.


RESULTS
Depressiveness was associated with intention to smoke (OR=2.41; 95% CI=2.22, 2.61), experimental smoking (OR=1.93; 95% CI=1.72, 2.17) and established smoking (OR=1.85; 95% CI=1.57, 2.18). The percent attenuation of these associations due to the inclusion of smoking-related KA and smoking refusal SE was 58% for intention to smoke (p<0.001), 68% for experimental smoking (p<0.001) and 86% for established smoking (p<0.001). The association of depressiveness with established smoking did not remain statistically significant (OR=1.16; CI=0.97, 1.40) after including smoking-related KA and smoking refusal SE. Attenuation was more pronounced in males and white students.


CONCLUSIONS
The results suggest that smoking-related KA and smoking refusal SE attenuated the relation between depressiveness and smoking, indicating that they may serve as mediators of the link between depressiveness and smoking. Tobacco use prevention programs targeting teens with the aim of increasing anti-smoking KA and smoking refusal SE may benefit from addressing depressiveness, particularly by using gender and racially/ethnically tailored strategies. The cross-sectional nature of the data precludes causal inferences.
Center for Cancer Prevention and Control Research, University of California, Los Angeles, United States; Department of Health Behavior and Health Education, University of Michigan, United States. Electronic address: riteshm@umich.edu.
Ritesh
R
Mistry
Department of Epidemiology, University of California, Los Angeles, United States; Indian Institute of Public Health-Hyderabad (Bangalore Wing), Public Health Foundation of India, India.
Giridhara R
GR
Babu
Department of Epidemiology, University of California, Los Angeles, United States.
Tanmay
T
Mahapatra
Center for Cancer Prevention and Control Research, University of California, Los Angeles, United States.
William J
WJ
McCarthy
D000293:Adolescent; D002648:Child; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology*; D004522:Educational Status; D005006:Ethnicity; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010379:Peer Group; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology / Q000523:psychology*; D014481:United States / Q000453:epidemiology
Adolescent; Depression; Gender; Mediation; Race/ethnicity; Smoking