title: Daily Smoking and Subjective Health Complaints in Adolescence.
abstract: Using data from the Health Behaviour in School-aged Children survey, this study used a repeated cross-sectional design to examine associations between daily smoking, gender, and self-reported health complaints in five cohorts of adolescents over a 16-year period.
  
  
  
  Data were from nationally representative cohorts of 15-year-old youth in Norway in 1993/1994, 1997/1998, 2001/2002, 2005/2006, and 2009/2010 (ntotal= 7761). Dependent variables were psychological, somatic, and total health complaints. A mixed GLM model examined main and interaction effects of smoking (daily, intermittent, nonsmoking), year, and gender in predicting complaints. Time periods were segmented to compare trends across smoking groups in specific periods.
  
  
  
  Prevalence of daily smoking declined from 15.5% (1993/1994) to 6.0% (2009/2010). All health complaint scores were significantly higher for smokers and for girls (vs. boys). Smoking status by year interactions were significant for all complaint variables during the period of sharpest decline of daily smoking prevalence (2001/2002-2005/2006), with daily smokers experiencing increases in health complaints while intermittent and nonsmokers did not. Smoking status by gender interactions were significant for all health complaint variables, indicating that the main effect for gender (females higher) was even stronger among smokers compared with nonsmokers. Using year as unit of analysis, the size of mean differences between daily smokers and intermittent/nonsmokers in total complaints was significantly negatively correlated with daily smoking prevalence (-.963, n = 5, p < .01).
  
  
  
  As prevalence of daily smoking declined, daily smokers reported higher levels of complaints, suggesting increasing health problems within this group. Girls who smoke daily had particularly elevated levels of complaints.
  
  
  
  This study indicates that the relationship between daily smoking and concurrent health symptomatology in adolescents is changing over time, with higher levels of health complaints reported as overall smoking prevalence declines. To our knowledge, this finding has not previously been reported. If youth are smoking to cope with distress, pain, or other health concerns, tobacco control objectives will be increasingly difficult to achieve with adolescents. Levels of health complaints are particularly high among girls who are daily smokers. The findings suggest that restrictive measures and persuasive communications may not be sufficient tobacco prevention strategies for adolescent populations. Young smokers may need counseling and support.
authors.affiliation: School of Social and Behavioral Health Sciences, Oregon State University, Corvallis, OR; marc.braverman@oregonstate.edu.
authors.forename: Marc T
authors.initials: MT
authors.lastname: Braverman
authors.affiliation: School of Social and Behavioral Health Sciences, Oregon State University, Corvallis, OR.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Stawski
authors.affiliation: Department of Health Promotion and Development, University of Bergen, Bergen, Norway.
authors.forename: Oddrun
authors.initials: O
authors.lastname: Samdal
authors.affiliation: Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.
authors.forename: Leif Edvard
authors.initials: LE
authors.lastname: Aarø
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D002648:Child; D003430:Cross-Sectional Studies; D059026:Diagnostic Self Evaluation; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D009664:Norway / Q000453:epidemiology; D015995:Prevalence; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology / Q000523:psychology / Q000639:trends; D014029:Tobacco Use Disorder / Q000150:complications* / Q000453:epidemiology / Q000523:psychology