5.5 Individual personality traits and psychiatric influences

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5.1 Introduction

5.2 Stages in the uptake of smoking

5.3 Factors influencing uptake by young people—overview

5.4 Physiological aspects

5.5 Individual personality traits and psychiatric influences

5.6 Intentions, attitudes and beliefs

5.7 The home environment

5.8 The smoking behaviour of peers, and peer attitudes and norms

5.9 The educational environment: achievements, aspirations and 'school connectedness'

5.10 Other drug use

5.11 Accessibility of tobacco products to young smokers

5.12 Affordability of tobacco products

5.13 Opportunity to smoke

5.14 Cultural background

5.15 Tobacco advertising and promotion targeted at young people

5.16 Products and packaging created to appeal to new users

5.17 Factors influencing uptake of smoking later in life

5.18 Uptake—a concluding note

5.19 What is meant by prevention?

5.20 Approaches to youth smoking prevention

5.21 Mass media strategies/campaigns

5.22 Interactive technology and multimedia

5.23 School-based interventions

5.24 Peer influence and education

5.25 Parent/family/home targeted interventions

5.26 Reducing tobacco access and supply

5.27 Reducing product appeal

5.28 Promotion and visibility of tobacco

5.29 Denormalising smoking

5.30 Taxation and pricing of tobacco products

5.31 Harnessing predictors of uptake to prevent smoking

5.32 Preventing smoking in more 'at risk' groups

Acknowledgments

References

5.5.1 Personality traits

Children with particular personality traits are more likely to take up smoking.1 These traits may occur in combination4 and in more extreme cases may present as psychiatric concerns (see following section). Personality traits may be moderated or exacerbated by family and peer factors43 (see Sections 5.7 and 5.8) and gender (Section 5.8.1).

Characteristics associated with increased likelihood of tobacco use include:

Having poorer self control. Individuals who are less adept at controlling certain other behaviours, including being impulsive, easily distracted or aggressive may be more inclined to take up smoking.10

Rebelliousness. Rebelliousness against school and adult authority are markers for adoption of smoking.1, 4, 10 As young people are generally told not to use tobacco, smoking may for some represent the flouting of an obvious symbol of adult authority.

Sensation-seeking and adopting risky behaviour. Sensation-seeking is the desire to experience novel sensations and the willingness to take risks in their pursuit. Sensation-seeking and risk-taking are closely associated with tobacco use and other risky behaviours during adolescence and adulthood.42 These may include inappropriate use of alcohol and other substances, risk-taking in sexual activity, and getting into trouble with the police.10, 44

Adoption of other poor lifestyle habits. Initiation of smoking is associated with a cluster of other poor lifestyle habits such as other drug use, not wearing a seatbelt, having an unhealthy diet, not getting enough sleep, not exercising and engaging in unsafe sex.44

Low self-esteem. Some studies have found that having low self-esteem may be a predictor for taking up smoking in situations where it is perceived that smoking will improve personal image.1 This factor may be more salient for younger girls.10

Coping with emotional distress. Adolescents who experience stress, anxiety, anger, irritability or depression may be more likely to take up smoking.10, 33, 44 Smoking may be seen as a means of coping with negative emotions and once this behaviour is established, the reinforcing effects of nicotine use (by modifying mood and provoking withdrawal symptoms) underpin its role.45

5.5.2 Psychiatric influences

A strong association between smoking behaviour and a range of psychiatric conditions in adolescence has been observed. Connections between tobacco use and disruptive behaviour disorders (such as oppositional defiant disorder, conduct disorder and attention-deficit/hyperactivity disorder), anxiety, major depressive orders46 and other substance use disorders47 have been consistently reported in the medical literature.7, 12, 48

A recent analysis of national smoking prevalence in the USA found that young teenagers who took up smoking were more likely to suffer from symptoms of mental illness such as hopelessness, worthlessness and depression than non-smokers.39 Earlier experience of symptoms of psychological distress was associated with earlier age of uptake of smoking. Overall, smokers aged between 12–17 were twice as likely to have experienced a major depressive episode in the previous year, compared to non-smokers of the same age.39

Early uptake of smoking is also associated with an increased likelihood of developing a range of anxiety disorders, including generalised anxiety disorder (experiencing chronic anxiety and worrying often for no reason), panic attacks and panic disorder, and post-traumatic stress disorder.39 Experiencing or witnessing trauma in childhood (such as childhood sexual or physical abuse or interpersonal violence) is also associated with an increased likelihood of uptake of smoking.49

State-wide surveys of adolescent smoking behaviour in Victoria undertaken between 1992 and 1995 showed that teenagers experiencing symptoms of anxiety or depression were much more likely to take up smoking, particularly in settings in which peer group smoking was present. Young girls were especially susceptible to this psychosocial combination of factors.50

Research into adolescent smoking behaviour in Queensland from the late 1990s has shown that 14 year olds presenting with delinquency, depression, anxiety or somatisation (conversion of an emotional, mental, or psychosocial problem to a physical complaint) were significantly more likely to be smokers. Male smoking was more strongly linked to 'external' behavioural factors (delinquency and depression) and female smoking was more strongly associated with 'internal' factors (anxiety/depression or somatisation).51 Childhood aggression is also associated with smoking behaviour in adolescence.25

The mechanisms for co-morbidity of psychiatric illness and smoking may arise because of common underlying factors, a predisposition due to neurobiological alterations to the adolescent brain caused by nicotine, or self-medication.39 Use of nicotine to ameliorate symptoms of depression and anxiety is particularly apparent, especially in girls.52 The connection between smoking and psychiatric symptoms may be bi-directional, one reinforcing and promoting the other.7

Adults with mental illness have a much higher prevalence of smoking than the background population. See Chapter 1, Section 1.10.2 for further discussion. The association between smoking and use of other substances is discussed in Section 5.10 below.