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Open Access Highly Accessed Research article

Emotional, behavioural problems and cigarette smoking in adolescence: findings of a Greek cross-sectional study

George Giannakopoulos1, Chara Tzavara1, Christine Dimitrakaki1, Gerasimos Kolaitis2, Vasiliki Rotsika3 and Yannis Tountas1*

Author Affiliations

1 Centre for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece

2 Department of Child and Adolescent Psychiatry, Medical School, University of Athens, "Agia Sophia" Children's Hospital, Athens, Greece

3 Community Mental Health Centre Byron-Kesariani, Department of Psychiatry, Medical School, University of Athens, Athens, Greece

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BMC Public Health 2010, 10:57  doi:10.1186/1471-2458-10-57

Published: 3 February 2010

Abstract

Background

Although several studies have reported findings concerning the association between smoking and emotional/behavioural problems, little research has investigated this association after controlling for confounding factors which have been found to be significantly correlated with both cigarette smoking and emotional/behavioural problems and may have a strong effect on the relationship between adolescents' mental health and smoking. The present study attempted to assess the association between adolescents' smoking status and their emotional/behavioural problems after controlling for a number of possible confounders (i.e. age, gender, parental smoking status, exposure to family smoking, family socioeconomic status, adolescents' leisure time) in a Greek nation-wide school-based sample.

Methods

Participants completed a questionnaire which retrieved information about age, gender, family socioeconomic status, smoking status, parental smoking, adolescents' leisure time and emotional/behavioural problems. Data were modelled using multiple logistic regression analysis with adolescents' smoking status as the dependent variable.

Results

A total of 1194 (i.e. 63% response rate) of self-reported questionnaires (40.1% boys, 59.9% girls; 12-18 years old) were returned. Data from 1030 participants with full data were analyzed. Cigarette smoking was strongly associated with higher levels of emotional/behavioural problems (p < 0.001) and the association was not moderated (OR = 1.13, 95% CI: 1.08-1.18) after controlling for the effects of other covariates. Emotional symptoms, conduct problems and hyperactivity/inattention were all significantly associated with adolescents' current smoking.

Conclusions

This study supports the association between smoking and emotional/behavioural problems among adolescents. Addressing adolescents' needs regarding their emotional/behavioural health could be helpful in the development of effective anti-smoking strategies in school environment and elsewhere.