Long-term Effects of Adolescent Smoking on Mental Health, Socioeconomic Status, and Social Integration in Adulthood

Background Despite the known adverse causal effects of cigarette smoking on mental health, there remain inconclusive findings for the effects of adolescent cigarette smoking on later mental health, socioeconomic status, and social integration outcomes. Other studies have shorter follow-up periods and did not have a representative portion of the African American population.

Purpose Using an analytical method that matches adolescent smokers with nonsmokers on important early variables, we provide evidence on the effects of adolescent regular smoking on adult socioeconomic status, social integration, depression, and anxiety symptoms.

Methods Our longitudinal study is from the Woodlawn project that followed 1242 African Americans from 1966-1967 (at age 6-7) through 2002-2003 (at age 42-43). We used propensity score matching method to find a regular and a non-regular adolescent smoking group with similar childhood socioeconomic and family background, first grade academic and behavioral performance. We compared the matched samples to assess the longitudinal effects of adolescent smoking on adult outcomes.

Results Comparing the matched 199 adolescent regular smokers and 199 non-regular smokers, we found statistical support for the effects of adolescent cigarette smoking on later educational attainment (OR: 2.13, 95% CI: 1.34, 3.39), long-term unemployment (OR: 1.74, 95% CI: 1.11, 2.75), but did not find support for the effects on adulthood social integration, major depressive disorders, or anxiety symptoms.

Conclusions With propensity score matching and a community population of urban African Americans followed for 40 years, our study contributes to the understanding of the relationships between adolescent smoking and later educational attainment and employment.