Association between self-esteem and nicotine dependence in adolescents

Abstract

SIGNIFICANCE: Early onset of nicotine dependence is associated with sustained and frequent smoking in adulthood and significant health consequences. While previous research has linked low self-esteem to smoking in adolescents, the association with nicotine dependence is unclear. The present study examined the association between self-esteem and nicotine dependence in Chinese adolescent smokers in Hong Kong. METHODS: In a 2014/15 survey of 15065 Hong Kong Secondary 1-6 (United States Grade 7-12) students, 339 (2.3%) reported smoking in the past 30 days, and was used in the present analysis. Nicotine dependence was indicated by morning smoking, average numbers of cigarettes consumed in a day when smoking occurred in the past 30 days, and urges to smoke. Students also completed the Rosenberg self-esteem scale, with higher scores denoted higher self-esteem. Linear regression yielded beta-coefficients of urge to smoke scores (USS) and cigarettes per day (CPD) and logistic regression odds ratios (ORs) of morning smoking in relation to the tertiles of self-esteem scores, with adjustment of age, sex, perceived family affluence, and school clustering effect. RESULTS: The 339 smokers had a mean (standard deviation [SD]) age of 15.8 (1.7) years, and 64.9% were boys. The means (SDs) of USS and CPD were 4.2 (2.9) and 8.0 (6.4), and 61.1% reported morning smoking. The tertile cut-points of self-esteem scores were ≤15, 16 to ≤18, and ≥19. Compared with the upper tertile, the adjusted beta-coefficients (95% confidence intervals [CI]) of USS related to the middle and lower tertiles were 0.83 (-0.05, 1.72) and 1.35 (0.69, 2.01); the corresponding figures for CPD were 1.89 (0.05, 3.73) and 4.30 (2.43, 6.17). The corresponding adjusted ORs (95% CI) for morning smoking were 1.57 (0.72, 3.44) and 1.83 (1.02, 3.26). The P values for linear trend for the three nicotine dependence indicators were all statistically significant. CONCLUSIONS: Low self-esteem was associated with nicotine dependence in Chinese adolescent smokers. Targeted intervention may be needed to protect adolescents with low self-esteem from smoking and nicotine dependence. FUNDING: Food and Health Bureau, the Government of Hong Kong SAR, China