Smoking Behavior in Adolescents: The Role of Psychological Distress and COVID-19

Young people are an important market for the tobacco industry since most smokers try their first cigarette before they are 18 years. The early onset of smoking among adolescents has been significantly associated with the diagnosis of major depressive disorder, but the direction of causality is not yet known. Therefore, this study aimed to investigate the association between smoking and mental health among adolescents during the COVID-19 pandemic. A cross-sectional study was carried out in Riyadh, Saudi Arabia. A self-designed questionnaire was used to assess participants’ smoking behavior including the validated Arabic Youth Mental Health Scale. The study achieved a 75% response rate. Overall, 186 (24.4%) participants reported being cigarette smokers. Of these respondents, 5.92 (9.56–13.67%) were male, and many of them lived with a smoker (tobacco or shisha). Beyond this, smoking e-cigarettes (odds ratio [OR] =20.16, 95% confidence interval [CI]: 8.09–50.25, P < 0.001) and living with shisha smoke (OR = 9.60, 95% CI: 4.15–22.16, P < 0.001) were independently associated with shisha use. Poor mental health was associated with smoking, either e-cigarette (OR = 1.8, 95% CI: 1.03–3.31 P = 0.037), cigarette (OR = 2.23, 95% CI: 1.14–4.37 P = 0.02) or shisha (OR = 2.76, 95% CI: 1.25–6.09, P = 0.01). Approximately 61% of the participants reported little knowledge of COVID-19, whereas 63% reported taking low precautionary measures against COVID-19. It has been discovered that smoking traditional cigarettes increases your likelihood of using an e-cigarette or shisha, as well as having a smoking family member. It is advised to enact comprehensive smoke-free regulations, raising the price of tobacco products, impose additional taxes, and launch national public awareness media campaigns as tobacco prevention and control measures.