Psychological Health and Smoking in Young Adulthood: Smoking Trajectories and Responsiveness to State Cigarette Excise Taxes Public Deposited

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  • March 19, 2019
  • Schmidt, Allison
    • Affiliation: Gillings School of Global Public Health, Department of Health Behavior
  • While smoking rates have significantly decreased among the general population in the past several decades, they have not significantly decreased among those with poorer psychological health. As posited by theories such as the Transactional Model of Stress and Coping, smoking may represent an important coping mechanism for individuals who experience stress or unpleasant feelings related to poorer psychological health. If poorer psychological health is experienced during young adulthood, a critical time for tobacco use experimentation and uptake, individuals may be particularly likely to become dependent on nicotine and develop longer term smoking habits. In addition, tobacco control policies that have reduced tobacco use in the general population, like raising the price of cigarettes, may be less effective among people with poorer psychological health. Using two indicators of psychological health, a continuum of psychological distress and ever diagnosis of a mental illness, this dissertation explored first, how psychological health accounts for variability within and between individuals in trajectories of smoking (status and amount) across the ages of 18 to 30, and second, whether psychological health moderates the effectiveness of cigarette excise taxes in preventing and reducing smoking. Using a longitudinal national sample across years 2007 to 2013, between-individual effects were found such that individuals with poorer psychological health were more likely to be smokers and to smoke greater numbers of cigarettes over young adulthood than those with better psychological health (Aim 1 and Aim 2). Additionally, the positive effect of having a diagnosed mental illness on smoking amount increased with age, suggesting older young adults may be important targets for intervention (Aim 1). While the effect of cigarette excise taxes encouragingly was not shown to differ by psychological health, cigarette excise taxes showed little effect on smoking at all, perhaps suggesting taxes need to be raised higher than they have been to meaningfully impact smoking (Aim 2). Interventions should aim to target high-risk young adults with poorer psychological health to treat unpleasant psychological symptoms simultaneously with smoking prevention and cessation programs. Overall, this work helps us understand the relationships between psychological health, smoking, and tobacco control policy, with implications for interventions.
Date of publication
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Rights statement
  • In Copyright
  • Gottfredson, Nisha
  • Golden, Shelley
  • Ribisl, Kurt
  • Ennett, Susan
  • Aiello, Allison
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2017

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