Depressive symptoms and smoking among Hong Kong Chinese adolescents


Sunita M. Stewart, Department of Psychiatry, UT Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390–8589, USA, Tel: 214 648 4303, Fax: 214 648 4455, E-mail:


Aims  To examine associations among depressive symptoms, smoking, smoking trajectories and quitting smoking in Hong Kong.

Design  Prospective longitudinal design, with wave 1 at baseline (T1) and wave 2 (T2) 12 months later.

Setting and participants  Form 1 (equivalent to 7th grade in the United States) students, mean age = 12.7 years, n = 1894.

Measurements  Self-reported smoking status, attempts to quit and depressive symptoms.

Findings  At both waves, current as well as ex-smokers had higher depressive symptoms than never smokers. T1 smoking predicted T2 depressive symptoms among those with low baseline depressive symptoms. Depressive symptoms at T1 predicted smoking at T2 among non-smokers at T1. Trajectories were defined by separating participants who were never smokers at both waves (‘non-smokers’), those who smoked at both waves (‘persistent smokers’), those who smoked at one time but were not smoking at either wave (‘past smokers), and those who had never smoked at T1 but reported smoking a year later (‘new smokers’). Persistent, past and new smokers had higher depressive symptoms at both waves than non-smokers. Smokers who reported not wanting or trying to quit and those who had been unsuccessful at quitting had higher depressive symptoms at T2 than those who successfully quit.

Conclusion  Our results suggest that depressive symptoms promote tobacco use in Asian adolescents by making it more likely that an adolescent will begin smoking and less likely that she or he will quit. These findings elucidate risk factors in Hong Kong for two important public health concerns for adolescents: smoking and depression.