Prevention Science [PREV] pp1182-prev-485273 April 5, 2004 19:35 Style ﬁle version Nov. 04, 2000
Prevention Science, Vol. 5, No. 2, June 2004 (
Exploring the Relationship Between Mental Health and
Smoking Cessation: A Study of Rural Teens
Catherine J. Massey,
and Tim McGloin
This study examined the association between mental health and smoking cessation among
rural youth. Participants were 113 male and 145 female adolescents ages 14–19 from rural
West Virginia and North Carolina. Participants were enrolled in the American Lung Associa-
tion’s 10-week Not On Tobacco (N-O-T) program or a 15-min single-dose brief intervention.
Baseline and postprogram measures were completed on smoking status (i.e., quit, reduction),
nicotine dependence, smoking history, and depression and anxiety. Results showed that more
N-O-T participants quit and reduced smoking than did brief intervention participants. In-
tervention group, baseline smoking rate, and the Group × Gender, Group × Anxiety, and
Group × Depression interactions were signiﬁcant predictors of change in smoking behavior
from baseline to postprogram. In conclusion, more N-O-T participants demonstrated favor-
able changes in smoking than did brief intervention participants. Approximately 1/3 of youth
exhibited mental health pathology; more females than males. Levels of depression and anxiety
improved from baseline to postprogram, overall. Although the extent of the impact of mental
health on cessation outcomes was inconclusive, ﬁndings suggest that rural youth who smoke
may be at risk for pathological depression and anxiety. Future cessation programming with
rural youth should consider the inclusion of coping and stress management skills and mental
health referral protocols as signiﬁcant program components.
KEY WORDS: teen smoking cessation; adolescent smoking; mental health.
Recent research suggests that increased atten-
tion should be directed toward youth smoking cessa-
tion efforts (e.g., Houston et al., 1998; Lamkin et al.,
1998; Sussman et al., 1999). Gillespie et al. (1995) fur-
ther posit that success should be determined both
by accessibility and dissemination of effective youth
cessation programs. Speciﬁc subpopulations of youth
have higher smoking rates than others and arguably
these youth should be the focus of cessation efforts.
Ofﬁce of Drug Abuse Intervention Studies, Prevention Research
Center, West Virginia University, Morgantown, West Virginia.
Prevention Research Center, University of North Carolina –
Correspondence should be directed to Kimberly Horn, EdD,
MSW, PO Box 9190, West Virginia University, Morgantown, West
Virginia 26506; e-mail: firstname.lastname@example.org.
For example, youth from less educated, impoverished,
rural areas are at greater risk for becoming smokers
than nonrural youth (Centers for Disease Control and
Prevention [CDC], 2000). Although the ﬁeld has iden-
tiﬁed these youth as being at high risk for smoking,
there is a limited knowledge base about the factors
that mediate, strengthen, or hinder cessation program
efﬁcacy. Identifying and understanding these factors
may help the ﬁeld provide effective and accessible
programs for rural youth.
One factor worthy of critical examination among
rural youth is mental health. There is some evidence
suggesting associations between stress and smoking
(Byrne et al., 1995; Carmody, 1992; Horn et al., 1998;
Pomerleau & Pomerleau, 1991; Sussman et al., 1993),
and depression and smoking (e.g., Carmody, 1992;
Covey & Tam, 1990; Glassman et al., 1990; Giovino
et al., 1995; Kandel, 1982). Moreover, it has been
2004 Society for Prevention Research