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Jeffrey G. Johnson, PhD; Patricia Cohen, PhD; Daniel S. Pine, MD; Donald F. Klein, MD; Stephanie Kasen, PhD; Judith S. Brook, PhD

JAMA. 2000;284:2348-2351.

Context  Cigarette smoking is associated with some anxiety disorders, but the direction of the association between smoking and specific anxiety disorders has not been determined.

Objective  To investigate the longitudinal association between cigarette smoking and anxiety disorders among adolescents and young adults.

Design  The Children in the Community Study, a prospective longitudinal investigation.

Setting and Participants  Community-based sample of 688 youths (51% female) from upstate New York interviewed in the years 1985-1986, at a mean age of 16 years, and in the years 1991-1993, at a mean age of 22 years.

Main Outcome Measure  Participant cigarette smoking and psychiatric disorders in adolescence and early adulthood, measured by age-appropriate versions of the Diagnostic Interview Schedule for Children.

Results  Heavy cigarette smoking (20 cigarettes/d) during adolescence was associated with higher risk of agoraphobia (10.3% vs 1.8%; odds ratio [OR], 6.79; 95% confidence interval [CI], 1.53-30.17), generalized anxiety disorder (20.5% vs 3.71%; OR, 5.53; 95% CI, 1.84-16.66), and panic disorder (7.7% vs 0.6%; OR, 15.58; 95% CI, 2.31-105.14) during early adulthood after controlling for age, sex, difficult childhood temperament; alcohol and drug use, anxiety, and depressive disorders during adolescence; and parental smoking, educational level, and psychopathology. Anxiety disorders during adolescence were not significantly associated with chronic cigarette smoking during early adulthood. Fourteen percent and 15% of participants with and without anxiety during adolescence, respectively, smoked at least 20 cigarettes per day during early adulthood (OR, 0.88; 95% CI, 0.36-2.14).

Conclusion  Our results suggest that cigarette smoking may increase risk of certain anxiety disorders during late adolescence and early adulthood.

Author Affiliations: Departments of Psychiatry, Columbia University and the New York State Psychiatric Institute (Drs Johnson, Cohen, Klein, and Kasen), and Community Medicine, The Mount Sinai Medical Center, New York, NY (Dr Brook); and Intramural Research Program, Program on Mood and Anxiety Disorders, National Institute of Mental Health, Bethesda, Md (Dr Pine).

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