To examine the association of adolescent depression and anxiety symptoms with daily smoking and nicotine dependence in Tunisians teenagers.

A cross-sectional study including teenagers (n = 162) from two colleges located in Gabes (south of Tunisia) and used a self-administered anonymous questionnaire. Adolescent depression and anxiety symptoms were assessed using the Hospital Anxiety and Depression scale translated and validated in Tunisia. adolescent tobacco use was defined as: daily use (6 or 7 days per week) and the loss of autonomy over tobacco use was evaluated with the Hooked on Nicotine Checklist (HONC).

The prevalence of smoking was 61.7%. It was 92% for boys and 8% for girls. In our sample, 30.7% of teenagers used manufactured cigarettes and chicha; 93.8% of daily smokers had already lost control of their smoking. Their average score the HONC was 5.5 (gap deviation 2.4). Of these, 61.3% had a score greater than or equal to 5. Rates of anxiety and depression were respectively 43% and 20%. Nicotine-dependent adolescents were significantly more anxious than non-dependent: 68.3% vs. 48.7% (P = 0.04). We do not note significant differences between depressed teenagers and adolescents without depression, regarding nicotine dependence.

Smoking is frequent among teenagers in Gabes. Adolescent smokers with anxiety symptoms are at increased risk for nicotine dependence. These results incite to pursue work that takes account of the specific diagnosis and treatment of tobacco dependence among adolescents, especially when psychiatric comorbidity makes smoking cessation more difficult.

The authors have not supplied their declaration of competing interest.