Association of anhedonia with adolescent smoking susceptibility and initiation

Abstract

Introduction: Emerging literature implicates anhedonia-diminished capacity to experience pleasure - as a maintaining factor underlying cigarette smoking in adults. The role of anhedonia in adolescent smoking uptake has largely been uninvestigated, leaving unclear whether anhedonia is associated with smoking initiation and with psychosocial determinants of susceptibility to smoking initiation that could be targeted in prevention. This study examined the association of anhedonia with smoking initiation (ever smoke: yes/no) and factors indicative of susceptibility to smoking initiation among never-smokers (smoking outcome expectancies, curiosity about smoking, and willingness and future intention to initiate smoking). Methods: Ninth grade students enrolled in high schools in Los Angeles, CA (N = 3299; mean [SD] age = 14.1 [0.42] years) were administered in-classroom surveys of anhedonia, depression, smoking and other characteristics. Results: For every 1 SD unit increase in anhedonia, there was (1) a 42% increase in odds of smoking initiation in the overall sample (odds ratio [95% CI] = 1.42 [1.30-1.56], p < .0001) and (2) higher scores on each marker of smoking initiation susceptibility in the subsample never-smokers (βs = .10-.19; ps ≤ .002). The associations remained after adjusting for demographics and major depression symptoms. Conclusions: By early adolescence: (1) anhedonia is associated with smoking initiation and (2) adolescents with higher (vs. lower) anhedonia who have never tried smoking may be more susceptible to smoking initiation perhaps due to stronger prosmoking intentions or willingness to smoke. Preventive interventions that target anhedonia and smoking-related intentions warrant consideration in interventions aimed at reducing risk of smoking initiation in affectively vulnerable youth. Implications: These data suggest that anhedonia may be useful to incorporate into theoretical models of the emotional determinants of smoking initiation risk and provide impetus for addressing anhedonia in smoking prevention efforts.