Effect of adolescent cigarette smoking on mental health and substance use outcomes in adulthood

Background. The evidence for whether cigarette smoking is a precursor of later depression or anxiety is inconclusive and academic debate continues. Even though the association between cigarette smoking and later substance use were demonstrated in the literature, there is still no compelling evidence that the use of drugs in the early sequence causes the use of any other drugs. There is a lack of studies that have examined the mediating mechanism of the effect of cigarette smoking on adult mental health and substance use outcomes.;Purpose. The main goal of this dissertation is to understand the effects of adolescent regular cigarette smoking on adulthood socioeconomic status, social integration, mental health, and substance use outcomes. I also examined the mediating role of socioeconomic status in the drug progression pathway.;Methods. My study used a longitudinal dataset from the Woodlawn project that followed 1242 African Americans from 1966--1967 (at age 6--7) through 2002--2003 (at age 42--43) from Woodlawn on the south side of Chicago. I used propensity score matching to find a regular and a non-regular adolescent smoking group with similar background. I used the matched sample to assess the longitudinal effects of adolescent smoking on adult outcomes and to study any mediation effects.;Main findings. I found evidence for the effect of adolescent cigarette smoking on later educational attainment, long-term unemployment, and substance use and abuse in adulthood, but did not find support for the effect on social integration and mental health in adulthood. Educational attainment in young adulthood was found to have mediation effect on the pathway of drug progression from adolescent cigarette smoking.;Significance. This study contributes to public health research by increasing the understanding of the causal effect of cigarette smoking on adult outcomes using propensity score matching methods. The prospective, longitudinal design allows us to better examine the role of factors in each phase in the life course. It adds to the literature of cigarette smoking behaviors among African Americans, when this population suffers disproportionately from tobacco-related health disparities.