Study Background and Disease Burden
Mood dysregulation during adolescence is a significant clinical concern, often associated with increased risk for substance use. Cigarette smoking, a highly prevalent behavior among youth, is sometimes assumed to provide mood stability or improvement. Yet, despite this common belief, there has been a surprising lack of rigorous real-time longitudinal studies assessing whether cigarette use actually stabilizes mood as smoking frequency increases. Understanding this relationship has implications for both mental health and tobacco control, given the high vulnerability and developmental changes occurring through adolescence and young adulthood.
Study Design
This observational cohort study included 255 adolescents (mean age 15.63 years; 52% female; 67% non-Hispanic White) recruited from 16 Chicago-area high schools with a focus on youth already enriched for current smoking. Participants underwent up to six waves of ecological momentary assessment (EMA) over a 6-year interval spanning adolescence into young adulthood. During each one-week EMA period, youth self-reported mood immediately before and after cigarette smoking events. Additionally, they responded to random prompts about their background mood approximately five times daily to capture mood variability unrelated to smoking.
Mood was quantified in terms of positive affect (PA) and negative affect (NA). Mixed-effects location scale (MELS) modeling was employed to evaluate smoking rate effects on within-person variability of mood change associated with smoking events (acute mood boost) and on background moods (outside smoking episodes).
Key Findings
Analysis revealed that as individual smoking rates increased over time, variability in the acute mood boost following smoking decreased by about 15-20% for both increased PA and decreased NA (statistically significant at P < 0.01). This suggests that the immediate mood-enhancing effect of cigarettes becomes more consistent or stable with increased use.
Moreover, gender differences emerged in background mood variability during nonsmoking times. Specifically, among boys only, greater smoking frequency was associated with approximately 10% reduction in variability of background PA and NA (P < 0.01). This indicates that as boys smoke more, their baseline moods outside of smoking episodes become more stable, whereas no such pattern was observed among girls.
Expert Commentary
The findings provide nuanced insights into the dynamic relationship between cigarette smoking and mood regulation during a critical developmental period. The stabilization of the acute mood boost may contribute to the reinforcing properties of smoking and the progression from occasional to habitual use. Gender-specific stabilization of background moods suggests biological or psychosocial factors that warrant further exploration.
However, the study’s observational design limits causal inference. Mood stabilization might be influenced by other concurrent developmental or environmental factors. Also, the cohort was enriched for smokers and thus may not reflect non-smoking youth. The reliance on self-reported mood and smoking data introduces potential for reporting bias, although the EMA method mitigates recall issues.
Despite these limitations, the study advances prior literature by using high-frequency real-time data collection over multiple years and applying sophisticated statistical modeling to address mood variability at the intra-individual level.
Conclusions
This study substantially fills a gap by demonstrating that increased cigarette use during adolescence and young adulthood is associated with more stable immediate mood improvements after smoking and, in boys, with stabilized background moods. These patterns may help explain smoking persistence and addiction development. Clinicians should be aware of these mood regulation dynamics when addressing smoking cessation in youth. Future research should elucidate underlying neurobiological mechanisms, explore interventions targeting mood variability, and extend findings to diverse adolescent populations.
References
Kendall AD, Hedeker D, Diviak KR, Mermelstein RJ. Does increasing cigarette use stabilize mood? A real-time investigation spanning 6 years of adolescence and young adulthood. Addiction. 2025 Sep;120(9):1816-1824. doi:10.1111/add.70094. Epub 2025 May 21. PMID: 40395061; PMCID: PMC12319658.