Marc Braverman, lead author and a professor in the College of Public Health and Human Sciences at Oregon State University (OSU), said while smoking is on the decline among adults and adolescents in most places around the world, "some adolescents smoke as an attempt to cope with their health problems, and that subgroup may represent a growing proportion of teen smokers."Teens who smoke daily found to have more health complaints"Teens who smoke report significantly higher levels of health complaints than nonsmoking teens, and we found that this gap has widened over the years, even as the overall prevalence of teen smoking has dropped," he said.

　　For the study, published in the journal Nicotine and Tobacco Research, researchers at OSU and their colleagues at University of Bergen and Norwegian Institute of Public Health used data from the Health Behavior in School-Aged Children study, an international collaborative project sponsored by the World Health Organization that began in the 1980s and currently includes 43 countries, where surveys of 11-, 13- and 15-year-olds are conducted every four years.

　　The researchers examined smoking behavior and health problems among 15-year-olds over five waves of the survey, from 1993-94 to 2009-10, in Norway, which saw dramatic declines in smoking rates over that time period; and as part of the survey, the students were asked about their smoking behavior and how often they experienced subjective physical and psychological health complaints such as headache, stomachache, backache, dizziness, irritability, nervousness, feeling "low" and sleep difficulties.

　　In addition to health complaints, the researchers found that girls, in general, reported more complaints than boys, and the difference between the sexes was significantly larger among smoking teens than nonsmoking teens. In particular, girls who smoked daily reported higher levels of complaints than any other subgroup, Braverman said, adding that the data did not allow for an explanation of the reason for the finding, but the study raises concerns that adolescent girls might be at especially high risk for health problems associated with smoking.

　　If teens are smoking as a coping mechanism for physical or psychological problems, they may be at greater risk for dependence and addiction than their peers who are smoking because of peer or social influences, he said. "For those teens who smoke to cope with health problems, getting them to stop will likely require different strategies and more intensive intervention efforts than those that are commonly used. A 'stop smoking' media campaign probably won't be enough."The researchers believe it is the first time that this shifting relationship between daily smoking and health complaints in adolescence has been reported.

　　As smoking rates decline, reducing them further becomes more challenging. Some researchers believe that the remaining smokers tend to be more "hard-core" smokers, who have been smoking for long periods and either do not wish to quit or believe they would not be successful if they tried, Braverman said, noting that understanding the links between health and smoking among teens will help public health officials determine better smoking cessation strategies for that age group.