Personality patterns and Smoking behavior among students in Tabriz, Iran
Keywords:
Smoking; Personality; Students; MCMI-IIIAbstract
Introduction: Psychological factors have always been considered for their role on risk taking behavior such as substance abuse, risky driving and smoking. The aim of this study was to determine the association between smoking behavior and potential personality patterns among high school students in Tabriz, Iran.
Methods: Through a multistage sampling in a cross-sectional study, 1000 students were enrolled to represent the final grade high school student population of Tabriz, Iran in 2013. The personality patterns along with smoking status and some background information were collected through standard questionnaires along with Millon Clinical Multiaxial Inventory-III (MCMI-III). Fourteen personality patterns and ten clinical syndromes. ANOVA and Kruskal Wallis tests were used to compare numeric scales among the study participants, with respect to their smoking status. Stata version 13 statistical software package was used to analyze the data. Multivariate logistic regression was used to predict likelihood of smoking by personality status.
Results: Two logistic models were developed in both of whom male sex was identified as a determinant of regular smoking (1st model) and ever-smoking (2nd model). Depressive personality increased the likelihood of being a regular smoker by 2.8 times (OR=2.8, 95% CI: 1.3-6.1). The second personality disorder included in the model was sadistic personality with an odds ratio of 7.9 (96% CI: 1.2-53%). Histrionic personality increased the likelihood of experiencing smoking by 2.2 times (OR=2.2, 95% CI: 1.6-3.1) followed by borderline personality (OR=2.8, 95% CI: 0.97-8.1).
Conclusion: Histrionic and depressive personalities could be considered as strong associates of smoking, followed by borderline and sadistic personalities. A causal relationship couldn’t be assumed unless well controlled longitudinal studies reached the same findings using psychiatric interviews.
References
Ezzati M, Lopez AD. Estimates of global mortality attributable to smoking in 2000. Lancet. 2003;
(9387): 847-52. doi: 10.1016/S0140-6736(03)14338-3. PMID: 13678970.
Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJ. Selected major risk factors and global and
regional burden of disease. Lancet. 2002; 360: 1347-60. doi: 10.1016/S0140-6736(02)11403-6. PMID:
Abdullah AS, Husten CG. Promotion of smoking cessation in developing countries: a framework for urgent
public health interventions. Thorax. 2004; 59(7): 623-30. PMID: 15223875, PMCID: PMC1747072.
Shek DT. Paternal and maternal influences on the psychological well-being, substance abuse, and
delinquency of Chinese adolescents experiencing economic disadvantage. J Clin Psychol. 2005; 61(3): 219- 34. doi: 10.1002/jclp.20057. PMID: 15515041.
Safiri S, Sadeghi-Bazargani H, Amiri Sh, Khanjani N, Safarpour H, Karamzad N, et al. Association
between Adult Attention Deficit-Hyperactivity Disorder and motorcycle traffic injuries in Kerman, Iran: a
case-control study. Journal of Clinical Research & Governance. 2013; 2(1): 17-21. doi:
13183/jcrg.v2i1.24.
Downey KK, Pomerleau CS, Pomerleau OF. Personality differences related to smoking and adult attention
deficit hyperactivity disorder. J Subst Abuse. 1996; 8(1): 129-35. doi: 10.1016/S0899-3289(96)90139-X.
PMID: 8743773.
Black DW, Zimmerman M, Coryell WH. Cigarette smoking and psychiatric disorder in a community
sample. Ann Clin Psychiatry. 1999; 11(3): 129-36. doi: 10.3109/10401239909147061. PMID: 10482122.
Brook JS, Zhang C, Balka EB, Seltzer N, Brook DW. Personality characteristics in the mid-forties predict
women's smoking cessation in their mid-sixties. Psychol Rep. 2013; 113(3): 921-9. doi:
2466/09.10.13.PR0.113x26z9. PMID: 24693821, PMCID: PMC3979540.
Leventhal AM, Japuntich SJ, Piper ME, Jorenby DE, Schlam TR, Baker TB. Isolating the role of
psychological dysfunction in smoking cessation: relations of personality and psychopathology to attaining
cessation milestones. Psychol Addict Behav. 2012; 26(4): 838-49. doi: 10.1037/a0028449. PMID:
, PMCID: PMC3445746.
Piñeiro B, López-Durán A, Fernández Del Río E, Martínez U, Becoña E. Gender differences in personality
patterns and smoking status after a smoking cessation treatment. BMC Public Health. 2013; 13: 306. doi:
1186/1471-2458-13-306. PMID: 23565918, PMCID: PMC3626676.
Piñeiro B, Fernández Del Río E, López-Durán A, Martínez U, Becoña E. The association between probable
personality disorders and smoking cessation and maintenance. Addict Behav. 2013; 38(8): 2369-73. doi:
1016/j.addbeh.2013.03.017. PMID: 23628430.
Fernández Del Río E, López-Durán A, Martínez Ú, Becoña E. Personality disorders and smoking in
Spanish general and clinical population. Psicothema. 2016; 28(3): 278-83. doi:
7334/psicothema2015.292. PMID: 27448261.
Distel MA, Trull TJ, de Moor MM, Vink JM, Geels LM, van Beek JH, et al. Borderline personality traits
and substance use: genetic factors underlie the association with smoking and ever use of cannabis, but not
with high alcohol consumption. J Pers Disord. 2012; 26(6): 867-79. doi: 10.1521/pedi.2012.26.6.867.
PMID: 23281672, PMCID: PMC3744119.
Cai Y, Li R, Zhu J, Na L, He Y, Redmon P, et al. Personality, perceived environment, and behavior
systems related to future smoking intentions among youths: an application of problem-behavior theory in
Shanghai, China. PLoS One. 2015; 10(3): e0122276. doi: 10.1371/journal.pone.0122276.
Millon T, Millon C, Davis R, Grossman S. Millon Clinical Multiaxial Inventory (MCMI-III). Minneapolis:
Pearson; 1997.
Sharifi A, Molavi H, Namdari K. Diagnostic validity of Millon Clinical Multiaxial Inventory-III (Persian
version). Knowledge and Research in Psychology. 2006; 34: 38.
Littlefield AK, Sher KJ. Smoking desistance and personality change in emerging and young adulthood.
Nicotine Tob Res. 2012; 14(3): 338-42. doi: 10.1093/ntr/ntr219. PMID: 22241829, PMCID: PMC3281241.
Lang UE, Hellweg R. (Prevalence and role of psychiatric disorders in disability). Versicherungsmedizin
; 58: 164-9. PMID: 17212298.
Fernandez Del RE, Becona IE. (Personality disorders in smokers: a review). Adicciones. 2010; 22: 155-72.
PMID: 20549151.
Zvolensky MJ, Taha F, Bono A, Goodwin RD. Big five personality factors and cigarette smoking: a 10- year study among US adults. J Psychiatr Res. 2015; 63: 91-6. doi: 10.1016/j.jpsychires.2015.02.008.
PMID: 25799395.
Sousa NO, Grevet EH, Salgado CA, Silva KL, Victor MM, Karam RG, et al. Smoking and ADHD: an
evaluation of self medication and behavioral disinhibition models based on comorbidity and personality
patterns. J Psychiatr Res. 2011; 45: 829-34. doi: 10.1016/j.jpsychires.2010.10.012. PMID: 21092985.
Dinn WM, Aycicegi A, Harris CL. Cigarette smoking in a student sample: neurocognitive and clinical
correlates. Addict Behav. 2004; 29(1): 107-26. PMID: 14667424.
Nieva G, Valero S, Bruguera E, Andion O, Trasovares MV, Gual A, et al. The alternative five-factor model
of personality, nicotine dependence and relapse after treatment for smoking cessation. Addict Behav. 2011;
(10): 965-71. doi: 10.1016/j.addbeh.2011.05.008. PMID: 21704460.
Aycicegi-Dinn A, Sisman S, Dinn WM. Cigarette Smoking and Personality Features. Procedia-Social and
Behavioral Sciences. 2014; 159: 232-4. doi: 10.1016/j.sbspro.2014.12.363.
Hakulinen C, Hintsanen M, Munafo MR, Virtanen M, Kivimaki M, Batty GD, et al. Personality and
smoking: individual-participant meta-analysis of 9 cohort studies. Addiction. 2015; 110(11): 1844-52. doi:
1111/add.13079. PMID: 26227786, PMCID: PMC4609271.
Keuroghlian AS, Frankenburg FR, Zanarini MC. The relationship of chronic medical illnesses, poor healthrelated lifestyle choices, and health care utilization to recovery status in borderline patients over a decade of
prospective follow-up. J Psychiatr Res. 2013; 47(10): 1499-506. doi: 10.1016/j.jpsychires.2013.06.012.
PMID: 23856083, PMCID: PMC3884821.
Distel MA, Trull TJ, de Moor MM, Vink JM, Geels LM, van Beek JH, et al. Borderline personality traits
and substance use: genetic factors underlie the association with smoking and ever use of cannabis, but not
with high alcohol consumption. J Pers Disord. 2012; 26(6): 867-79. doi: 10.1521/pedi.2012.26.6.867.
PMID: 23281672, PMCID: PMC3744119.
Ho SY, Alnashri N, Rohde D, Murphy P, Doyle F. Systematic review and meta-analysis of the impact of
depression on subsequent smoking cessation in patients with chronic respiratory conditions. Gen Hosp
Psychiatry. 2015; 37(5): 399-407. doi: 10.1016/j.genhosppsych.2015.05.002. PMID: 26022383.
Khan M, Monaghan M, Klein N, Ruiz G, John AS. Associations among Depression Symptoms with
Alcohol and Smoking Tobacco Use in Adult Patients with Congenital Heart Disease. Congenit Heart Dis.
; 10(5): E243-9. doi:10.1111/chd.12282. PMID: 26108339.
Reis TC, Silva RR, Pena GG, Domingos PL, Pereira CS, Farias LC, et al. Sex, age and smoking, but not
genetic variation in LEPR (rs1137101), are associated with depressive symptoms. Psychiatr Genet. 2015;
(3): 137-8. doi: 10.1097/YPG.0000000000000080. PMID: 25714446.
Zvolensky MJ, Bakhshaie J, Sheffer C, Perez A, Goodwin RD. Major depressive disorder and smoking
relapse among adults in the United States: a 10-year, prospective investigation. Psychiatry Res. 2015;
(1): 73-7. doi:10.1016/j.psychres.2014.11.064. PMID: 25650047, PMCID: PMC4448723.
Eory A, Rozsa S, Gonda X, Dome P, Torzsa P, Simavorian T, et al. The association of affective
temperaments with smoking initiation and maintenance in adult primary care patients. J Affect Disord.
; 172: 397-402. doi: 10.1016/j.jad.2014.10.036. PMID: 25451443.
Berlin I, Singleton EG, Pedarriosse AM, Lancrenon S, Rames A, Aubin HJ, et al. The Modified Reasons
for Smoking Scale: factorial structure, gender effects and relationship with nicotine dependence and
smoking cessation in French smokers. Addiction. 2003; 98(11): 1575-83. PMID: 14616184.
Smith PH, Kasza KA, Hyland A, Fong GT, Borland R, Brady K, et al. Gender differences in medication
use and cigarette smoking cessation: results from the International Tobacco Control Four Country Survey.
Nicotine Tob Res. 2015; 17(4): 463-72. doi: 10.1093/ntr/ntu212. PMID: 25762757, PMCID: PMC4402353.
Gorelick DA. Sex difference in response to varenicline for smoking cessation. Am J Psychiatry. 2015;
(4): 394-5. doi: 10.1176/appi.ajp.2015.14111429. PMID: 25827037.
Mayer D, Simetin IP, Rodin U, Benjak T, Puntaric E, Puntaric I. The impacts of media messaging and age
and sex variance on adolescent smoking habits in Croatia. J Addict Med. 2015; 9(2): 147-54. doi:
1097/ADM.0000000000000070. PMID: 25807453.
Ashare RL, Kable JW. Sex differences in time perception during smoking abstinence. Nicotine Tob Res.
; 17(4): 449-54. doi: 10.1093/ntr/ntu260. PMID: 25762755, PMCID: PMC4432399.
Published
Issue
Section
License
Copyright (c) 2020 KNOWLEDGE KINGDOM PUBLISHING
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
