Cigarette smoking prevalence and its risk factors, including social anxiety and depression, among adolescents in Turkey: A school-based cross-sectional study.

PURPOSE: This study aimed to determine the prevalence of smoking and levels of social anxiety and depression among adolescents and examine the risk factors that influence smoking.

METHODS

This cross-sectional study was conducted in Turkey in 2025 with 3636 adolescents aged 13-19 years. Data were collected using a Personal Information Form, the Social Anxiety Scale for Adolescents, and the Basic Depression Scale. Descriptive statistics, independent-samples t-tests, chi-square tests, and logistic regression analyses were used for the data analysis.

RESULTS

The prevalence of smoking in this study was 9.5%. Sex, grade level, having family members or friends who smoke, social anxiety, and depression were identified as significant smoking risk factors. Specifically, having peers who smoke increased the likelihood of adolescent smoking by 9.627 times, whereas having family members who smoke increased this likelihood by 1.412 times. Additionally, each one-unit increase in social anxiety score was associated with a 1.6% increase in the likelihood of smoking, whereas each one-unit increase in depression score was associated with a 5.2% increase.

CONCLUSION

The findings revealed that depression and social anxiety are critical psychological variables that must be considered when understanding cigarette smoking.

PRACTICAL IMPLICATIONS: School nurses can develop comprehensive approaches to reduce peer influence and strengthen psychosocial support systems in anti-smoking programs for adolescents. Additionally, they can facilitate the expansion of school-based mental health screenings.