The use of mental health services by adolescent smokers: A nationwide Israeli study

G. Shoval, I. Mansbach-Kleinfeld, I. Farbstein, R. Kanaaneh, G. Lubin, A. Krivoy, A. Apter, A. Weizman, G. Zalsman

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


In this study, we aimed to evaluate the utilization of mental health services by adolescent smokers, the presence of untreated mental disorders in this young population and the associated emotional and behavioral difficulties. We performed a nationwide survey study of an Israeli representative sample of 906 adolescents and their mothers. Mental disorders were assessed using the Development and Well-Being Assessment (DAWBA) Inventory. Emotional and behavioral difficulties were evaluated using the Strengths and Difficulties Questionnaire (SDQ). Mental health services use and smoking habits were evaluated by relevant questionnaires. Adolescent smokers were using significantly more mental health services than non-smokers (79% vs. 63%, respectively, P< 0.001), independently of their mental health status or ethnic group. Adolescent smokers also reported more emotional and behavioral difficulties in most areas (P< 0.001), which are consistent with their mothers' reports, except in the area of peer relationships. The treatment gap for the smoking adolescents was 53% compared to 69% in the non-smokers (P< 0.001). This is the first study characterizing the use of mental health services and the related emotional and behavioral difficulties in a nationally-representative sample of adolescents. The findings of a wide treatment gap and the rates of the associated emotional and behavioral difficulties are highly relevant to the psychiatric assessment and national treatment plans of adolescent smokers.

Original languageEnglish
Pages (from-to)269-275
Number of pages7
JournalEuropean Psychiatry
Issue number5
StatePublished - Jun 2013
Externally publishedYes

Bibliographical note

Funding Information:
This survey was supported by the Israel National Institute for Health Policy and Health Services Research (No. 25/2000), the Association for Planning and Development of Services for Children and Youth at Risk and Their Families (ASHALIM), the Englander Center for Children and Youth of the Brookdale Institute, and the Rotter Foundation of the Maccabi Health Services, Israel. The authors also wish to acknowledge the contribution of Itzhak Levav, MD, MSc. and Daphna Levinson, PhD, in the planning and execution of this project. The Judie and Marshall Polk Research Fund for Children at Risk (GZ) partially supported the statistical analysis in this paper. The authors thank Michaela Gerchek and Anneke Ifrah for scientific and English editing.


  • Adolescent
  • Epidemiology
  • Parents
  • Services
  • Smoking
  • Substance abuse


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