The Mediating Role of Cognitive Distortions in the Relationship between Psychological Distress and Smoking Attitudes among Adolescents

Abstract

Adolescence is a developmental stage marked by heightened emotional vulnerability and susceptibility to risk-taking behaviors such as tobacco smoking. Despite extensive evidence linking psychological distress to increased smoking prevalence among youth, the underlying cognitive mechanisms explaining this association remain insufficiently explored. The present study investigates the mediating role of cognitive distortions in the relationship between psychological distress and smoking attitudes among adolescents.

Grounded in Beck’s cognitive model, which posits that maladaptive thought patterns amplify negative emotions and influence behavior, this paper argues that adolescents experiencing psychological distress may develop favorable smoking attitudes through distorted cognitions. Such distortions include rationalizations. These thought patterns may serve as cognitive justifications that make smoking appear socially acceptable or emotionally beneficial, thereby shaping more permissive attitudes toward tobacco use. ‘The study adopts a cross-sectional survey design involving a representative sample of high school students aged 14–18 years.’ Standardized instruments are proposed to measure psychological distress, cognitive distortions, and smoking-related attitudes. Mediation analysis is employed to test whether cognitive distortions significantly explain the indirect pathway from distress to pro-smoking attitudes.

The findings suggest that adolescents reporting higher levels of psychological distress also demonstrate stronger cognitive distortions, which in turn predict more positive attitudes toward smoking. Importantly, the direct relationship between distress and smoking attitudes is substantially reduced when cognitive distortions are included in the study, highlighting their mediating role. First, it provides a psychological framework to understand adolescent smoking attitudes beyond peer and environmental influences. Second, it suggests that prevention and intervention strategies, particularly those informed by Cognitive-Behavioral Therapy (CBT), should target distorted thinking patterns to reduce smoking susceptibility among vulnerable adolescents.