The role of personal attributes in the genesis and progression of lung disease and cigarette smoking

Objectives: We examined early maladaptive personal attributes (e.g., depression), later lung disease, and later maladaptive personal attributes over a significant part of a woman's life. Methods: Wegathered longitudinal data ona prospective cohort ofcommunitydwelling women (n= 498) followed from young adulthood to late midlife. Results: We used structural equation modeling to assess the interrelations of maladaptive personal attributes, cigarette smoking, lung disease, and financial strain. The results supported a mediational model through which early maladaptive personal attributes were associated with smoking (b =0.17, P <.001), which in turn predicted later lung disease (b = 0.33, P <.001), and lung disease was related to later family financial difficulties (b = 0.09, P<.05), which in turn were associated with later maladaptive personal attributes (b = 0.35, P <.001). Conclusions: Our results address a number of important public health and clinical issues. An understanding of the interrelations of smoking, underlying mental health conditions, financial stress, and later mental health conditions on the part of physicians and other health care providers can be critical in managing patients with lung disease.