Gender and the tobacco-depression relationship: a sample of African American college students at a Historically Black College or University (HBCU)

Socioeconomic inequality in tobacco use in Kenya: a concentration analysis

This paper aims at assessing and exploring socioeconomic inequalities in tobacco use in Kenya. Using the theory of fundamental causes, and concentration index, we investigate the determinants of tobacco use, and whether it disproportionately affects the poor. All data used in this study emanated from the 2014 Global Adult Tobacco Survey implemented in Kenya on a nationally representative sample of men and women aged 15 years and older. Our results suggest a link between tobacco use and socioeconomic inequality. Overall, poorer households are more affected by tobacco use than richer households. This socioeconomic inequality is more evident among men and households living in urban areas. The decomposition of the concentration index indicates that the overall socioeconomic inequality for current tobacco smokers is explained by 69.11% of household wealth. To reduce the prevalence rate of smoking in Kenya, policymakers could design and implement tobacco control programs through the equity lens. Community health workers could be used to promote non-smoking behaviors among the poor.

Tobacco product use and mental health status among young adults

BACKGROUND

Individuals with mental health conditions represent a priority population for tobacco control. This population smokes cigarettes at disproportionately higher rates than the general population, but less is known about the relationship between non-cigarette tobacco use and mental health status.

METHOD

In 2013, 2370 young adults recruited from 11 colleges in North Carolina and Virginia completed an online survey on tobacco use. We compared past 6-month self-reported mental health diagnosis, past 30-day depression score, and past 7-day stress score to past 30-day cigarette, e-cigarette, waterpipe, cigar, and smokeless tobacco use. Models adjusted for age, gender, race, ethnicity, and mother's education. Non-cigarette products were also adjusted for past 30-day cigarette use.

RESULTS

Among participants, 249 (10.5%) reported a mental health diagnosis, most commonly depression (5.5%), ADHD/ADD (4.5%), and anxiety (0.8%). Those who reported a mental health diagnosis had greater odds of using cigarettes (AOR=1.55; CI=1.01, 2.27). Mean stress score was 16.0 (SD=6.9) of possible 40. Higher stress scale score was associated with increased odds of e-cigarette (AOR=1.03; CI=1.01, 1.05), waterpipe (AOR=1.04; CI=1.01, 1.06), and cigarette (AOR=1.02; CI=1.00, 1.04) use. Mean depression score was 7.2 (SD=5.6) of possible 33. Higher depression scale score was associated with increased odds for e-cigarette (AOR=1.04; CI=1.01, 1.08) and cigarette (AOR=1.03; CI=1.01, 1.06) use.

CONCLUSION

Findings in this study provide further evidence of a potential relationship between non-cigarette tobacco products and mental health status. Tobacco control efforts aimed at reducing tobacco use disparities among mental health populations should focus on non-cigarette tobacco products in addition to cigarettes.

Association of smoking status, cumulative smoking, duration of smoking cessation, age of starting smoking, and depression in Korean adults

BACKGROUND

Many previous studies did not sufficiently control for several confounding factors that may affect the association between smoking and depression, such as socioeconomic status. We investigated the association between depression and smoking status, smoking exposure, duration of smoking cessation, and age of starting smoking while controlling for socioeconomic factors.

METHODS

This study was based on a community health survey performed in Jeollanam-do, South Korea, between September and November 2009. In total, 20,084 subjects (9,118 males and 10,966 females) were included in the analysis. Information on smoking characteristics, such as smoking status, pack-years of smoking, and age of starting smoking, was collected using a standardized questionnaire. Depression was defined using the Korean CES-D score.

RESULTS

The odds ratios (ORs) of depression were 1.35 (0.92-1.98) for former smokers and 1.77 (1.27-2.48) for current-smokers among males, and 2.67 (1.38-5.16) for former smokers and 3.72 (2.11-6.54) for current-smokers among females, after adjusting for other confounding factors. Compared to light smoking, heavy smoking was significantly associated with depression in males [OR = 3.97, 95% confidence interval (CI) = 1.42-11.14], but not in females (OR = 1.24, 95% CI = 0.73-2.09). No significant associations between depression and age of starting smoking and duration of smoking cessation were observed among former smokers.

CONCLUSIONS

Our data demonstrate that smoking is strongly associated with depression, particularly among females. These findings suggest that depression prevention may need to be combined with smoking prevention and that different strategies may be needed for males and females.

Tobacco use and suicidality: latent patterns of co-occurrence among black adolescents

INTRODUCTION

Tobacco use is responsible for a considerable portion of the health disparities experienced by Blacks. In addition to its physiological effects, tobacco use has consistently been shown to be associated with suicidality among adolescents. The purpose of the present study is to describe the association between specific patterns of tobacco use behavior and those of suicidality among a nationally representative sample of Black high school students.

METHODS

Responses from Black adolescents (N = 2,931) who completed the 2007 Youth Risk Behavior Surveillance Survey were included. Latent class analysis was utilized to identify typologies based on two domains: (a) lifetime and recent tobacco use and (b) suicidality. The association between tobacco use class membership and suicidality class membership as well as the direct effects of age and gender on class membership was also investigated.

RESULTS

A significant proportion of Black youth reported smoking and suicidal behaviors. A 4-class model provided the best overall fit to the data for tobacco use behavior (nonsmokers, former smokers, light current smokers, and frequent current smokers); a 3-class model provided the best overall fit to the data for suicidality (not suicidal, mild suicidality, suicidal). Smoking status was associated with suicidality class membership, with more intense patterns of smoking related to increased probability of identification with both mild suicidality and being classified as suicidal compared with not suicidal.

CONCLUSIONS

The results of this study indicate that any current smoking status increases the likelihood of suicidality at least 5-fold and provides incentive to target this specific portion of the population of Black adolescent smokers.

Relationship between depressive symptoms and hypogonadism in men with COPD

The prevalence of depression in chronic obstructive pulmonary disease (COPD) is greater than in the general population, but the mechanism is unknown. Depression has been linked mechanistically to testosterone deficiency, and testosterone deficiency (hypogonadism) affects many men with COPD. Accordingly, we hypothesized that significant depressive symptoms would be associated with hypogonadism in men with COPD. The hypothesis was tested in a prospective cross-sectional investigation of 104 men (FEV1 = 43 ± 1% predicted (± SE)), 36 of whom had significant depressive symptoms (Geriatric Depression Scale score or GDS ≥ 11). Hypogonadism was present in 14 patients with GDS ≥ 11 (39%) and in 21 with GDS < 11 (31%; p = 0.41). The independent association between depressive symptoms and gonadal state was evaluated after adjusting for potential confounders: combined severity of lung disease and functional impairment (BODE-index), co-morbidities (Charlson co-morbidity-Index), age, active smoking, education, and marital status. After controlling for confounding variables, multivariable logistic-regression analysis revealed that only BODE-index (odds ratio 1.40; p = 0.003), lack of companion (2.73; p = 0.045) and younger age (0.93; p = 0.021) were independently associated with depressive symptoms. In a secondary analysis, patients were stratified into those with severe depressive symptoms (GDS ≥ 19) and those with mild depressive symptoms (GDS 11-18). Prevalence of hypogonadism was greater in first group than in the second (62% vs. 26%; p = 0.036). After controlling for confounders, however, gonadal state was not associated with severe depressive symptoms. Similarly, gonadal state was not associated with mood and motivation subscale scores of the GDS. In conclusion, presence of significant depressive symptoms was not associated with hypogonadism in men with COPD.

Depressed mood and the effect of two universal first grade preventive interventions on survival to the first tobacco cigarette smoked among urban youth

INTRODUCTION

As part of an evaluation of two first-grade, universal preventive interventions whose proximal targets were early learning and behavior, we investigated the influence of depressed mood, the interventions, and their interaction on survival to the first tobacco cigarette smoked through age 19. One intervention focused on improving teacher behavior management and instructional skills (Classroom-Centered, CC) as a means of improving student behavior and learning and the other on the family-school partnership (FSP). Variation in the relationship between depressed mood and first cigarette smoked by gender and grade was also examined.

METHODS

Self-reports of smoking behavior and depressed mood were collected on an annual basis from grade 6 through age 19. The present analyses were restricted to the 563 youth who had never smoked by grade 6, or 83% of the original sample of first grade participants. Discrete-time survival analysis was used to examine the effects of depressed mood and the interventions on survival to the first tobacco cigarette smoked.

RESULTS

Depressed mood was associated with reduced survival time to the first cigarette smoked (adjusted hazard ratio, aHR: 1.4; 95% CI: 1.1-1.9), whereas the CC intervention prolonged survival time (aHR: 0.8; 95% CI: 0.7-0.9). No significant variation in the effect of depressed mood on survival was found by gender or grade, nor was the effect of the CC intervention moderated by depressed mood.

CONCLUSIONS

Strategies to prevent tobacco cigarette smoking should include both a focus on depressed mood in adolescence as well as on early success in elementary school.

Tobacco smoking and depression--results from the WHO/ISBRA study

AIMS

To elucidate the relationship between tobacco smoking and depression, and to estimate the impact of other substance dependencies.

DESIGN

Cross-sectional.

PARTICIPANTS

A total of 1,849 men and women were interviewed face-to-face using a validated structured questionnaire. According to their tobacco smoking behavior, participants were grouped into never smokers, ex-smokers and current smokers.

MEASUREMENTS

Data were generated through the WHO/ISBRA study, an international multicenter study with a cross-sectional design. A standardized questionnaire was administered face-to-face by trained interviewers. Logistic regression analysis was used to predict depression.

RESULTS

There was a significant difference across the 3 smoking groups in the number of subjects who had major depression (DSM-IV) during their lifetime. The highest rate of depressives was found in current smokers (23.7%), the lowest rate in never smokers (6.2%), while the rate of those who had quit smoking (14.6%) was between both. In a logistic regression analysis, alcohol dependence (both current and during lifetime) as well as cocaine dependence were significant predictors of depression. However, the association between smoking and depression still remained statistically significant.

CONCLUSIONS

This study adds support to the evidence that smoking is linked to depression. It also elucidates the importance of taking into account alcohol and cocaine dependence since they have a significant impact on the relationship between smoking and depression.

Using an online survey to assess knowledge of HIV in general and testing specifically among black and white college students

BACKGROUND

Although there have been studies examining HIV knowledge among college population, current study is the first providing comparable information on HIV knowledge in general and testing specifically via online surveys among black and white college students.

METHODS

Blacks (N=222) were recruited from 15 historically black college and universities (HBCUs) and whites (N=335) from a traditionally white institution.

RESULTS

The majority of the students were aged 18-24 years. Reliability of the overall knowledge scale showed good internal consistency for both samples (alpha=0.70). Students overall scored higher on items related to HIV/AIDS in general (81.5% correct) and lower on items related to HIV testing (71.6% correct), with no significant difference between groups. However, blacks rated significantly higher on their subjective (or "perceived") HIV general knowledge (item mean 3.55 vs. 3.26) and testing specific knowledge (item mean 3.13 vs. 2.54) (p<0.01). Results showed that blacks were 6.9 times more likely to have been tested for HIV. Subjective HIV testing knowledge (OR=2.9) and nonheterosexual orientation (OR=3.2) were also significant predictors to prior testing behavior.

CONCLUSIONS

The knowledge scale assessed via the Internet demonstrated satisfactory reliabilities among diverse college students. Data showed that HBCU black students perceived significant higher knowledge levels, despite results showing similar knowledge scores as white students. Results have implications on HIV prevention among students attending their race/ethnic dominant institutions.

Depression and social phobia secondary to alcohol dependence

BACKGROUND

According to the self-medication hypothesis, individuals with depression and anxiety disorders use alcohol to control their symptoms and subsequently become dependent. Conversely, alcohol dependence disorder (ADD) can cause or exacerbate psychiatric disorders. This study analyzed the characteristics of depression and social phobia secondary to ADD. (1) What is their functional impact? (2) Are they independent or associated conditions? (3) Do they completely remit in abstinent individuals? (4) Is the remission of one disorder associated with the remission of the other disorder?

METHODS

Sixty-four inpatients with ADD were evaluated with depression and anxiety disorder scales upon admission to hospital and after 5 weeks of detoxification.

RESULTS

Baseline comparisons differentiated patients with a Hamilton Rating Scale for Depression (HDRS) score > 35 (n = 50; 78%) from those with an HDRS score < or = 35 by higher levels of generalized anxiety and lower global functioning. Patients with generalized social phobia [Leibowitz Social Anxiety Scale (LSAS) score > 60: n = 20; 31.2%] were not distinguishable from those with an LSAS score < or = 60 by depressive and anxiety disorder symptoms. In postdetoxification assessment, patients who remitted from depression (HDRS score < 7: n = 35; 54.6%) had a lower generalized anxiety and marginally higher levels of hypochondriasis compared to nonremitter subjects (HDRS score > or = 7). Patients who remitted from social phobia (LSAS score < 30: n = 32; 50%) did not significantly differ from nonremitter subjects in depressive and anxiety disorder symptoms. Generalized anxiety (Hamilton Rating Scale for Anxiety) and hypochondriasis (Whiteley Index) were the significant predictors of global functioning (Global Assessment Scale).

CONCLUSIONS

Depression and social phobia secondary to ADD are independent conditions that do not completely remit after cessation of drinking. Specific treatments are needed to reduce residual depressive and anxiety symptoms in abstinent alcoholics.