Depression and cigarette smoking behavior: A critical review of population-based studies

Sex differences in the relationship between quit attempt and smoking cessation self-efficacy in adults with depressive symptoms

OBJECTIVE

Smoking self-efficacy is a key predictor of being able to maintain smoking cessation. Smokers with depression have lower confidence that they can abstain from smoking (i.e., lower smoking self-efficacy) than those without depression. Additionally, individuals assigned female at birth (AFAB) have greater difficulty quitting smoking and lower self-efficacy than those assigned male at birth (AMAB). However, limited attention has been given to the experience of making a quit attempt on changes in smoking self-efficacy among smokers with depressive symptoms and how this may differ by abstinence outcomes and sex. The purpose of the current study was to examine whether abstinence or a reduction in cigarettes smoked during a standard smoking cessation treatment predicted post-treatment changes in smoking self-efficacy, and whether assigned sex moderated this relationship.

METHODS

Participants (n = 146; 72.6 % AFAB; mean age = 46.6 years) received 12-week standard smoking cessation treatment as part of a randomized controlled trial testing two adjunctive health- and fitness-based interventions. Pre- and post-treatment, participants reported smoking self-efficacy (i.e., confidence abstaining in negative/affective-, positive/social-, and habit/addiction-related situations).

RESULTS

Multiple regression analyses showed that abstinence was associated with higher increases in smoking self-efficacy in all facets, and decreasing cigarette use from baseline to post-treatment was significantly associated with increases in total smoking self-efficacy. AMAB smokers had higher levels of positive/social related smoking self-efficacy than did AFAB smokers, and for AFAB smokers, a reduction in cigarettes smoked was associated with greater positive/social smoking self-efficacy.

CONCLUSIONS

Findings related to the role of self-efficacy in smoking cessation outcomes of smokers with depressive symptoms and how assigned sex impacts the role of self-efficacy provide insight for smoking cessation outcomes. Future research is needed to understand mechanisms underlying smoking self-efficacy and to improve smoking cessation interventions.

Cigarette Use, Lung Cancer Screening Eligibility and Completion Among Persons With Poor Mental Health

BACKGROUND

Depression and mental distress are associated with greater cigarette use; however, it remains unclear how poor mental health relates to eligibility and completion of lung cancer screening (LCS).

METHODS

Study of a 2022 Behavioral Risk Factor Surveillance System (BRFSS) sample of adults aged 50+. Key mental health exposures for this paper were (i) any history of a depressive disorder, and (ii) frequent mental distress (FMD) in the last month. Descriptive analyses were conducted on all variables and ran separately on each mental health exposure to explore associations between mental health conditions, cigarette use, LCS eligibility, and completion.

RESULTS

Compared to adults without a depressive history, adults with a depressive history were more likely to currently smoke (19.9% vs. 10.8%); have a slightly higher average pack-year history (26.8 vs. 24.0 years); and were more likely to be eligible for LCS (18.9% vs. 10.8%). Among adults eligible for LCS, there was no difference in completion of screening in the last year between adults with versus without a depressive history (19.4% vs. 18.7%). A similar pattern of findings was observed for people with and without FMD.

CONCLUSIONS

Cigarette use is more common among persons with a history of depression or FMD, yet they are screened for lung cancer at similar rates compared to their counterparts without a history of depression or FMD. LCS rates are also low among persons with poor mental health, mirroring screening among general U.S. adults. Mechanisms to increase LCS rates among adults with mental health conditions are discussed.

Individual and joint associations of depression and physical multimorbidity with all-cause mortality: a prospective cohort study

The study aimed to investigate the separate, interactive, and combined effects of depression and physical multimorbidity on all-cause mortality using data from the National Health and Nutrition Examination Survey (NHANES) 2005-2016. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), and multimorbidity was defined as the presence of ≥ 2 chronic conditions. Cox proportional hazards models were used to assess these associations. During a median follow-up of 8.3 years (interquartile range, 5.4-11.4), 3,005 deaths occurred. After adjusting for potential confounders and multimorbidity, each one-point increase in depression score was associated with a 3% higher risk of mortality (hazard ratio [HR]: 1.03, 95% confidence interval [CI]: 1.02-1.04). Compared to those without depressive symptoms, mild and moderate to severe symptoms were linked to a 27% (HR: 1.27, 95% CI: 1.11-1.47) and 37% (HR: 1.37, 95% CI: 1.17-1.61) higher mortality risk, respectively. However, among women, only moderate to severe depression was significantly associated with increased mortality (HR: 1.50, 95% CI: 1.19-1.89). After adjusting for potential confounders and depression, multimorbidity was associated with a 64% higher mortality risk (HR: 1.64, 95% CI: 1.46-1.86). No significant interaction between depression and multimorbidity was found. Joint analysis showed that among participants without multimorbidity, moderate to severe depressive symptoms increased mortality risk (HR: 1.54, 95% CI: 1.09-2.17). In those with multimorbidity, risk increased with depression severity, peaking at HR: 2.22 (95% CI: 1.85-2.65). These findings highlight depression and multimorbidity as independent mortality risk factors, with their combined presence further amplifying this risk.

Bidirectional association between clustering of health-related behaviours and depression in mid- and older-aged adults: A longitudinal study in China and Japan

OBJECTIVES

To disentangle the direction between health-related behaviours (HRBs) and depression in East Asia, we examined the bidirectional longitudinal relationship of HRBs clustering and depression in Chinese and Japanese ageing populations gender-specifically.

METHODS

Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS) (N = 18,739) (2011-2015) and the Japan Study of Ageing and Retirement (JSTAR) (N = 7116) (2007-2011). Cross-lagged panel models (CLPM) were applied to assess bidirectional longitudinal relationships between HRB clustering and depression in adjacent waves, stratified by cohort and gender. Sensitivity analyses were conducted to explore key risk factors in risky clusters.

RESULTS

The prevalence of baseline depression was approximately 20 % in China and 4 % in Japan, with over 70 % of participants belonging to the risky cluster. A unidirectional negative association between the risky cluster and depression was observed only in Chinese females (βstandardized = -0.039, 95%CI: -0.054 to -0.024, P < 0.001). However, no association was found in Japanese females or males in either country. Further sensitivity analyses revealed that this association was primarily driven by overweight/obesity cluster. Sensitivity analyses also identified a positive effect of depression on the smoking and drinking cluster and a negative effect on the overweight/obesity cluster in Chinese females.

LIMITATION

This study was limited by reliance on self-report data, the CES-D cannot be used to diagnose depression and some other confounding factors were not considered (e.g., use of antidepressants).

CONCLUSIONS

Our findings highlight a unidirectional negative association of the risky cluster on depression in Chinese females, with notable variations observed across different countries and genders.

Predictors of cigarette smoking and physical inactivity among teachers during the SARS-CoV-2 pandemic in Germany: a cross-sectional analysis of a nationwide online survey

Background

The SARS-CoV-2 pandemic significantly impacted professional and private lives, which influenced social and health-related behavior. Schools in particular were greatly affected as restrictions made teaching more challenging, leading to new stresses and additional workloads. Prior to the pandemic, teachers were already facing many physical and psychological stressors that were exacerbated by the pandemic. This may have resulted in a deterioration in the teachers' health behaviors. Therefore, the aim of this study was to examine the prevalence of cigarette smoking and physical activity among German teachers during the SARS-CoV-2 pandemic, to assess possible changes considering cigarette smoking and physical activity habits during the pandemic compared to the pre-pandemic period, and to identify predictors of teachers' cigarette smoking and physical inactivity during the pandemic.

Methods

In March 2021, a nationwide online survey was conducted among teachers in Germany. A total of 31,089 participants entered the analysis. Data on cigarette smoking and physical activity as well as sociodemographic, workplace-related, psychological, SARS-CoV-2-related, and health-related items were collected using established instruments and, if necessary, self-developed items. Two binary logistic regressions with stepwise inclusion of six different variable groups were performed to predict cigarette smoking and physical inactivity.

Results

Among all surveyed teachers, 13.9% reported smoking cigarettes, and 76.6% did not meet the physical activity recommendations. The regression analyses revealed 16 significant predictors of cigarette smoking and six significant predictors of physical inactivity.

Conclusions

The predictors revealed in the present study can help target interventions for teachers who are at higher risk for unhealthy behaviors during the SARS-CoV-2 pandemic and potential future pandemics. In particular, the alarming finding that more than three-quarters of teachers were physically inactive during the pandemic should place special emphasis on improving physical activity.

Vaping transitions and incident depressive symptoms among young adults: a marginal structural model analysis

The extent to which vaping influences depression is unclear but could be estimated through application of novel epidemiologic methods. Among a prospective cohort of young adults from California who screened negative for depression, we estimated repeated-measures marginal structural models to examine the association of 4 vaping transitions from time T to T + 1 (persistent use, discontinuation, initiation, persistent nonuse) with risk of clinically significant depressive symptoms at T + 1, simultaneously across three ~ 1.5-year time intervals between 2017 and 2021. Stabilized inverse probability of treatment and censoring weights adjusted for time-dependent confounders and selection bias. Among n = 3496 observations (1806 participants, mean pooled baseline age = 19.5), 8.1% reported persistent vaping from T to T + 1, 6.2% reported discontinuation (ie, use at T and no use at T + 1), 6.5% initiated e-cigarettes (ie, no use at T and use at T + 1), and 79.2% reported persistent nonuse at both time points. Compared to persistent vaping at 2 waves, persistent nonuse (relative risk [RR] = 0.76; 95% CI, 0.62-0.93) and discontinuation (RR = 0.71; 95% CI, 0.52-0.96) were associated with lower risk of depression. Associations were robust to sensitivity analyses, including restricting to tobacco-naive participants and varying temporal assumptions to reduce potential for reverse causation. Young adults who consistently avoid or discontinue vaping may be protected from depressive symptom occurrence.

Prevalence and Associated Factors for Depression Among Patients With Sarcoma

PURPOSE

Prevalence and risk factors for depression among patients with sarcoma and survivors of sarcoma are not well characterized.

METHODS

A sarcoma survivorship cohort was constructed from patients diagnosed between April 2022 and September 2023. Depression symptoms were assessed via the eight-item Patient-Reported Outcomes Measurement Information System-57 depression scale at enrollment. Standardized T-score levels (<50, 50-59, and ≥60) were calculated and evaluated in association with demographics, lifestyle characteristics, clinical data, and modifiable factors using multinomial logistic regression models.

RESULTS

Among 612 participants, the mean T-score was 48.3 (standard deviation, 10.0); 58.8% had a T-score <50, 27.9% scored between 50 and 59, and 13.2% scored ≥60. Participants age 18-39 years and age 40-59 years were more likely to have a T-score ≥60, with respective odds ratios (ORs) of 3.65 (95% CIs, 1.70 to 7.83) and 2.80 (1.52 to 5.17) compared with participants older than 60 years. Household incomes of $70,000-$120,000 in US dollars (USD) (OR, 0.46 [95% CI, 0.23 to 0.92]) and >$120,000 USD (OR, 0.15 [95% CI, 0.06 to 0.37]) were inversely associated with T-score ≥60 compared with household incomes <$45,000 USD. Marijuana use within the past 30 days was positively (OR, 3.48 [95% CI, 1.46 to 8.27]) associated, while regular exercise (OR, 0.43 [95% CI, 0.24 to 0.75]) and emotional support (OR, 0.37 [95% CI, 0.28 to 0.48]) were inversely associated with having T-score ≥60.

CONCLUSION

A higher prevalence of depression symptoms was notable in younger participants, marijuana users, and households with lower incomes. Regular exercise and increased emotional support were inversely associated with depression symptoms. Our study provides information for developing personalized supportive care strategies to ameliorate depression symptoms among patients with sarcoma.

Distribution and association of depression with tobacco consumption among middle-aged and elderly Indian population: nested multilevel modelling analysis of nationally representative cross-sectional survey

BACKGROUND

Research on the distribution and association of depression with tobacco consumption among young population is commonly prioritised in India, while studies on tobacco use among middle-aged (45-59 years) and elderly (≥ 60 years) adults are noticeably lacking. Thus, we conducted this study with the objectives of estimating the prevalence, distribution and determining the association of depression and tobacco consumption among middle-aged and elderly Indian population; overall and stratified into age group, gender, and geographical location.

METHODS

Using dataset from Longitudinal Aging Study in India (LASI), a bivariate analysis was conducted among middle-aged (45-59 years) and elderly (≥ 60 years) Indians to estimate the prevalence of depression and tobacco consumption. States and Union Territories were categorised as low, medium, and high as per prevalence of depression and tobacco consumption, and spatial distribution maps were created. To reduce the confounding effects of demographic & socioeconomic and health-related & behavioural covariates; propensity score matching (PSM) was conducted. Nested multilevel regression modelling was employed to explore the association between depression (outcome variable) and tobacco consumption (explanatory variable) using STATA version 17. The p value < 0.05 was considered statistically significant.

RESULTS

Overall, 36.78% (36.03-37.55%) participants documented using any form of tobacco; with higher consumption of smokeless tobacco (SLT) (19.88%) than smoking (SM) (13.92%). The overall prevalence of depression was 7.62% irrespective of tobacco consumption, and 8.51% among participants consuming any form of tobacco. Mizoram had the highest consumption of tobacco in any form (78.21%), whereas Madhya Pradesh recorded the highest (14.62%) depression prevalence. Bihar, Uttar Pradesh, West Bengal, and Uttarakhand had both high prevalence of depression and any form of tobacco consumption. The average estimated treatment effect (ATE) indicated a positive association both between depression and any form of tobacco consumption (p value = 0.001) and with smokeless tobacco (p value = 0.001) consumption. Participants ever consuming any form of tobacco had 28% higher odds (aOR-1.28 (1.18-1.38). The odds of having depression were higher among females (aOR = 1.28 (1.17-1.41); richest (aOR-1.48 (1.32-1.65); living alone (aOR = 1.14 (1.01-1.33). Participants with comorbidity (aOR = 1.20 (1.10-1.30) and multimorbidity (aOR = 1.24 (1.13-1.36)) had higher odds of depression.

CONCLUSION

The study has established significant positive association between depression and tobacco consumption stratified into gender and age group. Prioritisation of mental health disorders like depression and tobacco prevention and cessation programmes must be implemented with focusing on females and the middle-aged population with community awareness and intersectoral collaborative effort irrespective of subnational-variations.

Effects of diagnosed depression on postoperative outcomes after microvascular decompression for patients with trigeminal neuralgia

BACKGROUND AND OBJECTIVES

Depression is believed to be prevalent in patients with trigeminal neuralgia (TN); however, its effect on postoperative outcomes in patients undergoing microvascular decompression (MVD) is not well understood. This study aims to characterize the association between a history of diagnosed depression and postoperative outcomes in patients undergoing MVD for TN.

METHODS

The medical records for 1007 patients with TN who underwent MVD at our institution from 2007 to 2023 were reviewed. Demographic characteristics, comorbid conditions, clinical TN characteristics, pain recurrence, and pre-operative and post-operative Modified Barrow Neurological Institute (BNI) pain and numbness scores were compared between groups. Differences in pain outcomes were evaluated via multivariate ordinal regression, Kaplan-Meier analysis, and Cox proportional hazards analysis.

RESULTS

181 (18.0 %) of patients had diagnosed depression. Patients with depression were younger (p = 0.005), more often female (p < 0.001), and more likely to be White (p = 0.012). Type 2 TN was more common in those with depression (p < 0.001). Depression was independently associated with higher pain at last follow-up (p = 0.009), less time to recurrent pain on Kaplan-Meier analysis (p = 0.0063), and was predictive of recurrent pain on Cox proportional hazards regression (p = 0.048).

CONCLUSION

A diagnosis of depression in patients undergoing MVD for TN is associated with greater postoperative pain and increased risk of pain recurrence, suggesting that depression is not only highly prevalent in patients with TN, but also may contribute to worse outcomes. These findings emphasize the need for adequate psychiatric screening before MVD and have implications for the preoperative counseling and management of this population.

Comparison of smoking behaviors and associated factors between HIV-infected and uninfected men in Guilin, China: a case-control study

Background

Smoking is highly prevalent among HIV-infected individuals and is associated with high morbidity and mortality. Studies on smoking among HIV-infected individuals in China, especially compared to uninfected individuals, are scarce.

Purpose

This study aimed to investigate and compare the prevalence and factors associated with smoking between HIV-infected and uninfected men in Guilin, China.

Methods

A survey was conducted among 1,395 HIV-infected men at Guilin Third People's Hospital from June to December 2022, with a 1:2 age (±1 year) and education-matched control group of 2,790 HIV-uninfected men, whose data were collected from March to August 2023. Both groups completed an online questionnaire on smoking behaviors and relevant characteristics, with a comparative analysis of associated factors conducted using chi-square tests and multivariable logistic regressions.

Results

The rates of former smokers were comparable between HIV-infected and uninfected men [12.3% (95% CI: 10.7-13.9%) vs. 12.0% (95% CI: 10.9-13.1%)], but the current smoking rate was significantly higher in the infected group than in the uninfected group [37.6% (95% CI: 35.2-40.0%) vs. 27.6% (95% CI: 25.9-29.3%), p < 0.05]. In both groups, the following factors were significantly associated with smoking: higher income, presence of chronic diseases, negative coping styles, lower social support, and having depression, anxiety, and suicidal ideation. Additionally, in HIV-infected men, the following factors were exclusively associated with smoking: heterosexual HIV transmission route, lower CD4+ T cell count, longer duration of antiretroviral therapy (ART), and drug use.

Conclusion

HIV-infected men had higher smoking rates than their uninfected counterparts, indicating that HIV diagnosis may be a critical timing to initiate behavioral changes and deliver smoking cessation interventions. Furthermore, multiple demographic, clinical, and psychosocial factors were associated with smoking, indicating the need to develop and implement comprehensive smoking cessation prevention and intervention programs.

Using machine learning models to identify the risk of depression in middle-aged and older adults with frequent and infrequent nicotine use: A cross-sectional study

BACKGROUND

Depression is very prevalent in middle-aged and older smokers. Therefore, we aimed to identify the risk of depression among middle-aged and older adults with frequent and infrequent nicotine use, as this is quite necessary for supporting their well-being.

METHODS

This study included a total of 10,821 participants, which were derived from the China Health and Retirement Longitudinal Study Wave 5, 2020 (CHARLS-5). Five machine learning (ML) algorithms were employed. Some metrics were used to evaluate the performance of models, including area under the receiver operating characteristic curve (AUC), positive predictive value (PPV), specificity, accuracy.

RESULTS

10,821 participants (6472 males, 4349 females) had a mean age of 60.47 ± 8.98, with a score of 8.90 ± 6.53 on depression scale. For middle-aged and older adults with frequent nicotine use, random forest (RF) achieved the highest AUC value, PPV and specificity (0.75, 0.74 and 0.88, respectively). For the other group, support vector machines (SVM) showed the highest PPV (0.74), and relatively high accuracy and specificity (0.72 and 0.87, respectively). Feature importance analysis indicated that "dissatisfaction with life" was the most important variable of identifying the risk of depression in the SVM model, while "attitude towards expected life span" was the most important one in the RF model.

LIMITATIONS

CHARLS-5 was collected during the COVID-19, so our results may be influenced by the pandemic.

CONCLUSIONS

This study indicated that certain ML models can ideally identify the risk of depression in middle-aged and older adults, which holds significant value for their health management.

Exposure to acrylamide and increased risk of depression mediated by inflammation, oxidative stress, and alkaline phosphatase: Evidence from a nationally representative population-based study

BACKGROUND

The health risk associated with acrylamide exposure has emerged as a significant issue of public health, attracting global attention. However, epidemiologic evidence on whether and how daily acrylamide exposure increases depression risk of the general population is unclear.

METHODS

The study included 3991 adults from the National Health and Nutrition Examination Survey. The urinary metabolites of acrylamide (N-Acetyl-S-(2-carbamoylethyl)-L-cysteine [AAMA] and N-Acetyl-S-(2-carbamoyl-2-hydroxyethyl)-L-cysteine [GAMA]) identified as reliable indicators of acrylamide exposure were examined to determine their relationships with depressive symptoms that were evaluated using the 9-item Patient Health Questionnaire. Besides, the measurements of alkaline phosphatase (ALP) and biomarkers of inflammation (white blood cell [WBC] count) and anti-oxidative stress (albumin [ALB]) were conducted to investigate their mediation roles in above relationships.

RESULT

AAMA, GAMA, and ΣUAAM (AAMA+GAMA) were linearly associated with increased risk of depressive symptoms. Each 2.7-fold increase in AAMA, GAMA, or ΣUAAM was associated with a 30 % (odds ratio: 1.30; 95 % confidence interval: 1.09, 1.55), 47 % (1.47; 1.16, 1.87), or 36 % (1.36; 1.13, 1.63) increment in risk of depressive symptoms, respectively. Increased WBC count (mediated proportion: 4.48-8.00 %), decreased ALB (4.88-7.78 %), and increased ALP (4.93-5.23 %) significantly mediated the associations between acrylamide metabolites and depressive symptoms.

CONCLUSIONS

Acrylamide exposure of the general adult population was related to increased risk of depressive symptoms, which was mediated in part by inflammation, oxidative stress, and increased ALP. Our findings provided pivotal epidemiologic evidence for depression risk increment from exposure to acrylamide.

Mental health and support for rigorous tobacco control strategies in South Australia

INTRODUCTION

Tobacco endgame strategy includes policies to end the tobacco epidemic. As tobacco smoking prevalence is higher among people with mental health conditions (MHC), understanding the impact of rigorous tobacco control strategies for this group is critical. This study examined support for five tobacco control strategies among people with MHCs: increasing tobacco product tax, reducing tobacco retail locations, ending tobacco sales in alcohol-licensed venues, limiting retailers to one tobacco point of sale and reduced nicotine in smoked tobacco.

METHODS

Cross-sectional surveying of a representative sample of 3006 South Australians in 2021 aged ≥15 years included demographic, tobacco control strategy, smoking status and mental health indicators. Multivariable logistic regression was used to examine the influence of mental health on strategy support.

RESULTS

Support was high for all tobacco control strategies, highest for reducing nicotine content (80.4%) and lowest for increasing tobacco tax (67.2%). Support for increased tobacco tax was lower among people with MHCs than for those without by 7.8% (aged 18+ years) to 9.5% (aged 15+ years). People who smoked had significantly lower support for all strategies, and smoking status and MHC did not interact in influencing support.

CONCLUSIONS

Support for tax-focused strategies was lower among people with MHCs. Retail and product-focused strategies may support equity in public acceptability of tobacco control action. Policy-makers must aim to maximise tobacco endgame support from populations most impacted by tobacco harms when implementing tobacco control strategies. Tax-focused approaches might be enhanced with consultation and advocacy for people with MHCs.

Addressing Mental Health in Rural Settings: A Narrative Review of Blueberry Supplementation as a Natural Intervention

Depression and anxiety are major public health issues; however, there is an unmet need for novel, effective, and accessible treatments, particularly in rural communities. Blueberries are an unexplored nutraceutical for these conditions due to their excellent nutritional profile, with particularly high levels of polyphenols and anthocyanins and benefits on mood, cognition, and health. Here, we present a narrative review of the literature concerning the etiology and treatments of major depressive disorder (MDD) and generalized anxiety disorder (GAD). In both animal and human studies, blueberry supplementation can ameliorate behavioral symptoms of both anxiety and depression. The mechanistic underpinnings of these behavioral improvements are not fully defined, but likely involve biochemical alterations in the gut-brain axis, including to inflammatory cytokines, reactive oxygen species, and growth factors. We also review the limitations of traditional therapies in rural settings. Finally, we assess the potential benefit of nutraceutical interventions, particularly blueberries, as novel therapeutics for these distinct, yet related mental health issues.

Patterns of Alcohol, Cannabis, and E-Cigarette Use/Co-Use and Mental Health Among U.S. College Students

Substance use and mental health are highly correlated, though few studies assess the risk for depression and anxiety associated with dual and polysubstance use among college students. The purpose of this study was to characterize the relationship between alcohol, cannabis, and e-cigarette exclusive, dual, and polysubstance use and depression and anxiety among U.S. college students by racial and ethnic subgroup and stratified by sex.

Data from 83,467 undergraduate students participating in the 2020-2021 Health Minds Survey, a multi-campus, web-based survey, were used. Sex-stratified logistic regression models examined the effects of exclusive (past 30-day cannabis use, past 30-day e-cigarette use, past 2-week heavy alcohol use), dual (two among cannabis, e-cigarette, or alcohol use), and polysubstance (all three substances) use on anxiety (≥10 GAD-7 score) and depression (≥15 PHQ-9 score).

The study included 60,746 females and 22,721 males. Among females, compared to those who exclusively used alcohol, dual users of cannabis and e-cigarette had the largest odds for depression (adjusted odds ratio (aOR) = 1.92) and anxiety (aOR = 1.69) followed by polysubstance users (aORs = 1.85 and 1.53, respectively). Among males, compared to those who exclusively used alcohol, dual users of cannabis and e-cigarette had the largest odds for depression (aOR = 2.72) and anxiety (aOR = 2.23) followed by polysubstance users (aOR = 1.71 and 1.85, respectively). African American female and male students had lower odds of anxiety and depression compared to White students.

The results suggest that single, dual, and polysubstance use are associated with anxiety and depression among U.S. college students, though not necessarily in additive ways.

Cigarette Smoking, Mental Health, Depression, Maryland Behavioral Risk Factor Surveillance System Survey, 2020

Background

Smoking cessation is linked to improved mental health that encompasses the overall well-being and psychological functioning of an individual.

Objective

Examine relationships between smoking, mental health, and social connectedness among adults in Maryland, US in 2020.

Methodology

This cross-sectional study used data from the Maryland 2020 Behavioral Risk Factor Surveillance System Survey of adults during the onset of COVID-19. Primary outcomes measured include demographics, depression, and number of not good mental health days among individuals with current and former smoking statuses compared to those who have never smoked.

Results

Compared to those who never smoked, individuals who currently smoked had an increased relative risk of reporting 14 or more days of not good mental health (RRR = 1.63, 95% CI: 1.35-1.97, P < .001) and a history of depression (RRR = 1.99, 95% CI: 1.69-2.35, P < .001). Individuals with former smoking status also showed elevated risk, with RRR = 1.24 (95% CI: 1.06-1.45, P = .006) for 14 or more days of not good mental health and RRR = 1.46 (95% CI: 1.28-1.66, P < .001) for a history of depression. Widowed, separated, or divorced; unemployed or unable to work; without a high school diploma; or recent physical exam were inclined to have a current or former smoking status.

Conclusion

We identify critical subpopulations vulnerable to life-long smoking behaviors amid the COVID-19 pandemic including adults under 35 years old, and those suffering from depression, a lack of social connectedness due to unemployment, changes in marital status, and outdated physical exams. The US Surgeon General's 2023 Advisory on the epidemic of loneliness and the 2021 Youth Mental Health Report emphasize the mental health crises among the young in which these findings serve as a compelling call to action for innovating targeted public health interventions.

Prospective longitudinal relations among frequent social media use, nicotine vaping and experiencing internalizing mental health problems

AIMS

To compare four a priori rival mediated pathways of frequent social media use, electronic nicotine delivery systems (ENDS) use and internalizing mental health (MH) problems across five waves of nationally representative data.

DESIGN, SETTING AND PARTICIPANTS

This was a longitudinal study using data drawn from waves 2-5 (October 2014-November 2019) of the Population Assessment of Tobacco and Health Study, a nationally representative cohort study spanning approximately 5 years, conducted in the United States. The analytical sample of participants included those who were aged 12-14 years at wave 2 and who provided data in subsequent waves until wave 4.5 (n = 4627, 69.7% were White and 51.4% were male).

MEASUREMENTS

Frequent social media use (several times a day), ENDS use (past 30-day use) and internalizing MH problems (endorsed symptoms on four items in the past year) were dichotomized for analysis.

FINDINGS

The weighted proportions of the three key variables increased over time. From wave 2 to wave 5, frequent social media use grew from 56.9 to 77.2%; internalizing MH problems from 18.9 to 29.0%; and ENDS use from 1.4 to 11.4%. In weighted logistic regressions using generalized linear mixed models with random effects, there was a significant within-person association between frequent social media use at time t and greater ENDS use at t + 1 [adjusted odds ratio (aOR) = 1.87; 95% confidence interval (CI) = 1.47, 2.37] and worsened internalizing MH problems at t + 1 (aOR = 1.19; 95% CI = 1.04, 1.37). A model-based causal mediation analysis and marginal structural models were fitted to estimate the average causal mediation effect. Among all four examined mediation pathways throughout the three constructs, partial mediation was observed, and all the pathways were significant for both boys and girls. Sex differences did not emerge in the examined prospective mediated pathways.

CONCLUSIONS

Among youth in the United States, frequent social media use appears to mediate the prospective association between experiencing internalizing mental health problems and using electronic nicotine delivery systems.

Association of depression and smoking cessation: outcomes of an 18-year retrospective cohort study

BACKGROUND

Depression is frequently associated with unsuccessful smoking cessation.

OBJECTIVE

In this study, we investigated the impact of depression history on smoking cessation success in a clinical setting.

METHODS

This retrospective study included 726 patients who visited our smoking cessation clinic between January 1, 2001, and December 31, 2018. Kaplan-Meier analyses and Cox proportional hazards regression models were used to perform univariate and multivariate analyses of smoking cessation success factors.

RESULTS

Among the 726 patients, 76 had a history of depression and demonstrated significantly lower 12-week quit rate compared to those without (33.6% vs. 69.6%, p < .001). Multivariate Cox analysis revealed a significant association between abstinence rate and history of depression (hazard ratio 2.251, 95% CI 1.505-3.315, p < .001), history of schizophrenia (hazard ratio 2.716, 95% CI 1.427-4.840, p = .003), and Fagerström Nicotine Dependence Test scores (hazard ratio 1.519, 95% CI 1.053-2.197, p = .025).

CONCLUSIONS

Our findings suggested that a history of depression is a significant prognostic factor for smoking cessation, underscoring the need for targeted interventions for patients with a history of depression. The findings of this study are subject to potential selection bias due to recruitment from a single hospital, which may limit the generalizability of our results. This study highlights the necessity for novel, specialized smoking cessation therapies to support patients with a history of depression in their cessation journey.

Serum Metabolomics Analysis Revealed Metabolic Pathways Related to AECOPD Complicated with Anxiety and Depression

Background

Anxiety and depression are two of the most common comorbidities of COPD, which can directly lead to the number of acute exacerbations and hospitalizations of COPD patients and reduce their quality of life. At present, there are many studies on anxiety and depression in stable COPD, but few studies on anxiety and depression in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients.

Objective

We aim to explore the changes of serum metabolomics in AECOPD complicated with anxiety and depression and to provide some clues for further understanding its pathogenesis.

Methods

This is an observational high-throughput experimental study based on retrospective data extraction. Twenty-one AECOPD with anxiety and depressive patients and 17 healthy controls (HCs) were retrospectively enrolled in the Second Affiliated Hospital of Anhui Medical University. Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD) for anxiety and depression were used to assess the patients with AECOPD. Untargeted metabolomics analysis was carried out to investigate different molecules in the serum of all participants. General information of all participants, baseline data and clinical measurement data of AECOPD patients were collected. Statistical analysis and bioinformatics analysis were performed to reveal different metabolites and perturbed metabolic pathways.

Results

A total of 724 metabolites in positive ionization mode and 555 metabolites in negative ionization mode were different in AECOPD patients with anxiety and depression. The 1,279 serum metabolites could be divided into 77 categories. Based on multivariate and univariate analysis, 74 metabolites were detected in positive ionization mode, and 60 metabolites were detected in negative ionization as differential metabolites. The 134 metabolites were enriched in 18 pathways, including biosynthesis of unsaturated fatty acids, aldosterone synthesis and secretion, protein digestion and absorption, ovarian steroidogenesis, long-term depression, retrograde endocannabinoid signaling, and so on.

Conclusion

This work highlights the key metabolites and metabolic pathways disturbed in AECOPD patients with anxiety and depression. These findings support the use of metabolomics to understand the pathogenic mechanisms involved in AECOPD patients with anxiety and depression.

Posttraumatic stress and probable post traumatic stress disorder as it relates to smoking behavior and beliefs among trauma exposed hispanic persons who smoke

There has been little scientific effort to evaluate the associations between cigarette smoking and cessation-related constructs and exposure to traumatic events, posttraumatic stress, and Posttraumatic Stress Disorder (PTSD) symptoms among Hispanic persons who smoke in the United States (US). Such trauma-related factors may pose unique difficulties for Hispanic persons who smoke and possess a desire to quit. As such, the present investigation sought to fill this gap in the literature and examine posttraumatic stress and probable PTSD in terms of their relations with several clinically significant smoking constructs among trauma-exposed Hispanic persons who smoke from the United States. Participants included 228 Spanish-speaking Hispanic persons who endorsed prior traumatic event exposure and smoked combustible cigarettes daily (58.3% female, Mage= 32.1 years, SD = 9.65). Results indicated that posttraumatic stress symptoms were related to increased cigarette dependence, perceived barriers for smoking cessation, and more severe problems when trying to quit with effect sizes ranging from small to moderate in adjusted models. Additionally, Hispanic persons who smoke with probable PTSD compared to those without probable PTSD showcased a statistically effect for perceived barriers for cessation (p < .008) and a severity of problems when trying to quit (p < .001). No effect was evident for cigarette dependence after alpha correction. Overall, the present study offers novel empirical evidence related to the role of posttraumatic stress symptoms and PTSD among Hispanic persons who smoke in the US. Such findings highlight the need to expand this line of research to better understand the role of posttraumatic stress and PTSD among Hispanic persons who smoke which can inform smoking cessation treatments for Hispanic persons who smoke experiencing trauma-related symptomology.

Risk of Cardiovascular Disease Hospitalization After Common Psychiatric Disorders: Analyses of Disease Susceptibility and Progression Trajectory in the UK Biobank

Whether associations between psychiatric disorders and hospitalization for cardiovascular diseases (CVDs) can be modified by disease susceptibility and the temporal pattern of these associated CVDs remain unknown. In our study, we conducted a matched cohort study of the UK Biobank including 44,430 patients with common psychiatric disorders (anxiety, depression, and stress-related disorders) between 1997 and 2019, together with 222,150 sex-, Townsend deprivation index-, and birth year- individually matched unexposed individuals. The hazard ratios (HRs) for CVD hospitalization associated with a prior psychiatric disorder were derived from Cox models, adjusted for multiple confounders. We then stratified the analyses by self-reported family history of CVD and CVD polygenic risk score (PRS) calculated based on summary statistics of independent genome-wide association studies. We further conducted disease trajectory analysis and visualized the temporal pattern of CVDs after common psychiatric disorders. During a mean follow-up of 12.28 years, we observed an elevated risk of CVD hospitalization among patients with psychiatric disorders, compared with matched unexposed individuals (hazard ratios [HRs] = 1.20, 95% confidence interval [CI]: 1.18-1.23), especially during the first six months of follow-up (1.72 [1.55-1.91]). The stratification analyses by family history of CVD and by CVD PRS obtained similar estimates between subgroups with different susceptibilities to CVD. We conducted trajectory analysis to visualize the temporal pattern of CVDs after common psychiatric disorders, identifying primary hypertension, acute myocardial infarction, and stroke as three main intermediate steps leading to further increased risk of other CVDs. In conclusion, the association between common psychiatric disorders and subsequent CVD hospitalization is not modified by predisposition to CVD. Hypertension, acute myocardial infarction, and stroke are three initial CVDs linking psychiatric disorders to other CVD sequelae, highlighting a need of timely intervention on these targets to prevent further CVD sequelae among all individuals with common psychiatric disorders.

Supplementary Information

The online version contains supplementary material available at 10.1007/s43657-023-00134-w.

Life-Course Associations Between Smoking and Depressive Symptoms. A 30-Year Finnish Follow-up Study

INTRODUCTION

Relatively little is known about whether the association between smoking and depressive symptoms changes with age and how the trajectories of smoking and depressive symptoms are intertwined during the life course. In this population-based study, these associations were examined from young adulthood to middle age.

METHODS

Participants of a Finnish cohort study (N = 1955) were assessed at the ages of 22, 32, 42, and 52 using questionnaires covering daily smoking (yes/no) and the short 13-item Beck Depression Inventory. Longitudinal latent class and longitudinal latent profile analyses were used to identify life course trajectories of smoking and depressive symptoms.

RESULTS

The proportions of daily smokers decreased, while levels of depressive symptoms increased among both females and males from age 22 to 52 years. Smoking was associated with higher levels of depressive symptoms from age 22 to 42 years, while not at 52. Associations among males prevailed when adjusting for education, marital status, and alcohol use. Four life course classes of daily smoking (nonsmokers, decreasing prevalence of smoking, persistent smokers, and increasing prevalence of smoking) and four trajectories of depressive symptoms (low, increasing/moderate, decreasing/moderate, and high) were identified. In males, persistent daily smokers (relative risk ratio (RRR) = 4.5, 95% confidence interval (CI): 2.2 to 9.2) and those in the class with increasing smoking prevalence (RRR = 3.2, 95% CI: 1.1 to 9.1) had an increased risk of belonging to the high depressive symptoms profile. In females these associations were nonsignificant.

CONCLUSIONS

Compared to females, the relationship between smoking and depressive symptoms seems more robust among males during adulthood. Specifically, males smoking persistently from young adulthood to middle age have an increased risk of high depressive symptoms trajectory.

IMPLICATIONS

This population-based cohort with 30 years of follow-up showed that the life course trajectories of daily smoking and depressive symptoms are associated. Persistent daily smokers and those starting late had an increased risk of belonging to the profile with constantly high levels of depressive symptoms during the life course. However, these associations were statistically significant only in males. Actions should be strengthened, especially in males, to prevent smoking initiation, to help smoking cessation, and to identify and treat depression in smokers with significant depressive symptoms.

Individual Predictors of Response to A Behavioral Activation-Based Digital Smoking Cessation Intervention: A Machine Learning Approach

Background: Depression is prevalent among individuals who smoke cigarettes and increases risk for relapse. A previous clinical trial suggests that Goal2Quit, a behavioral activation-based smoking cessation mobile app, effectively increases smoking abstinence and reduces depressive symptoms. Objective: Secondary analyses were conducted on these trial data to identify predictors of success in depression-specific digitalized cessation interventions. Methods: Adult who smoked cigarettes (age = 38.4 ± 10.3, 53% women) were randomized to either use Goal2Quit for 12 weeks (N = 103), paired with a 2-week sample of nicotine replacement therapy (patch and lozenge) or to a Treatment-As-Usual (TAU) control (N = 47). The least absolute shrinkage and selection operator was utilized to identify a subset of baseline variables predicting either smoking or depression intervention outcomes. The retained predictors were then fitted via linear regression models to determine relations to each intervention outcome. Results: Relative to TAU, only individuals who spent significant time using Goal2Quit (56 ± 46 min) were more likely to reduce cigarette use by at least 50% after 12 weeks, whereas those who spent minimal time using Goal2Quit (10 ± 2 min) did not exhibit significant changes. An interaction between educational attainment and treatment group revealed that, as compared to TAU, only app users with an educational degree beyond high school exhibited significant reductions in depression. Conclusions: The findings highlight the importance of tailoring depression-specific digital cessation interventions to individuals' unique engagement needs and educational level. This study provides a potential methodological template for future research aimed at personalizing technology-based treatments for cigarette users with depressive symptoms.

Analysis of patient health questionnaire-9 (PHQ-9) based depression prevalence according to a discordance between quantitative urinary cotinine levels and self-report of second-hand smoke exposure among adults: A cross-sectional study

Background

Second-hand smoke (SHS) exposure appears to be more common among individuals with depression. However, self-report of SHS exposure is an inaccurate classification compared to confirming SHS exposure using urinary cotinine (UC). Additionally, the dose-response relationship between depression and UC is controversial.

Methods

The severe stress rate and depression prevalence was estimated among 14530 Korean participants aged ≥19 years using data patient health questionnaire-9 (PHQ-9) and on UC from the Korean National Health and Nutrition Examination Survey. Measured UCs were divided into four categories: UC- (≤0.3 μg/L), UC± (0.4 μg/L-0.9 μg/L), UC+ (1.0 μg/L-11.9 μg/L), and UC++ (≥12.0 μg/L).

Results

About 55.0 % participants were female and participants' mean age was 51.1 years. Non-smokers were 80.3 %. Among non-smokers, non-SHS exposure participants (SR-) and SHS exposure participants (SR+) were 83.0 % and 17.0 %, respectively. When UC- was used as the reference subgroup, the UC++ subgroup showed a higher depression prevalence, whereas the UC ± subgroup showed a lower prevalence. In the same UC categories, the depression prevalence and severe stress rate were higher among females than among males. Furthermore, the SR + subgroup had a higher severe stress rate than the SR- subgroup.

Conclusions

Our study showed a paradoxical reduction in the depression prevalence and severe stress rate in the UC ± subgroup compared to the UC- subgroup. Additionally, the dose-response relationship between the SHS exposure biomarker and the depression prevalence was not linear. Our study indicates that an emotional stress-based model may be more appropriate for explaining the relationship between depression and SHS exposure.

Sex Differences in Withdrawal-Induced Anxiety in Rats After Exposure to Tobacco Smoke

Nicotine, a component of cigarettes, possesses strong reinforcing properties and improves cognitive function, which can lead to dependence. Upon cigarette smoking cessation, withdrawal symptoms occur and may cause an individual to relapse. Affective withdrawal symptoms, such as anxiety, is of great concern as studies have shown its ability to cause relapse in men and women. In this in vivo study, anxiety resulting from smoking cessation after 2-day smoke-free intervals per week for the duration of 4 weeks was investigated in 8 male and 8 female rats after their exposure to cigarette smoke compared to unexposed control rats (8 males and 8 female rats). The anxiety in rats during smoke-free intervals was investigated using an elevated plus-maze (EPM), open-field (OF), and light/dark test (LD). In all tests male rats exhibited significantly higher anxiety symptoms compared to female rats during nicotine withdrawal, despite control rats showing no differences. In the EPM, male rats spent less time in open arm as well having as lower number of crossings than female rats. As for the OFT, the amount of time spent in the center of the open field was also lower in male rats than female rats. In the LD test, the time spent in the light chamber and the latency (delay) to enter the dark chamber was lower in male rats compared to female rats. Our study showed that male rats show greater nicotine withdrawal effects, in terms of anxiety-like behavior than female rats.

Association between psychosocial factors and co-morbid cigarette smoking and alcohol use in a population experiencing homelessness

The prevalence of combustible cigarette smoking in populations experiencing homelessness in the United States is five times that of the general population. The psychosocial well-being of persons who smoke and experience homelessness is poorer if such persons also use alcohol heavily. The PTQ2 study was a randomized clinical trial among persons experiencing homelessness who were also current smokers and heavy alcohol consumers. Secondary data analysis of the PTQ2 baseline data was conducted to examine associations among psychosocial variables (anxiety, depression, hopelessness, social network size), heaviness of smoking (cigarettes/day) and alcohol consumption (drinking days/month), and duration and frequency of homelessness. Among the 420 participants, the majority were male (75%), black (70%) and non-Hispanic (94%) with a mean age of 46.6 years (SD = 11.6).  Bivariate analyses show that heaviness of smoking was positively correlated with social network size (r = 0.16, p = .001). Heaviness of drinking was positively correlated with the MINI anxiety score (r = 0.13, p = .009) and marijuana use (median total number of drinks in past 30 days among those who used marijuana in past 30 days vs. did not use: 50 vs. 24, p < .0001), and associated with frequency of homelessness (median total number of drinks in past 30 days among those experiencing homelessness once vs. >1 time: 30 vs. 44, p = .022). The findings highlight the psychosocial factors that warrant consideration when addressing heavy smoking and alcohol consumption in persons experiencing homelessness.

Emotional dysregulation among English-speaking Hispanic persons who smoke living in the United states

Hispanic/Latinx (hereafter Hispanic) individuals in the United States (US) experience serious tobacco-related disparities and factors contributing to such disparities need to be adequately identified and clinically addressed. Emotion dysregulation is a key transdiagnostic relevant to smoking. The present cross-sectional investigation sought to test if emotion dysregulation was related to more severe problems during smoking quit attempts (e.g., irritability, weight gain), perceptions of difficulty about quitting, as well as negative and positive beliefs about smoking abstinence in a sample of English-speaking Hispanic adults residing in the US who smoke. Participants included 332 Hispanic adults who engaged in daily cigarette smoking (35.46 years old, 37 % identified as female). Emotion dysregulation was significantly related to more severe problems when quitting and perceived barriers for quitting, as well as negative beliefs about smoking abstinence. Additionally, emotion dysregulation was significantly and negatively related to positive outcomes about smoking abstinence. The amount of change in the various smoking criterion variables accounted for by emotion dysregulation was small (sr2 range: 0.028-0.085), but evident in adjusted models that accounted for a wide range of factors (e.g., depression, drug use severity). Overall, this investigation found consistent empirical evidence that individual differences in emotion dysregulation in Hispanic individuals were associated with several clinically significant smoking processes, suggesting this construct may represent an important factor involved in the maintenance and relapse of smoking among this ethnic population.

Depressive symptoms and smoking: Effect on mortality in a primary care cohort

OBJECTIVE

Depressive symptoms have been suggested to increase mortality risk but causality remains unproven. Depressive symptoms increase likelihood of smoking which is thus a potential factor modifying the effect of depressive symptoms on mortality. This study aims to assess if the association of depressive symptoms and all-cause mortality is affected by smoking.

METHODS

A prospective cohort study in Finnish primary care setting was conducted among 2557 middle-aged cardiovascular disease (CVD) risk persons identified in a population survey. Baseline depressive symptoms were assessed by Beck's Depression Inventory (BDI) and current smoking by self-report. Data on mortality was obtained from the official statistics. Effect of depressive symptoms and smoking on all-cause mortality after 14-year follow-up was estimated.

RESULTS

Compared to non-depressive non-smokers, the adjusted hazard ratio (HR) for all-cause mortality was 3.10 (95% CI 2.02 to 4.73) and 1.60 (95% CI 1.15 to 2.22) among smoking subjects with and without depressive symptoms, respectively. Compared to the general population, relative survival was higher among non-depressive non-smokers and lower among depressive smokers. Relative standardized mortality ratio (SMR) for all-cause mortality was 1.78 (95% CI 1.31 to 2.44) and 3.79 (95% CI 2.54 to 6.66) among non-depressive and depressive smokers, respectively, compared to non-depressive non-smokers. The HR for all-cause mortality and relative SMR of depressive non-smokers were not increased compared to non-depressive non-smokers.

CONCLUSION

Current smoking and increased depressive symptoms seem to additively contribute to excess mortality.

Major Depressive Disorder Impacts Peripheral Artery Disease Risk Through Intermediary Risk Factors

BACKGROUND

Major depressive disorder (MDD) has been identified as a causal risk factor for multiple forms of cardiovascular disease. Although observational evidence has linked MDD to peripheral artery disease (PAD), causal evidence of this relationship is lacking.

METHODS AND RESULTS

Inverse variance weighted 2-sample Mendelian randomization was used to test the association the between genetic liability for MDD and genetic liability for PAD. Genetic liability for MDD was associated with increased genetic liability for PAD (odds ratio [OR], 1.17 [95% CI, 1.06-1.29]; P=2.6×10-3). Genetic liability for MDD was also associated with increased genetically determined lifetime smoking (β=0.11 [95% CI, 0.078-0.14]; P=1.2×10-12), decreased alcohol intake (β=-0.078 [95% CI, -0.15 to 0]; P=0.043), and increased body mass index (β=0.10 [95% CI, 0.02-0.19]; P=1.8×10-2), which in turn were associated with genetic liability for PAD (smoking: OR, 2.81 [95% CI, 2.28-3.47], P=9.8×10-22; alcohol: OR, 0.77 [95% CI, 0.66-0.88]; P=1.8×10-4; body mass index: OR, 1.61 [95% CI, 1.52-1.7]; P=1.3×10-57). Controlling for lifetime smoking index, alcohol intake, and body mass index with multivariable Mendelian randomization completely attenuated the association between genetic liability for MDD with genetic liability for PAD.

CONCLUSIONS

This work provides evidence for a possible causal association between MDD and PAD that is dependent on intermediate risk factors, adding to the growing body of evidence suggesting that effective management and treatment of cardiovascular diseases may require a composite of physical and mental health interventions.

Development and psychometric assessment of Health Action Process Approach (HAPA) in terms of smoking cessation among Chinese smokers

The Health Action Process Approach (HAPA) is a two-stage (pre-intentional and post-intentional) behavioral change model that distinguishes between motivation and volition in behavior change process. This study aims to develop HAPA-based assessments for smoking cessation among current smokers. The HAPA-based measures were developed and the draft measures included nine constructs, namely, risk perception in smoking-induced cancer, risk perception in smoking-induced systemic disease, positive outcome expectancy, negative outcome expectancy, self-efficacy in quitting smoking, self-efficacy in maintaining, self-efficacy in re-initiating, quitting planning and coping planning in smoking cessation, with a total of 26 items. A cross-sectional survey was conducted in China in 2022. Principal Component Analysis was used for Exploratory Factor Analysis (EFA). Cronbach's α coefficient was calculated to evaluate the internal consistency. Variables such as severity of smoking addiction were selected to evaluate the correlation between the HAPA scale and these variables. Of the 928 participants, 76.4% (709/928) were male and the median age was 35 years. Five factors were extracted by EFA. The factor loadings of each item were all greater than 0.60, and the cumulative variance contribution rate was 90.15%. The Cronbach's α coefficient of each HAPA-based subscales was 0.929-0.986. The HAPA-based measurements are comprehensive, reliable and valid in the assessment of smokers' smoking cessation cognition, which can be used to guide the design and implementation of intervention and the development of theory.

Environmental stress during adolescence promotes depression-like behavior and endocrine abnormalities in rats

OBJECTIVE

To assess the ability of environmental stress (ES) during adolescence on depression-like behaviors and endocrinology in rats.

METHODS

Male and female Sprague-Dawley rats before or during puberty were divided into three groups: control group (CON), low-frequency ES group (LF), and high-frequency ES group (HF). ES included water/food deprivation and reversal of day and night. After 4 weeks of ES, the behavioral tests were performed. Plasma concentrations of hormones and peptides were determined by enzyme-linked immunosorbent assay (ELISA).

RESULTS

ES induced a significant decrease in sucrose preference value in female adolescent rats but not males. In prepubertal rats, the reductions in sucrose preference upon ES were observed without a sex-specific effect. Compared with the CON group, female adolescent rats showed a significant increase, while male adolescent rats showed a significant decrease in plasma corticosterone (CORT) after ES. Also, ES significantly increased plasma leptin in female and male adolescent rats. Moreover, ES significantly increased plasma cholecystokinin (CCK), neuropeptide Y (NPY), and testosterone (TS) levels in adolescent female rats but not in males. No significant differences were found in plasma progesterone and E2 among adolescent rats. The prepubertal male rats showed significant plasma E2 and TS increase after ES, while there were no significant differences between groups in plasma CORT, leptin, CCK, NPY, and progesterone.

CONCLUSIONS

ES may cause depression-like behaviors in adolescent female rats. Our findings supplement the scientific basis for formulating strategies to treat and prevent adolescent depression.

Effectiveness of Contingency Management in Tobacco Smokers with Depressive Symptoms: A Systematic Review

Background: Effective interventions are required to address tobacco smoking in people with depressive symptomatology. In this context, contingency management could be one useful therapeutic strategy. Objectives: This study is a systematic review of tobacco cessation interventions for smokers with depressive symptomatology including a contingency management component, evaluating their efficacy with regards to tobacco abstinence, depressive symptomatology, adherence to treatment and other variables related to tobacco use. For this purpose, a search was carried out in Pubmed, PsycINFO, Cochrane, Web of Science and ClinicalTrials.gov in September 2022. The quality of the studies was assessed using the Cochrane Risk of Bias tool. Results: Of the 208 articles identified, six were included in this review. Results: For the most part, the research included suggests that contingency management is an effective strategy for improving abstinence outcomes, adherence, and other smoking-related variables such as delay discounting and intensity of cigarette demand in smokers with depressive symptomatology. Conclusions: Although contingency management could be a promising intervention in tobacco smokers with depressive symptomatology, further research in this area is still required.

Relationship between mood disorders and substance involvement and the shared genetic liabilities: A population-based study in Taiwan

BACKGROUND

This study explored the phenotypic association of mood disorders, including major depressive disorder (MDD) and bipolar disorder (BPD), with a range of substance involvement, including lifetime experience and age at initiation of tobacco, alcohol, and betel nut use. Additionally, we elucidated polygenic risk score (PRS) association.

METHODS

In total, 132,615 community participants were recruited from the Taiwan Biobank. Genome-wide genotyping data were available for 106,806 unrelated individuals, and the PRS for MDD and BPD was calculated. The significance of mood disorders and PRSs associated with substance involvement were evaluated using a linear/logistic regression model with adjustment for potential confounders. Sex differences were assessed.

RESULTS

MDD and BPD were associated with regular alcohol consumption, drinking cessation, tobacco smoking, smoking cessation, betel nut chewing, and earlier onset of drinking. BPD was associated with an earlier onset of smoking. MDD PRS was associated with regular alcohol use (odds ratio [OR] per standard deviation increase in PRS = 1.03, p = 0.018), alcohol cessation (OR = 1.05, p = 0.03), regular tobacco use (OR = 1.08, p < 0.0001), and betel nut chewing (OR = 1.06, p < 0.0001), whereas BPD PRS was not associated with substance use. Phenotypic association strengths between MDD/BPD and regular drinking/smoking and the polygenic association between MDD PRS and regular smoking were larger in females than in males.

LIMITATIONS

Retrospective self-reported MDD/BPD diagnoses and substance involvement.

CONCLUSIONS

Mood disorders were associated with a range of substance involvement. Shared genetic architecture contributed to the co-occurrence of MDD and substance involvement. These findings may help design prevention and cessation strategies for substance use.

Unhealthy behaviors associated with mental health disorders: a systematic comparative review of diet quality, sedentary behavior, and cannabis and tobacco use

Background

There are well-established literatures documenting the associations between mental disorders and unhealthy behaviors such as poor diet quality, sedentary behavior, and cannabis and tobacco use. Few studies have attempted to understand the respective findings in light of each other, however.

Objective

The purpose of this review was to assemble comparable data for each behavior-disorder association and assess the associations in terms of their overall strength. The review aimed to include a representative, but not exhaustive, range of studies that would allow for explorative comparisons.

Methods

Eligible studies were identified via Pubmed searches and citation searching, restricted to publications no older than 2015 written in English. To obtain comparable data, only studies that reported findings as odds ratios were included, and risk of bias related to study samples, behavioral measurement disparities, and control variables was assessed via sensitivity analyses. Findings for each disorder were compared on the basis of different measures of central tendency.

Results

From 3,682 records, 294 studies were included. The review found evidence of associations between each of the four unhealthy behaviors and psychosis, depression, anxiety, bipolar disorder, attention-deficit/hyperactivity disorder (ADHD), and post-traumatic stress disorder (PTSD), while personality disorder was only investigated in relation to cannabis and tobacco use. In overall comparison, the associations were generally of similar strength, and only the association between cannabis use and personality disorder was exceptional in terms of being significantly stronger than its counterparts across disorders and across behaviors. Analyses of bias risk identified some influence from behavioral measurement disparities and lack of adequate statistical control, but findings were generally robust across a range of sensitivity analyses.

Conclusion

This explorative and comparative review found that poor diet quality, sedentary behavior, and cannabis and tobacco use are about equally strongly associated with a range of different mental disorders. Given the general nature of these associations, we should probably understand them to reflect a general and shared etiology. However, the findings in this review should be regarded as tentative until confirmed by more comprehensive investigations.

Depressive symptoms prospectively increase risk for new onset cigarette and ENDS dependence symptoms

Little research has examined the new onset of cigarette and Electronic Nicotine Delivery System (ENDS) dependence symptoms among young adults. This study aims to 1) examine new onset cigarette and ENDS dependence symptoms over a 4.5-year period and 2) examine how depressive symptoms impact new onset dependence symptoms among young adults. Participants were drawn from 24 colleges in Texas who were participating in a multi-wave cohort study (2014-2019). The present study included 4536 participants aged 18-25 who did not report cigarette or ENDS dependence symptoms at wave 1 (64.1% female; 65.2% non-white; m age = 20.62 [SD = 1.80] at wave 1). Cox's regression models were employed to determine the hazard of new onset cigarette and ENDS dependence symptoms overall and the impact of depressive symptoms. Models controlled for sociodemographic factors and other tobacco product use. 14.4% of participants reported new onset cigarette dependence symptoms and 14.6% reported new onset ENDS dependence symptoms over the 4.5 years of the study. Depressive symptoms significantly predicted increased risk for new onset cigarette (HR = 1.30, CI = [1.21, 1.39]) and ENDS (HR = 1.20, CI = [1.12, 1.29]) dependence symptoms. Young adults exhibited dependence symptoms for cigarettes and ENDS products at similar rates across the 4.5 years of the study. Elevated depressive symptoms increased risk of new onset cigarette and ENDS dependence symptoms, advancing evidence for the self-medication hypothesis. Tobacco and nicotine prevention and cessation programs and messaging are needed particularly among young adults who experience depressive symptoms.

Effects of elevated emotional symptoms on metabolic disease development: a 10-year follow-up study

Background

In recent decades, the relationship between emotional disorders (i.e., depression and anxiety) and alterations in physiological functions (i.e., inflammation or metabolism) have been well supported. However, studies on a symptom-based approach have provided mixed results. Our study aims to gain insight into how subclinical statuses, featured by elevated depressive and/or anxious symptoms, may influence immunometabolic alterations in the concurrent relationship; and the development of metabolic diseases at 10-year follow-up: diabetes, hypertension and hypercholesterolemia.

Methods

Data from 758 Greek adults [394 men (aged 41 ± 10 years) and 364 women (aged 37 ± 12 years)] were used. Four groups were created according to the levels of depressive and anxiety symptoms: (1) control group (CG), (2) depressive group (DG), (3) anxiety group (AG) and (4) depressive and anxiety group (DAG). Multi-indicator multi-causes (MIMIC) modeling was used to estimate metabolic function and inflammatory response scores, on a wide selection of blood biomarkers. Finally, a binary logistic regression was carried out to study the influence of symptoms on the development of the aforementioned metabolic diseases on a 10-year follow-up.

Results

Group membership was not associated with metabolic function score. Conversely, DAG membership was related with higher inflammatory response score (B = 0.20, CI95 = 0.01, 0.40), with respect to the CG (p < 0.05). Both age and sex were significant variables in the calculation of both scores. Regarding disease at 10-year follow-up effect, risk of developing diabetes, hypertension and hypercholesterolemia was associated with age and socioeconomic status. Moreover, DG membership was significant for diabetes risk (OR = 2.08, CI95 = 1.00, 4.22) and DAG for hypercholesterolemia (OR = 1.68, CI95 = 1.16, 2.43).

Limitations

Data on anti-inflammatory drugs and psychopharmacological medication were not collected in this study.

Conclusions

Elevated symptoms of depression and anxiety accounts for inflammatory alterations at concurrent relationship and a higher risk of 10-year follow-up metabolic diseases.

Youth mental health and nicotine vape use: The moderating role of rural-urban/suburban school environments

OBJECTIVE

To understand and compare the association between nicotine vape use and mental health among youth in rural and urban/suburban areas.

METHODS

This cross-sectional study included 146,489 high school students from the 2019-2020 California Student Tobacco Survey. Descriptive statistics were estimated with frequencies and percentages. Separate bivariate associations between each covariate/predictor variable and mental health were examined using linear regression. Multivariate linear regression models were used to examine the association between nicotine vape use and mental health for youth attending school in rural versus suburban/urban communities.

RESULTS

Findings showed that vaping nicotine was associated with poorer overall mental health (b = -0.307, SE = 0.019, p < 0.001), and that this association differed based on rural versus urban/suburban school environments (b = -0.135, SE = 0.046, p = 0.004). Specifically, the relationship between vaping and poor mental health was stronger for youth attending school in rural areas (b = -0.443, SE = 0.042, p < 0.001) than in urban/suburban localities (b = -0.307, SE = 0.019, p < 0.001).

CONCLUSIONS

Although differences in mental health were not shown based on rural versus urban/suburban school environments alone, findings showed that the relationship between nicotine vape use and mental health was stronger for youth attending high school in rural areas. Additional research is needed to understand the underlying social and environmental mechanisms that exacerbate this relationship. Future interventions might consider how to support and improve the mental health of rural nicotine vapers to better achieve health equity across different school environments.

Association between 14 candidate genes, PM2.5, and affective disorders: a study of the Taiwan Biobank

BACKGROUND

Most studies have focused on the risk factors, treatment, and care of affective psychosis, and several have reported a relationship between ambient air quality and this psychosis. Although an association has been reported between psychosis and genes, studies mainly explored the associations between one type of psychosis and one gene; few have identified genes related to affective psychosis. This study investigates the genetic and environmental factors of affective psychosis.

METHODS

In this retrospective longitudinal study, 27 604 participants aged 30-70 were selected from Taiwan Biobank. The participants' propensity scores were calculated based on their demographic information, and propensity score matching was performed to divide the participants into an experimental (i.e., affective psychosis) and control group at a 1:5 ratio. Plink was used to analyze the major and minor types of gene expression related to affective psychosis, and PM2.5 exposure was incorporated into the analyses.

RESULTS

According to the generalized estimating equation analysis results, 8 single nucleotide polymorphisms (SNPs) belonging to the ANK3, BDNF, CACNA1C, and GRID1 genotypes were significantly correlated with depressive disorder (P < .001), with the majority belonging to the ANK3 and CACNA1C. A total of 5 SNPs belonging to the CACNA1C, GRID1, and SIRT1 genotypes were significantly correlated with bipolar disorder (P < .001), with the majority belonging to the CACNA1C. No significant correlation was identified between ambient air pollution and affective psychosis.

CONCLUSIONS

CACNA1C and GRID1 are common SNP genotypes for depressive disorder and bipolar disorder and should be considered associated with affective psychosis.

Impulsivity Drives Adolescents to Smoke and Drink: Gender Differences in the Mediating Effects of Resilience and Depression

High and rising rates of smoking and drinking among Chinese adolescents are contributing to increasingly serious physical and mental health issues. While impulsivity has been demonstrated to be significantly related to adolescent cigarette and alcohol use, little is known about the mechanisms behind this association. The current study focused on resilience and depressive symptoms as potential mediators of this link, exploring the indirect pathways connecting impulsivity to teenage tobacco and alcohol use. Possible gender differences in this indirect pathway were also explored. Participants were secondary school students from southern China (N = 3466; 49.2% were female; Mage = 14.18; SDage = 1.57). Results revealed that adolescents who were more impulsive used cigarettes and alcohol more frequently, and that this effect was partially mediated by lower resilience and more depressive symptoms. It is noteworthy that there were gender differences in this mediating effect, with the effect of impulsivity on cigarette use for girls being mediated by resilience and depressive symptoms, whereas this statistically significant association was not identified for boys. These findings show how adolescents' impulsivity drives them to smoke and drink, and also emphasize gender as a crucial consideration for intervening with adolescents' drinking and smoking behaviors.

Pharmacotherapy for Treatment of Tobacco Use Disorder

Tobacco use disorder (TUD), the leading cause of preventable deaths in the United States, disproportionally impacts those with psychiatric disorders. There are multiple first-line, U.S. Food and Drug Administration-approved pharmacotherapy options for the treatment of TUD. The current review focuses on these medications, underlining practical tips to improve cessation rates, while emphasizing a harm reduction and patient-centered approach to treatment. [Journal of Psychosocial Nursing and Mental Health Services, 61(11), 6-9.].

Implementation of Specialty Tobacco Use Disorder Services in a Community Health Setting: Support for Enhanced Prescription Practices

OBJECTIVES

Although public efforts to reduce tobacco use have been successful, millions of US adults currently smoke tobacco. Reducing the public health burden of tobacco use disorder (TUD) and eliminating disparities experienced by underresourced communities requires increased accessibility to services. The goal of this study was to assess whether prescriptions for evidence-based medications for tobacco treatment showed steeper growth rates among community health clinics providing specialty TUD services as compared with treatment as usual.

METHODS

Clinic-wide data on prescriptions for smoking cessation pharmacotherapy at 18 primary care or mental health community clinics operated by Los Angeles County were retrieved for 4 years of an ongoing implementation trial. Specialty services included behavioral counseling and medications for tobacco treatment. Descriptive statistics characterized prescriptions rates across clinics and time. Analyses compared the slopes of the changes between intervention groups across time for primary care and mental health sites.

RESULTS

Within primary care clinics, the most commonly prescribed smoking cessation medications were nicotine patches, nicotine gum, and varenicline. Throughout the trial, all clinics displayed increased rates of prescribing smoking cessation medications. Analytic results supported overall steeper increases in prescription rates for these medications among clinics randomized to specialty services versus treatment as usual within primary care ( P = 0.020) and mental health sites ( P = 0.004).

CONCLUSIONS

This work provides support for the effectiveness of community-based implementation interventions that promote prescribing smoking cessation medications with the potential to reduce health disparities among communities at greater risk for TUD and its consequences.

Depressive symptoms predict trajectories of electronic delivery nicotine systems, cigarette, and cannabis use across 4.5 years among college students

BACKGROUND

This study examined the role of depressive symptoms on trajectories of electronic nicotine delivery systems (ENDS), cigarette, and cannabis use across 4.5 years in a sample of college students aged 18-19 at the initial study wave.

METHODS

Participants were 2,264 students enrolled in one of 24 Texas colleges that participated in a multi-wave study between 2014 and 2019. Latent growth mixture models were fit to identify longitudinal trajectories for past 30-day ENDS, cigarette, and cannabis use over a 4.5-year period. Class membership was regressed on baseline depressive symptoms in multinomial regression models.

RESULTS

Four trajectory classes were identified for each product: abstainer/minimal, decreasing, increasing, and high. Depressive symptoms were associated with a greater likelihood of belonging to the decreasing, increasing, and high trajectory classes relative to the abstainer/minimal class for all products, with the exception of the increasing ENDS class and the decreasing cannabis class.

DISCUSSION

The findings demonstrate that there is considerable similarity across trajectories of ENDS, cigarette, and cannabis use during traditional collegiate years. Furthermore, depressive symptoms increased the likelihood of belonging to substance using trajectory classes for all products.

Behavioral Activation-Based Digital Smoking Cessation Intervention for Individuals With Depressive Symptoms: Randomized Clinical Trial

BACKGROUND

Depression is common among adults who smoke cigarettes. Existing depression-specific cessation interventions have limited reach and are unlikely to improve smoking prevalence rates among this large subgroup of smokers.

OBJECTIVE

This study aimed to determine whether a mobile app-based intervention tailored for depression paired with a mailed sample of nicotine replacement therapy (NRT) is efficacious for treating depression and promoting smoking cessation.

METHODS

A 2-arm nationwide remote randomized clinical trial was conducted in the United States. Adults (N=150) with elevated depressive symptoms (Patient Health Questionnaire-8≥10) who smoked were enrolled. The mobile app ("Goal2Quit") provided behavioral strategies for treating depression and quitting smoking based on Behavioral Activation Treatment for Depression. Goal2Quit participants also received a 2-week sample of combination NRT. Treatment as usual participants received a self-help booklet for quitting smoking that was not tailored for depression. Primary end points included Goal2Quit usability, change in depression (Beck Depression Inventory-II) across 12 weeks, and smoking cessation including reduction in cigarettes per day, incidence of 24-hour quit attempts, floating abstinence, and 7-day point prevalence abstinence (PPA).

RESULTS

In total, 150 participants were enrolled between June 25, 2020, and February 23, 2022, of which 80 were female (53.3%) and the mean age was 38.4 (SD 10.3) years. At baseline, participants on average reported moderate depressive symptoms and smoked a mean of 14.7 (SD 7.5) cigarettes per day. Goal2Quit usability was strong with a mean usability rating on the System Usability Scale of 78.5 (SD 16.9), with 70% scoring above the ≥68 cutoff for above-average usability. Retention data for app use were generally strong immediately following trial enrollment and declined in subsequent weeks. Those who received Goal2Quit and the NRT sample reported lower mean depressive symptoms over the trial duration as compared to treatment as usual (difference of mean 3.72, SE 1.37 points less; P=.01). Across time points, all cessation outcomes favored Goal2Quit. Regarding abstinence, Goal2Quit participants reported significantly higher rates of 7-day PPA at weeks 4 (11% vs 0%; P=.02), 8 (7-day PPA: 12% vs 0%; P=.02), and 12 (16% vs 2%; P=.02).

CONCLUSIONS

A mobile app intervention tailored for depression paired with a sample of NRT was effective for depression treatment and smoking cessation. Findings support the utility of this intervention approach for addressing the currently unmet public health treatment need for tailored, scalable depression-specific cessation treatments.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03837379; https://clinicaltrials.gov/ct2/show/NCT03837379.

Rotator cuff outcomes and mental health indices: Correlation or causation?

Background

Psychological factors such as catastrophizing, anxiety, and depression influence clinical outcomes in many conditions. Our purpose was to examine trends and associations between these and outcomes of rotator cuff surgery.

Methods

148 patients (76 W:72 M, 55.1 ± 8.2 years) with unilateral symptomatic rotator cuff syndrome were followed for 1 year after surgery. The Western Ontario Rotator Cuff Score (WORC), the Pain Catastrophizing Score (PCS), and the Hospital Anxiety and Depression Score (HADS) were administered. Evolution and associations of WORC, HADS and PCS scores were examined using uni- and multivariate analyzes.

Results

At 1 year, PCS, HADS-A, and HADS-D scores negatively correlated with WORC score (R = -0.6, -0.61, -0.69). The strength of correlation was lower between baseline PCS, HADS-A, and HADS-D scores and 1-year WORC score (R = -0.38, -0.43, -0.42). Prior anxiety diagnosis was associated with higher HADS-A scores at 2- and 6- weeks post-op (p = 0.013, 0.011). 106 participants experienced an improving HADS-D over the year of follow-up. Worse pre-op pain, WORC, PCS, HADS-A, HADS-D, cardiovascular disease and current smoking were associated with non-improving HADS-D.

Discussion

Patient-reported outcomes of rotator cuff surgery are associated with patient-reported anxiety, depression, and pain catastrophizing. In many, all outcome scores improved over time suggesting a two-way association between shoulder condition and psychological parameters.

Level of evidence

II.

Does Asthma Disrupt Psychological Wellbeing in Pregnancy?

(1) Background: Asthma is a very prevalent disease with special characteristics during pregnancy, however, little is known about its relationship to the psychological wellbeing of women in this period; we aimed to know whether depression and anxiety symptoms are more frequent in asthmatic pregnant women. (2) Methods: Family Apgar (week 20), Edinburgh Postnatal Depression Scale (weeks 20 and 32) and State-Trait Anxiety Inventory (STAI) (week 32) tests were administered to 738 pregnant women (81 asthmatics) in the Nutrition in Early Life and Asthma (NELA) birth cohort. (3) Results: There were no significant differences between asthmatic and non-asthmatic pregnant women in any of the different tests at any of the time points. The mean scores for the different tests and timepoints between asthmatic and non-asthmatic pregnant women were: Apgar 20, 17.9 ± 2.2 vs. 10.0 ± 2.2; Edinburgh 20, 6.7 ± 4.2 vs. 6.9 ± 4.3; Edinburgh 32, 5.9 ± 4.4 vs. 5.6 ± 4.3; and STAI 32, 16.7 ± 8.4 vs. 15.8 ± 8.3. The proportion of pregnant women out of the normal range score for any of the tests and time points was also similar in both populations. (4) Conclusions: asthma is not associated with the psychological wellbeing of pregnant women.

Longitudinal Examination of ENDS Use Among Young Adult College Students: Associations with Depressive Symptoms and Sensation Seeking

The present study examined (1) intraindividual changes in the frequency of electronic nicotine delivery systems (ENDS) use across young adulthood, 18 to 30 years old, and (2) if depressive symptoms and sensation-seeking tendencies, independently and in interaction with one another, were associated with these changes. Data were from a longitudinal study of students recruited from 24 Texas colleges and followed across six waves from fall 2015 to spring 2019. Participants (n = 1298; 36.3% non-Hispanic white, 56.3% women) were 18 to 26 years old in fall 2015 and all reported past 30-day ENDS use on at least one wave. We used growth curve modeling for an accelerated longitudinal design to examine if ENDS use frequency changed with increasing age and if depressive symptoms and sensation seeking, independently and in interaction with one another, were associated with these changes. Results showed that ENDS use frequency increased with increasing age. Depressive symptoms and sensation seeking were not independently associated with more frequent ENDS use or an accelerated increase in ENDS use frequency across increasing age. However, a significant two-way interaction indicated that young adults with elevated depressive symptoms used ENDS more frequently, but only when they had higher levels of sensation seeking. Findings indicate that young adults with depressive symptoms are a heterogeneous population and that those with high levels of sensation-seeking tendencies are at elevated risk for more frequent ENDS use. Interventions for young adults high in both sensation-seeking and depressive symptoms may help prevent and decrease ENDS use.

Underlying patterns of the co-occurrence of tobacco use and mental health among youth

We aimed to examine how bidirectional relationships between mental health problems and tobacco use are formed over time by types of tobacco use in recent samples of U.S. youth. Data were drawn from Waves 1-4 of the Population Assessment of Tobacco and Health Study (N = 10,082) and analyzed using cross-lagged panel models. A high level of internalizing problems at Wave 1 predicted conventional cigarette smoking (adjusted odds ratio [AOR] = 1.19, 95% CI = 1.06-1.34) and e-cigarette use (AOR = 1.25, 95% CI = 1.09-1.43) at Wave 2, but not vice versa. Both cigarette smoking and e-cigarette use at Wave 2 tended to persist into Wave 3, which, in turn, increased the risk of subsequent internalizing problems in late adolescence or young adulthood (Wave 4). The bidirectional relationship between tobacco use and internalizing problems seems to begin as a procession from internalizing problems to tobacco use, and then from persistent tobacco use to exacerbated internalizing problems over time.

Association between home and community-based services and depressive symptoms in Chinese older adults: a multilevel analysis

BACKGROUND

As the phenomenon of ageing continues to intensify, home and community-based services (HCBSs) have been increasingly important in China. However, the association between HCBSs utilization and depressive symptoms in older adults in China is unclear. Consequently, this study aimed to examine the association between HCBSs utilization and depressive symptoms in Chinese older adults.

METHODS

This study included 7,787 older adults (≥ 60 years old) who were recruited within the framework of the 2018 China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale (CES-D-10). HCBSs utilization was assessed via the question, "What kind of HCBSs were being utilized in their community?". Data were analyzed using binary logistic regression models and generalized hierarchical linear models (GHLM).

RESULTS

Of the 7,787 participants, 20.0% (n = 1,556) reported that they utilized HCBSs, and 36.7% (n = 2,859) were evaluated that they had depressive symptoms. After adjusting for individual- and province-level covariates, the HCBSs utilization was found to be associated with depressive symptoms (OR = 1.180, 95% CI: 1.035-1.346, p < 0.05). Additionally, the depressive symptoms were significantly associated with gender, residence, educational level, marital status, number of chronic diseases, self-rated health (SRH), smoking, and provincial Gross Domestic Product (GDP) per capita.

CONCLUSIONS

This study found HCBSs utilization might be a protective factor against depressive symptoms in Chinese older adults. It is of utmost significance for the government to provide targeted HCBSs at the community level to address the unmet care needs of older adults, which can reduce the occurrence of negative emotions, consequently contributing to less severe depressive symptoms.

Interplay of Depression, Smoking Intention, and Smoking Behavior in Chinese Dai Adolescents

ABSTRACT

Tobacco smoking and depression are important contributors to the burden of disease in China, and their onset typically occurs in adolescence. However, there is no consensus on the nature and underlying mechanisms of their interplay, and related studies on Chinese adolescents and ethnic minorities are limited. This study tested the mediation role of depression in the link between smoking intention and behavior in relation to sex. A secondary analysis was conducted on data from a survey of 1,322 Chinese Dai middle school students aged 15-19 years (M = 17.02 years; 773 female students and 542 male students) in Xishuangbanna, China. We found that the mediation role of depression between smoking intention and smoking behavior was nonsignificant, although smoking intention and depression both had significant associations with smoking behavior. Therefore, depression might be better theorized as an underlying predictor of smoking intention or that other volitional factors may link smoking intention and smoking behavior more closely. Nevertheless, depression was a significant independent variable for smoking behavior even when smoking intention was adjusted. Women perceived more depression than men with similar smoking intention levels, yet the relationship between smoking intention and smoking behavior was stronger in men. Although it seems that men were abler to translate their smoking intention into actual smoking, the high level of depression among young women who reported higher levels of smoking intention is noteworthy. Tobacco control for Chinese adolescents could incorporate sex-specific psychological therapies for negative emotions and for the internalization of problems by children.

Lifestyle factors and clinical severity of Parkinson's disease

Genetic factors, environmental factors, and gene-environment interactions have been found to modify PD risk, age at onset (AAO), and disease progression. The objective of this study was to explore the association of coffee drinking, aspirin intake, and smoking, with motor and non-motor symptoms in a cohort of 35,959 American patients with PD from the Fox Insight Study using generalized linear models. Coffee drinkers had fewer problems swallowing but dosage and duration of coffee intake were not associated with motor or non-motor symptoms. Aspirin intake correlated with more tremor (p = 0.0026), problems getting up (p = 0.0185), light-headedness (p = 0.0043), and problems remembering (p = 1 × 10^-5). Smoking was directly associated with symptoms: smokers had more problems with drooling (p = 0.0106), swallowing (p = 0.0002), and freezing (p < 1 × 10^-5). Additionally, smokers had more possibly mood-related symptoms: unexplained pains (p < 1 × 10^-5), problems remembering (p = 0.0001), and feeling sad (p < 1 × 10^-5). Confirmatory and longitudinal studies are warranted to investigate the clinical correlation over time.