Smoking and nicotine dependence in relation to depression, anxiety, and stress in Egyptian adults: A cross-sectional study

Exploring the association between anhedonia and nicotine dependence: A study among female undergraduate students in Saudi Arabia

INTRODUCTION

Nicotine dependence and its psychological foundations, including anhedonia, are major public health issues, especially among young adults. There is a dearth of knowledge regarding nicotine dependence and anhedonia especially among female young adults. Thus, this study aimed to investigate the associations between anhedonia and nicotine dependence among female undergraduate students.

METHODS

A cross-sectional study was conducted in March 2024, among 449 female undergraduate students, in Saudi Arabia. Data were collected using the Fagerström test for nicotine dependence (FTND) and the Snaith-Hamilton Pleasure Scale (SHAPS).

RESULTS

A total of 449 female undergraduate students participated in the study. The majority were aged 18-20 years (62.8%). The study found that 11.4% of participants reported nicotine use, primarily e-cigarettes (66.7%). Nicotine users reported higher parental [45.1% vs 26.4%, χ2(1)=7.770, p=0.005] and sibling nicotine use [52.9% vs 30.7%, χ2(1)=17.992, p=0.001]. Mental health conditions were more prevalent in nicotine users [39.2% vs 15.1%, χ2(1)=17.992, p<0.001]. Logistic regression identified mental health conditions (OR=4.44, p<0.001), sibling nicotine use (OR=2.37, p=0.006), and parental nicotine use (OR=2.27, p=0.01) as key predictors of nicotine use. Anhedonia was present in 19.8% of participants, associated with mental health conditions [38.2% vs 12.8%, χ2(1)=31.501, p<0.001], nicotine use [27% vs 7.5%, χ2(1)=8.309, p=0.005] and sibling nicotine use [46.1% vs 30%, χ2(1)=26.857, p<0.001]. Mental health conditions (OR=3.47, p<0.001) and nicotine use (OR=3.34, p<0.001) strongly predicted anhedonia.

CONCLUSIONS

The study's results support the notion that psychological discomfort influences nicotine use, demonstrating a substantial association between anhedonia and nicotine use. Given the influence of familial nicotine use, there is an immediate need for targeted interventions that address both social and psychological aspects.

Effectiveness of nurse-initiated smoking cessation intervention: a systematic review and meta-analysis

BACKGROUND

Smoking is a major preventable cause of death, associated with cancers and chronic diseases. Nurse-initiated smoking cessation programs have proven effective, providing counseling, education, and mental health support. These interventions increase quit rates by tackling nicotine addiction, emphasizing the important role of nurses and the need for targeted training. Systematic reviews and meta-analyses are essential for gaining a deeper understanding of the effectiveness of various cessation strategies.

METHODS

A literature search was conducted using eight electronic databases (CINAHL, EMbase, MEDLINE, Cochrane, RISS, KMbase, KISS, and NDSL). The literature search was conducted from March, 27, 2024, to August 1, 2024. All included studies were randomized controlled trials (RCTs). Quality assessment was conducted using the Risk of Bias (ROB) tool. RevMan 5.4 was used for qualitative analysis, with effect sizes measured as odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

Thirteen studies, all published after 2005, were included in the evidence assessment of nurse-initiated smoking cessation programs. The interventions examined comprised 11 intensive or personalized counseling programs and 3 telephone-based approaches. The OR for self-reported quit success 7-day smoking cessation rate at 6-month follow-up was 1.43 (95% CI [1.08, 1.90]), indicating a significant difference in quit effectiveness (Z = 2.27, p =.01), with moderate heterogeneity observed across studies (I2 = 67.0%, p =.001). A meta-analysis of 7-day point abstinence rate at 12-month follow-up revealed a pooled OR of 1.18 (95% CI [0.96, 1.44]), showing no significant difference in quit effectiveness (Z = 1.58, p =.11) and moderate heterogeneity among the studies (I2 = 55.0%, p =.02).

CONCLUSIONS

A comprehensive approach by trained nursing professionals is essential in addressing the complexities of smoking cessation. Further clinical trials are needed to assess intervention methods and follow-up strategies. Future research should emphasize long-term outcomes and ongoing support to sustain behavior change, contributing to more effective, tailored cessation programs and improved public health outcomes.

A Comparative Evaluation of Hearing and Psychological Distress in Smokers and Non-smokers: A Cross-Sectional Study

Background Smoking is a major global health concern, linked to numerous medical conditions, including hearing loss and psychological distress. Research suggests that smokers have a significantly higher risk of hearing impairment than non-smokers, possibly due to oxidative stress and vascular damage. Smoking is also associated with psychological effects such as depression, anxiety, and stress, though the relationship is complex. This study aims to compare the prevalence and degree of hearing loss between smokers and non-smokers using pure tone audiometry, and to evaluate the levels of psychological distress (depression, anxiety, and stress) in both groups using the Depression, Anxiety, and Stress Scale-21 (DASS-21) score. It also aims to assess the relationship between smoking frequency and duration with hearing loss and psychological distress. Materials and methods A prospective cross-sectional study was conducted at the ENT Outpatient Department of AIIMS Bhopal over three months. A total of 100 male participants aged 18-55 years were divided into two groups: 50 smokers (current or past) and 50 age- and gender-matched non-smokers. Hearing was evaluated through pure tone audiometry, tuning fork tests, and otoscopy. Psychological distress was assessed using the DASS-21, while nicotine dependence was measured using the Fagerström Test for Nicotine Dependence. Data were analyzed using IBM SPSS Statistics for Windows, Version 21 (Released 2012; IBM Corp., Armonk, NY, USA), applying the Chi-square test, with a significance level of p < 0.05. Results Hearing loss was significantly more prevalent in smokers (18, or 36%) than in non-smokers (7, or 14%) (p = 0.017). However, no statistically significant correlation was found between the severity of hearing loss and the frequency or duration of smoking. Psychological distress was observed in both groups, with depression (10 (20%) vs. 6 (12%)), anxiety (18 (36%) vs. 23 (46%)), and stress (2 (4%) vs. 0%) being more common in smokers, though these differences were not statistically significant. Nicotine dependence varied, with 22 (44%) of smokers having very low dependence, while two (4%) had very high dependence. Higher cigarette consumption was significantly associated with greater nicotine dependence (p < 0.001). Conclusion Smoking is associated with a significantly higher risk of hearing loss, reinforcing the need for awareness and early screening among smokers. However, no strong link was found between smoking and psychological distress in this study. Given the limitations of sample size and study duration, further research is needed to explore the long-term effects of smoking on both hearing and mental health. Smoking cessation programs should incorporate regular hearing assessments and psychological support for better overall well-being.

Outcomes of metabolic syndrome and anxiety levels in light and heavy smokers

Background

This study aimed to assess the impact of smoking status, as measured by pack-years (PY), on components of metabolic syndrome while considering the influence of anxiety.

Design

This cross-sectional study was conducted at a smoking cessation clinic in Turkey, enrolling individuals who visited the clinic in 2022. The Fagerstrom Test for Nicotine Dependence and the State-Trait Anxiety Inventory were utilized as assessment tools, while metabolic syndrome parameters (body mass index, hypertension, hyperglycemia, dyslipidemia) were evaluated. Smoking status was classified based on pack-years.

Results

The study revealed a dose-dependent relationship between smoking status and essential metabolic factors such as systolic blood pressure (SBP), diastolic blood pressure (DBP), hemoglobin A1c (HbA1c), and low-density lipoprotein (LDL). Notably, triglyceride (TG) levels exhibited a significant increase, particularly at 25 pack years. While anxiety levels did not exhibit a significant correlation with smoking status, they demonstrated an upward trend with increasing SBP and DBP values. Anxiety levels did not exhibit a significant correlation with smoking status.

Conclusions

A significant association was identified between nicotine addiction, as indicated by PY, and both metabolic syndrome parameters and anxiety levels. Early smoking cessation is strongly recommended for current smokers, and former smokers are advised to abstain from smoking to mitigate its adverse effects on metabolic syndrome components. These findings underscore the interconnectedness of cigarette smoking's effects on both physical and mental health, emphasizing the necessity of comprehensive approaches encompassing both metabolic disorder management and mental health support within cessation programs.

Prediction of depressive disorder using machine learning approaches: findings from the NHANES

BACKGROUND

Depressive disorder, particularly major depressive disorder (MDD), significantly impact individuals and society. Traditional analysis methods often suffer from subjectivity and may not capture complex, non-linear relationships between risk factors. Machine learning (ML) offers a data-driven approach to predict and diagnose depression more accurately by analyzing large and complex datasets.

METHODS

This study utilized data from the National Health and Nutrition Examination Survey (NHANES) 2013-2014 to predict depression using six supervised ML models: Logistic Regression, Random Forest, Naive Bayes, Support Vector Machine (SVM), Extreme Gradient Boost (XGBoost), and Light Gradient Boosting Machine (LightGBM). Depression was assessed using the Patient Health Questionnaire (PHQ-9), with a score of 10 or higher indicating moderate to severe depression. The dataset was split into training and testing sets (80% and 20%, respectively), and model performance was evaluated using accuracy, sensitivity, specificity, precision, AUC, and F1 score. SHAP (SHapley Additive exPlanations) values were used to identify the critical risk factors and interpret the contributions of each feature to the prediction.

RESULTS

XGBoost was identified as the best-performing model, achieving the highest accuracy, sensitivity, specificity, precision, AUC, and F1 score. SHAP analysis highlighted the most significant predictors of depression: the ratio family income to poverty (PIR), sex, hypertension, serum cotinine and hydroxycotine, BMI, education level, glucose levels, age, marital status, and renal function (eGFR).

CONCLUSION

We developed ML models to predict depression and utilized SHAP for interpretation. This approach identifies key factors associated with depression, encompassing socioeconomic, demographic, and health-related aspects.

Exploring Nicotine Dependence Among People Using Methamphetamine During Methadone Maintenance Treatment in Vietnam

Introduction

Cigarette smoking is common among individuals with substance use disorders and those undergoing addiction treatment. Cigarette use is highly comorbid with methamphetamine use, and among individuals who co-use methamphetamine and opioids, nicotine dependence may further complicate smoking cessation efforts. This study examines nicotine dependence levels and associated factors among people who use methamphetamine undergoing methadone maintenance treatment (MMT) in Vietnam.

Methods

This cross-sectional analysis utilized baseline data from 667 participants enrolled in a randomized controlled trial designed to evaluate the effectiveness of various combinations of behavioral evidence-based interventions for methamphetamine use among patients on MMT in Vietnam (STAR-OM R01DA050486). Data on levels of nicotine dependence and other covariates including demographic, health status, treatment characteristics and substance use were collected. Nicotine dependence was measured using the Fagerström Test for Nicotine Dependence, with a score of 6 or higher indicating high dependence. Logistic regression estimated the association between nicotine dependence and various psychosocial and behavioral factors.

Results

Overall, 96.7% of the participants were current smokers with 247 of them (38.3%) exhibiting high nicotine dependence. Greater severity of methamphetamine withdrawal symptoms (OR: 1.03; 95% CI: 1.01-1.05) and a high risk of depression, anxiety or stress (OR: 1.76; 95% CI: 1.14-2.72) were associated with increased odds of high nicotine dependence. Conversely, older age at onset of methamphetamine use was associated with lower odds of high nicotine dependence.

Conclusions

Cigarette smoking was highly prevalent among individuals using methamphetamine during MMT, with many exhibiting high nicotine dependence. Providing smoking cessation support with efforts to manage methamphetamine withdrawal symptoms, could help improve cessation outcomes.

Exploring the association between melatonin and nicotine dependence (Review)

Due to the addictive qualities of tobacco products and the compulsive craving and dependence associated with their use, nicotine dependence continues to be a serious public health concern on a global scale. Despite awareness of the associated health risks, nicotine addiction contributes to numerous acute and chronic medical conditions, including cardiovascular disease, respiratory disorders and cancer. The nocturnal secretion of pineal melatonin, known as the 'hormone of darkness', influences circadian rhythms and is implicated in addiction‑related behaviors. Melatonin receptors are found throughout the brain, influencing dopaminergic neurotransmission and potentially attenuating nicotine‑seeking behavior. Additionally, the antioxidant properties of melatonin may mitigate oxidative stress from chronic nicotine exposure, reducing cellular damage and lowering the risk of nicotine‑related health issues. In addition to its effects on circadian rhythmicity, melatonin acting via specific neural receptors influences sleep and mood, and provides neuroprotection. Disruptions in melatonin signaling may contribute to sleep disturbances and mood disorders, highlighting the potential therapeutic role of melatonin in addiction and psychiatric conditions. Melatonin may influence neurotransmitter systems involved in addiction, such as the dopaminergic, glutamatergic, serotonergic and endogenous opioid systems. Preclinical studies suggest the potential of melatonin in modulating reward processing, attenuating drug‑induced hyperactivity and reducing opioid withdrawal symptoms. Chronotherapeutic approaches targeting circadian rhythms and melatonin signaling show promise in smoking cessation interventions. Melatonin supplementation during periods of heightened nicotine cravings may alleviate withdrawal symptoms and reduce the reinforcing effects of nicotine. Further research is required however, to examine the molecular mechanisms underlying the melatonin‑nicotine association and the optimization of therapeutic interventions. Challenges include variability in individual responses to melatonin, optimal dosing regimens and identifying biomarkers of treatment response. Understanding these complexities could lead to personalized treatment strategies and improve smoking cessation outcomes.

Correlations among nicotine dependence, health-related quality of life, and depression in current smokers: a cross-sectional study with a mediation model

Background

Although the negative impact of smoking and health-related quality of life (HRQoL) on depression has been confirmed in various studies, There has been little exploration of how HRQoL mediates the relationship between smoking and depression. The purpose of the current study was to examine the relationship between smoking and depression in the Chinese current smokers with nicotine dependence and the mediating role of HRQoL.

Methods

A cross-sectional study named "Psychology and Behavior Investigation of Chinese Residents" was conducted from July 10 to September 15, 2021 in China. Nicotine dependence, HRQoL and depression were measured by Fagerstrom Test for Nicotine Dependence (FTND), the European Five Dimensional Five Level Health scale (EQ-5D-5L) and the 9-item Patient Health Questionnaire (PHQ-9) respectively. Information on age, gender, place of residence, household registration, education level, marital status, employment status, average family monthly income, drinking frequency, living status, BMI, multiple chronic conditions were also collected. Pearson's correlation test and logistic regression analysis were conducted to explore the association between nicotine dependence, HRQoL and depression and a mediation analysis was applied to explore the mediating effect of the HRQoL on this relationship.

Results

A total of 1,381 current smokers were included in the study. The participants showed a moderate level of nicotine dependence with a mean of 1.36(SD=1.50), a relatively high level of HRQoL scores (Mean=0.94, SD=0.13), and a depression score with a mean of 6.48(SD=6.09). Approximately 22.74% (314/1,381) of the participants were considered to indicate depression. In the univariable regression model, it was found that nicotine dependence was positively associated with depression (OR:1.094, 95%CI: 1.008-1.187), while HRQoL was negatively associated with depression (OR:0.011, 95%CI: 0.004-0.033). In the multivariable regression model, HRQoL was still notably associated with depression (OR:0.008, 95%CI: 0.002-0.027), however, the positive association was not observed between nicotine dependence and depression. The Pearson's correlation test demonstrated that nicotine dependence was negatively correlated with HRQoL(rs= -0.147, P<0.001) and HRQoL was negatively correlated with depression(rs= -0.275, P<0.001). In contrast, nicotine dependence was positively correlated with depression(rs= 0.136, P<0.001). Mediation analysis found that HRQoL moderated the relationship between nicotine dependence and depression with a mediating effect of 26.49%.

Conclusions

The findings support that nicotine dependence is positively associated with depression and HRQoL is negatively associated with depression in current smokers. HRQoL mediated the relationship between nicotine dependence and depression. The well-established imperative interventions aimed at promoting smoking cessation and improving quality of life may benefit for alleviation of depression in current smokers.

Mother's psychopathological conditions and parenting characteristics according to smoke exposure

The study aims to investigate the relationship between maternal smoking and smoke exposure with the mother's parenting attitude and psychopathological conditions in the absence of any health problems in the mother-child pairs. A descriptive form consisting of 27 questions, a "Parental Attitude Scale", and a "Depression, Anxiety, and Stress Scale" was applied by mothers with children aged 2 to 6 years. Of the 450 voluntary mothers included in the study, 107 (23.8%) had environmental smoke exposure and 69 (15.0%) were smokers. The highest quartile of democratic subscores was associated with maternal smoking and smoke exposure when confounding factors were controlled. Compared to non-smokers and unexposed, the adjusted odds ratio of having abnormal anxiety scale subscores was 3.90 [95% CI: 1.69-8.97] for smokers. When parenting types were included, mothers' smoking status and overprotective subscores were found to be associated with anxiety. There is an interaction among mothers' smoking, parenting types, and anxiety scores.

Self-system and mental health status among Malaysian youth attending higher educational institutions: A nationwide cross-sectional study

Introduction

Mental health disorders (MHDs) are a global health burden with an increasing prevalence. During the COVID-19 pandemic, depression was the commonest MHD, followed by anxiety and stress. This nationwide study aimed to determine the prevalence and associated factors of depression, anxiety and stress among Malaysian students attending higher educational institutions.

Methods

A cross-sectional study was conducted from June to December 2021. Institutions were selected via stratified random sampling and students via convenience sampling. A self-administered questionnaire comprising questions on socio-demographic characteristics, academic background, substance abuse, childhood abuse, religiosity and the Depression Anxiety Stress Scale-21 was used. Data were analysed using SPSS version 27; descriptive, point-biserial correlation, chi-square and multiple binary logistic regression analyses were conducted.

Results

Sex and adverse childhood experiences significantly predicted all three MHDs (P<0.05). The students from public institutions (odds ratio [OR]=0.71, 95% confidence interval [CI]=0.56-0.90, P=0.004) had a lower risk of depression than those from private institutions. The smokers/vapers (OR=1.43, 95% CI=1.02-2.02, P=0.041) a higher risk of depression than the non-smokers/non-vapers. The social science students (OR=1.29, 95% CI= 1.01-1.65, P=0.039) had a higher risk of anxiety than the science students. The students who highly engaged in organisational religious activity (OR=0.91, 95% CI=0.84-0.98, P=0.015) had a lower risk of anxiety than their counterparts.

Conclusion

Anxiety is the commonest MHD among Malaysian youth, followed by depression and stress. Childhood abuse is a crucial related factor requiring further attention. Screening, surveillance, preventive measures and comprehensive interventions for MHDs should be initiated among youth.

Smoked tobacco dependence and its correlates among participants attending life skills training and counselling services programme across Karnataka (2017-2022)

Introduction

Indian National Mental Health Survey reports an alarming prevalence of 20.9% for tobacco dependence in India. Dependence on smoked tobacco can be prevented by thorough knowledge of the risk factors associated with it.

Objectives

To estimate the prevalence and identify the factors associated with smoked tobacco dependence among participants attending the life skills training and counselling services programme (LSTCSP) across Karnataka from 2017 to 2022.

Materials and Methods

Pretraining data of 3104 participants from training programmes between 2017 and 2022 were utilised. Univariate and multivariable logistic regression analysis was performed based on a conceptual framework with various hypothesised exposure variables and smoked tobacco dependence as outcome.

Results

The overall prevalence of smoked tobacco dependence among LSTCSP participants who used smoked tobacco products was 59.4%. Ever use of smokeless tobacco products (Adjusted odds ratio (AOR) =2.05, 95% CI: 1.11-3.78) and screening positive for symptoms of generalised anxiety (AOR = 2.53, 95% CI: 1.32-4.84) significantly increased the odds of smoked tobacco dependence, whereas making decisions collectively in the family (AOR = 0.35, 95% CI: 0.18-0.66) and individuals with increased score for neurotic personality traits (AOR = 0.64, 95% CI: 0.44-0.93) were the factors associated with reduced odds of smoked tobacco dependence.

Conclusion

The identified risk factors associated with smoked tobacco dependence are important to develop tobacco control programmes as well as in preventing its onset. With the risk factors for smoked tobacco dependence identified, the results of this study have implications for health promotion and prevention programmes as well as cessation programmes related to smoked tobacco dependence, within India and similar countries.

Maternal and Fetal Outcomes Among Pregnant Women Exposed to Violence

Introduction Domestic violence against women is now widely recognized as a public health issue and a major human rights violation on a global scale. It is a significant risk factor for women's health problems. Pregnancy places a woman under significant physical and psychological pressure, even without additional stressors like abuse. This pressure can have a negative impact on both the mother's and the child's health. This study aims to assess the prevalence of violence among pregnant women and to determine the maternal and fetal outcomes among pregnant women exposed to violence. Materials and methods This cross-sectional study was conducted among 347 postpartum women to assess maternal and fetal outcomes among those who were exposed to violence during their pregnancy. A face-to-face interview was done using one tool with three parts to collect the necessary data. Part one included socio-demographic characteristics and reproductive history for participants, part two included safe and validated dates-physical violence victimization scale, and part three included maternal and fetal outcomes. Result The findings of this study showed that the prevalence of victimization occurred one to three times (28.8%), while 11.5% of victimization occurred four to nine times, and 2.6% of victimization occurred 10 times or more. Many factors play a role in violence, including family income, husband's jobs, husband smoking, being forced into marriage, a higher number of children, and parity. Additionally, it was discovered that adverse pregnancy and fetal outcomes include preterm birth (PTB), early onset of labor, low birth weight (LBW), and neonatal admission to the intensive care unit. Conclusion The result indicates that violence against pregnant women is at a significant rate. Their findings show that there are several factors that may have caused this percentage. Among the factors that contributed to violence in this study were family income, smoking, husbands' work, forced marriage, the number of pregnancies, and the number of children. To reduce violence during pregnancy, it is crucial to empower women, especially those without a source of income of their own. It is also critical to educate partners and foster healthy relationships between partners.