Suicide and Other-Cause Mortality after Early Exposure to Smoking and Second Hand Smoking: A 12-Year Population-Based Follow-Up Study

Early smoking lead to worse prognosis of COPD patients: a real world study

BACKGROUND

Smoking remains a major risk factor for the development and progression of chronic obstructive pulmonary disease (COPD). Due to the adolescent smoking associated with worse health state, the age, at which an individual started smoking, might play a key role in shaping the trajectory of COPD development and the severity.

METHODS

We conducted an observational study from September 2016 through January 2023 of eligible patients hospitalized with COPD. Patients who started smoking during the alveolar development stage (ADS, smoking initiation ≤ 24 years old) were defined as early smoking patients, and patients who started smoking after ADS (smoking initiation > 24 years old) were defined as late smoking patients. We collected demographic and clinical data characterizing the patients and documented their condition from hospital discharge to follow-up. The primary endpoints were short-term (within one year), 3-year, and long-term (beyond 3 years) all-cause mortality after discharge.

RESULTS

Among 697 COPD patients, early smoking patients had a lower smoking cessation rate (P < 0.001) and a higher smoking index (P < 0.001) than late smoking patients. Although adjusted smoking index, early smoking patients still had poorer lung function (P = 0.023), thicker left ventricular diameters (P = 0.003), higher frequency of triple therapy use during stable stage (P = 0.049), and more acute exacerbations in the past year before enrollment (P < 0.05). Survival analysis showed that they had a higher risk of death after discharge within three years (P = 0.004) and beyond three years (P < 0.001). Furthermore, even in early smoking COPD patients who quit smoking after adjusting the smoking index had poorer lung function (P < 0.05) and thicker left ventricular diameters (P = 0.003), and survival analysis also showed that they had a higher long-term mortality rate (P = 0.010) and shorter survival time (P = 0.0128).

CONCLUSION

Early smoking COPD patients exhibited multiple adverse clinical outcomes, including heavy cigarette addiction, compromised pulmonary function, augmented left ventricular diameter, and elevated mortality risk. Additional, smoking cessation could not bring enough improvement of health state in early smoking COPD patients as late smoking COPD patients. Consequently, early intervention and specialized cessation approaches for younger smokers are of paramount importance in this context.

Tobacco smoking, second-hand smoking exposure in relation to psychotic-like experiences in adolescents

BACKGROUND

Previous literature supports that tobacco smoking and second-hand smoking (SHS) exposure were strongly associated with poor mental health in the general population. However, there is a lack of empirical data on the relationship between tobacco smoking, SHS exposure and psychotic-like experiences (PLEs). This study conducted a cross-sectional survey to explore PLEs and the associations of PLEs with tobacco smoking and SHS exposure among adolescents in China.

METHODS

A total sample of 67 182 Chinese adolescents were recruited from Guangdong province in China (53.7% boys, mean age = 12.79 years) from December 17 to 26, 2021. All adolescents have completed self-reported questionnaires on demographic characteristics, smoking status, SHS exposure and PLEs.

RESULTS

Within the sample, only 1.2% of participants had an experience of tobacco smoking while approximately three-fifths reported being exposed to SHS. 10.7% of adolescents reported frequent PLEs over the past month. Adolescents who smoked showed a higher prevalence of PLEs than in non-smoking samples. After controlling for confounders, SHS exposure was a robust risk factor for PLEs with or without the effect of tobacco smoking.

DISCUSSION

These findings support the importance of smoke-free legislation, and anti-smoking measures in educational settings directed at both adolescents and their caregiver, which may decrease occurring rates of PLEs among adolescents.

Is secondhand smoke associated with mental health issues? A narrative review of the evidence and policy implications

Secondhand smoke (SHS) is a well-established cause of lung cancer, respiratory disease, heart disease and developmental issues in children, with an overwhelming evidence base spanning over four decades. In this narrative review, we describe studies which have also linked self-reported or cotinine-assessed SHS exposure in the home, workplace and other settings to mental health disorders including depression, suicide, anxiety, and psychological distress in children and adults, sleeping disorders, Attention Deficit Hyperactivity Disorder and behavioural issues in children, and dementia in older adults. In general, evidence indicates that SHS exposure is associated with these disorders in a dose-response manner, with higher odds reported in people who are exposed to SHS at high levels, frequently, and in the home environment. Most studies so far are cross-sectional albeit in large, nationally representative samples from various countries with a smaller number of longitudinal studies. More research is needed in this area to determine whether SHS is a direct cause of adverse mental health outcomes, and whether creating smokefree environments leads to improved mental wellbeing. In particular, more research is needed on the impact of smokefree home environments, an area which has received relatively little focus in smokefree interventions which generally target public places.

Comparison between cytisine and Nicotine Replacement Therapy in smoking cessation among inpatient psychiatric patients

Introduction: Smoking is more common among people with mental disorders and is associated with adverse effects. Some compounds, including nicotine and cytisine, have been used in many individuals to increase success in smoking cessation. In this study, the effect of cytisine on the smoking status of patients hospitalized in the psychiatry department was investigated.Method: Forty-seven patients, hospitalized in the psychiatry ward, motivated to quit smoking, participated in this open-label randomized trial. Thirty patients used nicotine gums 2 mg (Nicolife®) for eight weeks, and the remaining took cytisine pills (Tabex®) according to the manufacturer's instructions for 25 days. All patients were followed up for six months. The primary outcome was smoking cessation, measured by the mood and physical symptoms scale (MPSS), the AUDIT alcohol consumption questions (AUDIT-C), confirmatory factor analyses, and reliability of the modified cigarette evaluation questionnaire at the end of the 1st week and at 1st, 2nd and 6th months after quit day.Findings: Only two out of 30 patients (6.66%) in the group taking Nicotine Replacement Therapy (NRT) could quit smoking entirely (no cigarettes after six months). In contrast, three out of 17 patients (17.64%) managed to do so in the cytisine group. The number of cigarettes smoked by the patients in both groups decreased, but the reduction was significant in the cytisine group.Conclusion: Cytisine is an effective and suitable agent for smoking cessation in patients with psychological problems, with fewer adverse effects and more success rate compared to NRT.

Second-hand smoke exposure in adolescents in Latin America and the Caribbean: a pooled analysis

Background

Second-hand smoke exposure is prevalent amongst adolescents, despite of being a preventable risk factor associated with unfavourable outcomes. The distribution of this risk factor varies by underlying determinants and public health officers need contemporary evidence to update policies. Using the most recent data available from adolescents in Latin America and the Caribbean (LAC), we described the prevalence of second-hand smoking.

Methods

Pooled analysis of Global School-based Student Health (GSHS) surveys conducted from 2010 to 2018 was conducted. Two indicators were analysed based on information from the 7 days prior to the survey: a) any exposure to second-hand smoking (0 vs ≥1 days of exposure); and b) daily exposure (<7 vs 7 days). Prevalence estimates were carried out accounting for the complex survey design, and reported overall, by country, by sex, and by subregion.

Findings

GSHS surveys were administered in 18 countries, yielding a total of 95,805 subjects. Pooled age-standardised prevalence of second-hand smoking was 60.9% (95% CI: 59.9%-62.0%) with no substantial differences between boys and girls. The age-standardised prevalence of any second-hand smoking varied from 40.2% in Anguilla to 68.2% in Jamaica, and the highest prevalence was in the Southern Latin America subregion (65.9%). Pooled age-standardised prevalence of daily second-hand smoking was 15.1% (95% CI: 14.2%-16.1%), and was higher in girls than boys (16.5% vs 13.7%; p < 0.001). The age-standardised prevalence of daily second-hand smoking ranged between 4.8% in Peru to 28.7% in Jamaica, and the highest age-standardised prevalence was in Southern Latin America (19.7%).

Interpretation

The prevalence of any second-hand smoking is high among adolescents in LAC, though estimates changed substantially by country. While policies and interventions to reduce/stop smoking are implemented, attention should also be paid to avoid second-hand smoke exposure.

Funding

Wellcome Trust International Training Fellowship (214185/Z/18/Z).

Atypical working hours are associated with tobacco, cannabis and alcohol use: longitudinal analyses from the CONSTANCES cohort

BACKGROUND

This study examined prospective associations between atypical working hours with subsequent tobacco, cannabis and alcohol use as well as sugar and fat consumption.

METHODS

In the French population-based CONSTANCES cohort, 47,288 men and 53,324 women currently employed included between 2012 and 2017 were annually followed for tobacco and cannabis use. Among them, 35,647 men and 39,767 women included between 2012 and 2016 were also followed for alcohol and sugar and fat consumption. Three indicators of atypical working hours were self-reported at baseline: working at night, weekend work and non-fixed working hours. Generalized linear models computed odds of substance use and sugar and fat consumption at follow-up according to atypical working hours at baseline while adjusting for sociodemographic factors, depression and baseline substance use when appropriate.

RESULTS

Working at night was associated with decreased smoking cessation and increased relapse in women [odds ratios (ORs) of 0.81 and 1.25], increased cannabis use in men [ORs from 1.46 to 1.54] and increased alcohol use [ORs from 1.12 to 1.14] in both men and women. Weekend work was associated with decreased smoking cessation in women [ORs from 0.89 to 0.90] and increased alcohol use in both men and women [ORs from 1.09 to 1.14]. Non-fixed hours were associated with decreased smoking cessation in women and increased relapse in men [ORs of 0.89 and 1.13] and increased alcohol use in both men and women [ORs from 1.12 to 1.19]. Overall, atypical working hours were associated with decreased sugar and fat consumption.

CONCLUSIONS

The potential role of atypical working hours on substance use should be considered by public health policy makers and clinicians in information and prevention strategies.

Physical exertion at work and addictive behaviors: tobacco, cannabis, alcohol, sugar and fat consumption: longitudinal analyses in the CONSTANCES cohort

We examined the prospective association of physical exertion at work with subsequent tobacco, cannabis, alcohol use, and sugar and fat consumption. Volunteers of the French population-based CONSTANCES cohort currently employed were included from 2012 to 2017 for tobacco and cannabis outcomes (n = 100,612), and from 2012 to 2016 for alcohol and sugar and fat outcomes (n = 75,414). High level of physical exertion at work was defined as a score ≥ 12 at the Rating Perceived Exertion Borg scale. Substance use was self-reported and diet rich in sugar and fat was obtained from principal component analysis and analyzed as quartiles. Generalized linear models computed odds of substance use and sugar and fat consumption at follow-up according to baseline physical exertion at work, while adjusting for sociodemographic factors, depressive symptoms and baseline level of consumption. High physical exertion was associated with tobacco use with dose-dependent relationships. It was also associated with increased odds of cannabis use at least once per month compared to no use in the past and with increased odds of diet rich in sugar and fat. Hence, the role of physical exertion at work on tobacco and cannabis use and diet rich in sugar and fat should be tackled for information and prevention strategies.

Association of heated tobacco product use and secondhand smoke exposure with suicidal ideation, suicide plans and suicide attempts among Korean adolescents: A 2019 national survey

INTRODUCTION

The consumption of heated tobacco products (HTPs) is increasing among adolescents worldwide. Although suicide and HTP use are linked, the association between suicide-related behavior, HTP use, and indirect smoking exposure are not yet properly studied. This study examined the association of HTP use and exposure to secondhand smoke (SHS) with suicidal ideation, suicide plans, and suicide attempts among South Korean adolescents.

METHODS

Data from 57303 respondents (95.3% response rate) were obtained from the 2019 Korean Youth Risk Behavior Web-based Survey. Chi-squared tests and multivariable logistic regression analyses were used to examine the association of HTP use and SHS exposure with suicidal ideation, suicide plans, and suicide attempts among adolescents. Multivariable logistic regression analyses included: Model 1, which was adjusted for demographic characteristics such as sex, school type, perceived school performance, economic status, and residence type; and Model 2, which was adjusted for demographics, depression, and drug use.

RESULTS

The risk of suicidal ideation was 1.37 (95% CI: 1.10–1.70) and 1.44 (95% CI: 1.18–1.75) times higher among HTP users who were exposed to SHS at home and at public places, respectively, compared to non-users. The risk of suicide attempts was 1.88 (95% CI: 1.37–2.57), 1.45 (95% CI: 1.63–2.00), and 2.21 (95% CI: 1.63–3.00) times higher among HTP users exposed to SHS at home, school, and at public places, respectively.

CONCLUSIONS

HTP use, and SHS exposure are likely indicators of risk behaviors. Our findings suggest possible directions for initiating, implementing, and evaluating programs and services to monitor HTP use and SHS exposure among Korean adolescents.

Nicotine Inhalation and Suicide: Clinical Correlates and Behavioral Mechanisms

BACKGROUND AND OBJECTIVES

Extensive evidence links smoking and suicide independently of psychiatric diagnoses, but there are questions about the pathophysiology and specificity of this relationship. We examined characteristics of this linkage to identify potential transdiagnostic mechanisms in suicide and its prevention.

METHODS

We reviewed literature that associated suicide with smoking and e-cigarettes, including the temporal sequence of smoking and suicide risk and their shared behavioral risk factors of sensitization and impulsivity.

RESULTS

Smoking is associated with increased suicide across psychiatric diagnoses and in the general population, proportionately to the number of cigarettes smoked per day. Rapid nicotine uptake into the brain through inhalation of conventional cigarettes, electronic cigarettes (e-cigarette), or even second-hand smoke can facilitate long-term sensitization and short-term impulsivity. Both impair action regulation and predispose to negative affect, continued smoking, and suicidal behavior. Intermittent hypoxia, induced by cigarettes or e-cigarettes, synergistically promotes impulsivity and sensitization, exacerbating suicidality. Two other shared behavioral risks also develop negative urgency (combined impulsivity and negative affect) and cross-sensitization to stressors or to other addictive stimuli. Finally, early smoking onset, promoted by e-cigarettes in never-smokers, increases subsequent suicide risk.

CONCLUSION AND SCIENTIFIC SIGNIFICANCE

Prevention or cessation of nicotine inhalation can strategically prevent suicidality and other potentially lethal behavior regardless of psychiatric diagnoses. Medications for reducing smoking and suicidality, especially in younger smokers, should consider the neurobehavioral mechanisms for acute impulsivity and longer-term sensitization, potentially modulated more effectively through glutamate antagonism rather than nicotine substitution. (Am J Addict 2021;30:316-329).

Association of Tobacco Use and Exposure to Secondhand Smoke With Suicide Attempts Among Adolescents: Findings From 33 Countries

INTRODUCTION

There is evidence to suggest that tobacco use is associated with suicide attempts. However, it is unclear whether such an association can be extended to include secondhand smoke exposure. Using nationally representative data of school-attending adolescents from 33 countries, we examined the association of tobacco use and exposure to secondhand smoke with suicide attempts.

METHODS

We used data from the Global School-based Student Health Survey, a cross-sectional survey conducted among adolescents 12-15 years of age. We used logistic regression to estimate the country-specific associations. We then conducted random effect meta-analyses to obtain overall and country-income level pooled estimates. Lastly, we used logistic regression analyses to investigate a dose-response association of cigarette smoking and exposure to secondhand smoke with suicide attempts.

RESULTS

A positive association between tobacco use and suicide attempts among adolescents was present regardless of country-income level (low income: odds ratio 4.98, 95% CI: 3.11-7.96; lower middle income: 3.47, 2.91-4.15; upper middle income: 3.09, 2.75-3.47; and high income: 3.18, 2.63-3.84) and gender (boys: 3.28, 2.86-3.76; girls: 3.86, 3.30-4.51). Exposure to secondhand smoke was associated with suicide attempts, albeit weakly, among girls only (1.26, 1.14-1.39; boys: 1.00, 0.87-1.15). There was some evidence that a dose-response association of cigarette smoking and exposure to secondhand smoke with suicide attempts may only exist among girls.

CONCLUSIONS

Adolescents who use tobacco, and adolescent girls exposed to secondhand smoke were found to be more likely to attempt suicide; however, future longitudinal studies are warranted to assess causality.

IMPLICATIONS

Our findings indicate that routine screening of adolescents for tobacco use should be implemented globally, especially when assessing suicidal behaviors and risk. Future longitudinal and intervention studies are warranted to assess causality and whether prevention efforts such as tobacco control interventions and programmes targeting tobacco use and exposure to secondhand smoke among adolescents could ultimately lead to a reduction in the occurrence of suicide attempts.

Associated factors for depression, suicidal ideation and suicide attempt among asthmatic adolescents with experience of electronic cigarette use

INTRODUCTION

While electronic cigarette (EC) use is rapidly increasing among asthmatic adolescents, little is known about the links between EC use and depression or suicidality. We assessed associated factors for depression and suicidality in asthmatic adolescents with experience of EC use.

METHODS

We analyzed the data from the 11th to 13th Korea Youth Risk Behavior Web-based Surveys, which were completed from 2015 to 2017. Data were obtained from a stratified, multistage, clustered sample. Students supplied ‘yes or no’ answers to questions about previous asthma diagnosis by a doctor. Associated factors for depression and suicidality were evaluated by logistic regression models after controlling for potential confounding factors. We targeted 203336 adolescents, and 195847 completed the survey.

RESULTS

The proportion of asthma among the respondents was 8.9%. The rate of experience of EC use was higher among asthmatic respondents than non-asthmatic respondents (10.3% vs 8.6%). Asthmatic respondents with experience of EC use had a much higher proportion of negative mental health states including depression and suicidality than subjects without EC experience. In our adjusted models, perception of stress was most strongly associated with depression (adjusted odds ratio, AOR=4.79; 95% CI: 4.12–5.58), and perception of unhappiness was most strongly associated with suicidal ideation (AOR=5.24; 95% CI: 4.51–6.09) and suicide attempt (AOR=4.37; 95% CI: 3.36–5.69).

CONCLUSIONS

Many Korean asthmatic adolescents with experience of EC use report relatively high depression and suicidal behaviors. A multidisciplinary approach, including psychological help, may be required to prevent suicide among this population, especially those who report associated factors.

Associations Between Secondhand Smoke and Mental Health in Korean Adolescents

This study assessed secondhand smoke exposure among nonsmokers and examined its association with mental health in Korean adolescents. We used the 14th Korea Youth Risk Behavior Survey in 2018 to extract data and analyzed 60 040 adolescents through three secondhand smoke exposure categories: home, school, and public places. Mental health included stress, insufficient sleep, depressive symptoms, and suicidal ideation. Secondhand smoke exposure was reported at 23.0% for home, 20.0% for school, and 51.4% for public places. Secondhand smoke exposures were associated with stress insufficient sleep, depressive symptoms, and suicidal ideation. Furthermore, in the stratified analysis, secondhand smoke exposure was related to poor mental health in both nonsmokers and smokers. Based on the results, we concluded that Korean adolescents may experience poor mental health symptoms from being exposed to secondhand smoke.

Association between cigarette use and adolescents' behavior

OBJECTIVE

To determine the prevalence of cigarette use among adolescents and to identify associated health risk behaviors.

METHODS

This is a cross-sectional study with a representative sample, composed of 1059 adolescents between 13 and 19 years old, enrolled in primary and secondary public schools of Olinda, Pernambuco, in 2014. Information was obtained through self-administered questionnaires (validated version of YRBS 2007). Cigarette experimentation was defined as smoking at least once in life. Adolescents who smoked at least one day within 30 days prior to the survey were considered current smokers. Most students were female and 16 years old or older.

RESULTS

Almost 30% used it in life and about 10% smoked within the 30 days before the survey. Suicidal ideation (PR = 1.51, 95%CI 1.25–1.82), alcohol use (PR = 1.41, 95%CI 1.03–1.92), marijuana (PR = 1.64, 95%CI 1.37–1.96), excessive alcohol consumption (PR = 1.57, 95%CI 1.15–2.16) and sexual experience (PR = 1.78, 95%CI 1.43–2.21) have increased the risk of using cigarettes. Feelings of sadness (PR = 1.70, 95%CI 1.22–2.36), alcohol use (PR=2.40, 95%CI 1.12–5.12), excessive alcohol consumption (PR = 2.5, 95% CI 1.24–5.38), marijuana (PR = 2.31, 95%CI.57–3.39) and cocaine (PR = 1.99, 95%CI.32–3.01) increased the risk of cigarette use within the 30 days before the survey.

CONCLUSIONS

Cigarette use among adolescents from Olinda was high, being considered higher than the national prevalence. Possible factors associated with cigarette use were drug use (alcohol, marijuana, and cocaine) and behaviors related to sexual experience, feelings of sadness and suicidal ideation.

Positive Effects of the National Cigarette Price Increase Policy on Smoking Cessation in South Korea

Background

In January 2015, South Korea's government raised the cigarette tax, and the retail price of cigarettes abruptly increased by 80% compared to the previous year. This research aimed to determine the effect of this increase on smoking cessation among South Korean smokers.

Methods

We analyzed data collected by the 2013–2015 South Korea National Health and Nutrition Examination Survey of 15,203 South Koreans over 19 years old using regression analysis. We examined the recent non-smoking period of nonsmoking people, prepared according to the survey, and analyzed the recent smoking cessation ratio.

Results

Among smokers, from 2013 to 2014, the smoking cessation rate was 7.2%, and it increased to 9.9% in 2015 after the increase in the cigarette tax. In 2015, the recent smoking cessation rate was higher among people over the age of 60 (odds ratio [OR], 2.67) compared to those between the ages of 40 and 49. The recent smoking cessation rate was higher among people with below elementary education (OR, 2.28) and above university education (OR, 1.94) compared to high school, higher for those with apartments (OR, 1.74) compared to general type residences, and higher among those with a household income in the low-middle quartile (Q2) (OR, 2.32) compared to the highest quartile (Q4).

Conclusion

This innovative policy including increase in cigarette prices affected smoking cessation, and its impact varied by sub-group of smokers in South Korea.

Suicidality among patients with asthma: A systematic review and meta-analysis

BACKGROUND

Asthma is associated with multiple psychiatric comorbidities. However, the relationship between asthma and suicidality has not be well established.

METHODS

According to the PRISMA guidelines, protocol of the study was registered in the PROSPERO database (CRD42019123150). A systematic search of the PubMed, Embase and PsycINFO databases was performed for relevant studies published from its inception to January 25, 2019. Studies that reported the risk of suicidal ideation, attempts and mortality in asthmatics compared with non-asthmatics were included. A random-effects model was used to synthesize the estimates and the quality of the included studies was assessed under the Newcastle-Ottawa Scale.

RESULTS

Twenty-eight studies including 2,759,841 asthmatic patients and 16,290,362 non-asthmatic controls were pooled and analyzed in the current study. The pooled data showed that asthmatic patients had increased risk of exhibiting suicidal ideation (OR, 1.52; 95%CI, 1.37-1.70), suicide attempts (OR, 1.60; 95%CI, 1.33-1.92) and suicide mortality (OR, 1.31; 95%CI, 1.11-1.55) compared to non-asthmatic controls. Noticeably, adolescent asthmatic patients had a more than 2-fold risk of suicide mortality compared to non-asthmatic controls (OR, 2.14; 95%CI, 1.61-2.83).

LIMITATIONS

The limitations of the present study were variability in study designs and various measures of asthma and suicidality, which possibly contribute to notable heterogeneity.

CONCLUSIONS

Patients with asthma have a significantly increased risk of suicidal ideation, suicide attempts and suicide mortality. Clinical physicians should pay more attention to the increased risk of suicidality in asthmatics, screen for these suicidal thoughts and behaviors, and make appropriate mental health referrals when necessary.

The association of religiosity with suicidal ideation and suicide attempts in the United Kingdom

OBJECTIVE

The goal was to analyze the association of religiosity with suicidal ideation and suicide attempts in a UK nationally representative sample.

METHODS

This study used cross-sectional data from 7403 people who participated in the 2007 Adult Psychiatric Morbidity Survey (APMS). Religion was assessed with the question 'Do you have a specific religion?' with 'yes' and 'no' answer options. Lifetime and past 12-month suicidal ideation and suicide attempts were assessed. The association between religiosity and suicidality was studied in multivariable logistic regression models adjusted for sociodemographic, behavioural, and psychopathological factors.

RESULTS

Compared to those without a religion, the prevalence of past 12-month suicidal ideation (3.2% vs. 5.4%), past 12-month suicide attempts (0.4% vs. 0.9%), lifetime suicidal ideation (11.2% vs. 16.4%), and lifetime suicide attempts (3.6% vs. 6.0%) was lower among those with a religion. In the fully adjusted model, having a religion was significantly associated with lower odds for all types of suicidality except past 12-month suicide attempts: suicidal ideation (past 12-month: OR = 0.71, 95% CI = 0.51-0.99; lifetime: OR = 0.83, 95% CI = 0.69-0.99) and suicide attempts (past 12-month: OR = 0.71, 95% CI = 0.35-1.45; lifetime: OR = 0.69, 95% CI = 0.53-0.90).

CONCLUSION

There is a negative association between religiosity and suicidality in the UK. Future studies should focus on the underlying mechanisms.

Secondhand Smoking Is Associated with Poor Mental Health in Korean Adolescents

In Korea, the prevalence of depression is increasing in adolescents and the most common cause of death of adolescents has been reported as suicide. At a time of increasing predicament of mental health of adolescents, there are few studies on whether secondhand smoking is associated with mental health in adolescents. The objective of this study was to determine whether exposure to secondhand smoke is associated with mental health-related variables, such as depression, stress, and suicide, in Korean adolescents. Data from the eleventh Korea youth risk behavior web-based survey, a nationally representative survey of 62,708 participants (30,964 males and 31,744 females), were analyzed. For students of aged 12 to 18 years, extensive data including secondhand smoking, mental health, sociodemographic variables, and physical health were collected. Chi-square analysis, multiple logistic regression analysis and ordered logistic regression analysis were performed to estimate the association and dose-response relation between secondhand smoking and mental health. Compared with the non-exposed group, the odds ratios (OR) of depression, stress, suicidal ideation, suicidal planning and suicidal attempt in the secondhand smoking exposed group were 1.339, 1.192, 1.303, 1.437 and 1.505, respectively (all P < 0.001). When subjects were classified into two secondhand smoke exposure groups, with increasing secondhand smoking experience, higher was the OR for each mental health related variable, in a dose-response relation. Our findings suggest that secondhand smoking is associated with poor mental health such as depression, stress, and suicide, showing a dose-response relation in Korean adolescents.

Job exposure to the public in relation with alcohol, tobacco and cannabis use: Findings from the CONSTANCES cohort study

Objectives

To examine the associations between job exposure to the public (e.g., customers, guests, users of a public service, patients) and alcohol, tobacco and cannabis use.

Methods

From the French population-based CONSTANCES cohort, 16,566 men and 17,426 women currently working were included between 2012 and 2016. They reported their exposure to the public (daily versus no daily), and among the daily exposed participants (10,323 men and 13,318 women), the frequency of stressful exposure (often versus rarely). Dependent variables were: chronic alcohol consumption (<1(1), 1-27(1–13), 28-42(14–28), >42(28) drinks per week in men(women)), heavy episodic drinking (never, at most once a month, more than once a month), alcohol use risk with Alcohol Use Disorders Identification Test (mild, dangerous, problematic or dependence), tobacco use (non-smoker, former smoker, 1–9, 10–19, >19 cigarettes per day) and cannabis use (never, not in past year, less than once a month, once a month or more). Logistic regressions provided odds ratios of substance use, stratifying for gender and adjusting for sociodemographic confounders, depression, effort-reward imbalance and perceived health status.

Results

Exposed men had higher risks of alcohol (chronic alcohol consumption, heavy episodic drinking and alcohol use risk), tobacco and cannabis use. Exposed women had higher risks of tobacco and cannabis use. In men, stressful exposure was associated with increased risks of heavy episodic drinking, tobacco and cannabis use. In women, stressful exposure was associated with increased risks of chronic alcohol consumption, alcohol use risk, tobacco and cannabis use. All these findings remained significant in multivariable analyses, taking into account sociodemographic variables, depressive symptoms, perceived health status and effort-reward imbalance.

Conclusions

Interventions to reduce emotional job demand should systematically integrate assessment and prevention measures of addictive behaviors. Vulnerable workers may be offered more specific interventions to reduce the impact of exposure to the public on their substance use.

Global trends in suicide epidemiology

PURPOSE OF REVIEW

Suicide is a major cause of mortality accounting for nearly 1 million deaths globally per year. Suicide occurs throughout the lifespan; therefore, large epidemiological samples are needed to identify patterns in suicide death. This review examines emerging evidence relating to risk and protective factors as well as preventive measures for suicide.

RECENT FINDINGS

The global financial crisis, natural disasters, air pollution and second-hand smoke have all been associated with increased suicide rates. At an individual level, past self-harm, parental loss or separation and younger age relative to classmates all confer risk. There is mixed evidence for religious affiliation and lithium levels in drinking water as protective factors. Means restriction strategies including barriers at suicide hotspots, firearms restrictions and limiting access to both pesticides and charcoal have all prevented suicide. Other interventions with recent evidence include improvements in mental health systems, selective serotonin reuptake inhibitor (SSRI) and lithium treatment in youth and mental health awareness in schools.

SUMMARY

The evidence for risk/protective factors for suicide continues to grow and, more importantly, numerous prevention efforts continue to demonstrate positive outcomes. Public policy experts should attend to the environmental and social determinants of health when devising suicide prevention programs, and the evidence-based prevention strategies identified here should be implemented more broadly.

Medications between psychiatric and addictive disorders

INTRODUCTION

Many epidemiological studies have revealed a frequent co-occurrence of psychiatric and substance use disorders. The term used in the literature to refer to this co-occurrence is dual diagnosis. The high prevalence of dual diagnosis has led physicians to observe the effects of medication prescribed to treat psychiatric disorders on the co-occurring substance use disorder and vice versa. The concept of medications between psychiatric and addictive disorders stems from these clinical observations, alongside which, however, it has developed from the observation that both psychiatric and substance use disorders share common neurobiological pathways and trigger common cognitive disorders. This has led researchers to develop medications on the basis of neurobiological and cognitive rationales.

MATERIAL AND METHOD

In our article, we review peculiar medications based on neurobiological and cognitive rationales and that have an impact in both psychiatric and addictive disorders.

RESULTS

We highlight how interesting these new prescriptions are for clinical observation and for the treatment of patients suffering from dual diagnosis.

CONCLUSION

We then go on to discuss the interest in them from the perspective of clinical practice and clinical research, in that the development of medications to treat dual diagnosis helps to further our knowledge of both psychiatric and substance use disorders.

Household Factors Associated with Self-Harm in Johannesburg, South African Urban-Poor Households

Introduction

Low and middle income countries bear the majority burden of self-harm, yet there is a paucity of evidence detailing risk-factors for self-harm in these populations. This study aims to identify environmental, socio-economic and demographic household-level risk factors for self-harm in five impoverished urban communities in Johannesburg, South Africa.

Methods

Annual serial cross-sectional surveys were undertaken in five impoverished urban communities in Johannesburg for the Health, Environment and Development (HEAD) study. Logistic regression analysis using the HEAD study data (2006–2011) was conducted to identify household-level risk factors associated with self-harm (defined as a self-reported case of a fatal or non-fatal suicide attempt) within the household during the preceding year. Stepwise multivariate logistic regression analysis was employed to identify factors associated with self-harm.

Results

A total of 2 795 household interviews were conducted from 2006 to 2011. There was no significant trend in self-harm over time. Results from the final model showed that self-harm was significantly associated with households exposed to a violent crime during the past year (Adjusted Odds Ratio (AOR) 5.72; 95% CI 1.64–19.97); that have a member suffering from a chronic medical condition (AOR 8.95; 95% 2.39–33.56) and households exposed to indoor smoking (AOR 4.39; CI 95% 1.14–16.47).

Conclusion

This study provides evidence on household risk factors of self-harm in settings of urban poverty and has highlighted the potential for a more cost-effective approach to identifying those at risk of self-harm based on household level factors.