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Private space second-hand smoke exposure and the mental health of non-smokers: A cross-sectional analysis of Canadian adults

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... Conversely, former smokers and non-smokers showed a significant correlation. This finding can be elucidated by studies indicating that non-smokers exposed to secondhand smoke may experience heightened sensitivity to stress and pain 22 . Unlike depression, which is characterized by a tendency to recall negative memories and a diminished response to positive stimuli, anxiety differs by not avoiding or suppressing positive stimuli 13 . ...
... These findings hold implications for addressing the mental health challenges faced by adolescents via policy measures, particularly regarding the diverse activities engaged in by adolescents, such as exposure to secondhand smoke in various public settings, which can influence the prevalence of anxiety 22 . Further research may elucidate the underlying mechanisms between secondhand smoke exposure and anxiety from a longitudinal viewpoint while considering any potential confounding variables that may impact the observed associations. ...
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INTRODUCTION Adolescents are especially susceptible to the harmful effects of secondhand smoke exposure. Mental health issues may be one of these negative consequences. This study aimed to explore the association between secondhand smoke exposure and anxiety among Korean adolescents. METHODS This study used the nationwide representative cross-sectional data obtained from the 4-year (2020-2023) Korea Youth Risk Behavior Survey. In total, 214514 individuals aged 12–18 years were included in this study (109910 males and 104604 females). Secondhand smoke exposure was assessed based on responses to questions concerning the days they were exposed (at home and in public places), while anxiety levels were measured using the Generalized Anxiety Disorder 7 scale. Multivariable logistic regression analysis divided by sex was performed to explore the association (p=0.0173 for interaction by secondhand smoke exposure and sex), and adjusted odds ratios (ORs) with 95% confidence intervals (CI) were calculated. RESULTS Among the study population, 8.8% of the male and 15.6% of the female participants had anxiety. After adjusting for covariates, adolescents with secondhand smoke exposure had a higher likelihood of reporting anxiety than those without the exposure (male, OR=1.23; 95% CI: 1.16–1.29; female, OR=1.27; 95% CI: 1.21–1.33). In additional stratified analyses, this association was more prominent among those who were never smokers, were exposed for more days, and had severe levels of anxiety. CONCLUSIONS This study found that secondhand smoke exposure was associated with anxiety in adolescents; hence, proper political interventions to reduce secondhand smoke exposure may be required.
... It has been shown that non-smokers reporting substantial SHS exposure are nearly 50% more likely to experience psychological distress [20]. The relationship between SHS exposure and increased rates of internalizing problems such as depression, anxiety, and panic attacks has been found in the US [21,22], Korea [23][24][25][26][27][28], Canada [29], Germany [30], Japan [31,32], and China [33,34], with some demonstrating dose-response relationships [34]. A growing literature suggests that vaping e-cigarettes is independently associated with increased rates of depressive symptoms specifically [35][36][37][38][39], and internalizing disorders broadly [40][41][42][43][44][45]. ...
... This is the first study that we are aware of to identify an association between recent exposure to secondhand e-cigarette emissions and moderate to severe internalizing problems, and the risk was found to be comparable to that of SHS exposure in this large, nationally representative sample of the US adult population. Consistent with the literature on combustible cigarette smoking [56][57][58][59][60], SHS exposure [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34], and more recently e-cigarette use [35,39,61,62], the data in the current study indicate that every category of tobacco product use or exposure assessed was associated with an increased likelihood of mental health problems. Of all categories of tobacco use/ exposure, dual users of combustible and e-cigarettes had the highest risk. ...
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Background Cigarette smoking, secondhand cigarette smoke (SHS) exposure, and e-cigarette use (“vaping”) are each associated with increased rates of depressive symptoms and other internalizing mental health disorders. The prevalence of vaping has increased greatly, yet the mental health correlates of secondhand exposure to e-cigarette emissions are as yet to be investigated. This study examined the potential adverse mental health outcomes associated with different tobacco exposures (direct and passive), with a particular focus on the mental health correlates of secondhand exposure to e-cigarette emissions. Methods The Population Assessment of Tobacco and Health Study data collected from a sample of 16,173 Wave 4 adults were used to test the hypothesis that secondhand e-cigarette emissions exposure is associated with increased odds of internalizing mental health disorders. Individuals were categorized as exclusive cigarette smokers, exclusive e-cigarette users, cigarette and e-cigarette dual users, exclusive noncombustible tobacco users, secondhand smoke exposed non-users, secondhand e-cigarette emissions exposed non-users, and non-users with no current SHS/secondhand e-cigarette aerosol exposure. Adjusted weighted logistic regression analysis was used to investigate the association between exposure type and internalizing problems as assessed by scores on the Global Appraisal of Individual Needs-Short Screener (GAIN-SS), a widely used instrument for assessing mental health problems. Results Cigarette smokers (AOR = 2.53, 95% CI: 2.19–2.92), e-cigarette users (AOR = 3.14, 2.41–4.09), dual users (AOR = 3.37, 2.85–4.00), noncombustible tobacco users (AOR = 1.48, 1.01–2.17), SHS exposed non-users (AOR = 1.63, 1.37–1.94), and secondhand e-cigarette emissions exposed non-users (AOR = 1.43, 1.03–1.99) were each associated with increased odds of moderate to severe internalizing mental health problems as compared to unexposed non-users. Odds of internalizing problems among SHS and secondhand e-cigarette emissions exposed non-users did not differ ( p = 0.46). Conclusions This is the first study, to our knowledge, to identify an association between recent secondhand exposure to e-cigarette emissions and mental health problems, and the risk is comparable to that of SHS. Corroboration of this relationship needs further research to explicate directionality and mechanisms underlying this association.
... Three of these studies used blood or salivary cotinine as biomarkers of exposure [81][82][83]. Of 14 studies that determined SHS exposure by questionnaire [84][85][86][87][88][89][90][91][92][93][94][95][96][97], 5 of these were among pregnant women [87][88][89][90]97] and 1 specifically examining post-partum depression [88]. Two of the pregnancy studies were in Taiwan where maternal smoking during pregnancy is illegal, presumably increasing the likelihood that mothers truly did not smoke during pregnancy and so were only exposed to SHS [89,90]. ...
... Eight of the studies were cohort studies, 2 randomized experiments, 1 case-crossover, 1 casecontrol, and 1 time-series study. Two studies used anxiety diagnosis as indicated by ICD codes in hospital records [57,106], and 3 were based on self-reported diagnosis or symptoms [92,107,108]. Other studies used various anxiety measurement scales, including the State-Trait Anxiety Inventory (STAI) (n = 6), CIDI (n = 5), Brief Symptom Inventory (BSI) (n = 2), Crown-Crisp Index (CCI) (n = 2), HADS (n = 2), Profile of Mood States (POMS) (n = 2), Symptom Checklist-90 (SCL-90) (n = 2), GHQ (n = 1), Beck's Anxiety Inventory (BAI) (n = 1), Generalized Anxiety Disorder scale (n = 1), CES-D (n = 1), and the World Health Organization Neurobehavioral Core Test Battery (WHO-NCTB) (n = 1). ...
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Purpose of review: Despite a call for better understanding of the role of environmental pollutant influences on mental health and the tremendous public health burden of mental health, this issue receives far less attention than many other effects of pollutants. Here we summarize the body of literature on non-occupational environmental pollutant exposures and adult depression, anxiety, and suicide-in PubMed, Embase, Web of Science, and PsychINFO through the end of year 2018. Recent findings: One hundred twelve articles met our criteria for further review. Of these, we found 88 articles on depression, 33 on anxiety, and 22 on suicide (31 articles covered multiple outcomes). The earliest article was published in 1976, and the most frequent exposure of interest was air pollution (n = 33), followed by secondhand smoke (n = 20), metals (n = 18), noise (n = 17), and pesticides (n = 10). Other exposures studied less frequently included radiation, magnetic fields, persistent organic pollutants (POPs), volatile organic compounds, solvents, and reactive sulfur compounds. The current literature, although limited, clearly suggests many kinds of environmental exposures may be risk factors for depression, anxiety, and suicide. For several pollutants, important limitations exist with many of the studies. Gaps in the body of research include a need for more longitudinal, life-course studies, studies that can measure cumulative exposures as well as shorter-term exposures, studies that reduce the possibility of reverse causation, and mechanistic studies focused on neurotoxic exposures.
... Most previous studies examining this association have focused on adults. In general, previous studies of adults have revealed detrimental consequences of SHS exposure such as depression (Nakata et al., 2008;Taha & Goodwin, 2014), poor mental health (Asbridge, Ralph, & Stewart, 2013;Hamer, Stamatakis, & Batty, 2010;Shiue, 2014;Sobotova, Liu, Burakoff, Sevcikova, & Weitzman, 2011), high perceived stress (Asbridge et al., 2013), and risk of future mental illness (Hamer et al., 2010). Similarly, previous studies of non-smoking youth have shown harmful effects of SHS exposure on mental health, including depression, anxiety disorder, ADHD, conduct disorder, and psychological distress Hamer et al., 2011;K. ...
... Most previous studies examining this association have focused on adults. In general, previous studies of adults have revealed detrimental consequences of SHS exposure such as depression (Nakata et al., 2008;Taha & Goodwin, 2014), poor mental health (Asbridge, Ralph, & Stewart, 2013;Hamer, Stamatakis, & Batty, 2010;Shiue, 2014;Sobotova, Liu, Burakoff, Sevcikova, & Weitzman, 2011), high perceived stress (Asbridge et al., 2013), and risk of future mental illness (Hamer et al., 2010). Similarly, previous studies of non-smoking youth have shown harmful effects of SHS exposure on mental health, including depression, anxiety disorder, ADHD, conduct disorder, and psychological distress Hamer et al., 2011;K. ...
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This study examined the association between household secondhand smoke exposure (HSHSE) and health status among non-smoking adolescents in Korea using two subsamples obtained from nationally representative cross-sectional secondary data: males (n = 25,653) and females (n = 31,187). Two self-reported HSHSE measures included exposure to household secondhand smoke during the week before the survey (yes or no) and number of days of HSHSE (1–7 days); and five self-reported health problems included asthma, perceived stress, depression, suicidal ideation, and self-rated health. For each subsample, this study performed (1) multivariate logistic regressions to examine HSHSE effects on asthma, depression, and suicidal ideation; and (2) multiple linear regressions to examine HSHSE effects on perceived stress and self-rated health. The rate and number of days of HSHSE were significantly higher among females (30.1% and 3.4 days) than among males (25.9% and 3.1 days). In both subsamples, HSHSE was associated with all five health problems (ORs 1.15–1.32; βs: 0.04–0.14). An increase in the number of days of HSHSE was positively associated with (1) greater perceived stress and poorer self-rated health in both subsamples (βs: 0.01–0.04), and (2) greater odds of asthma, depression, and suicidal ideation in the female subsample (ORs 1.03–1.12). Given the findings related to the strong associations (1) between HSHSE and physical, mental, and general health problems; and (2) between days of HSHSE and a greater number of health problems in females, health professionals should actively implement interventions that encourage adult smokers to stop smoking in their homes.
... Studies have established a significant association between SHS exposure and psychological distress, compounded by the potential impacts of nicotine on blood pressure and heart rate. 5,6 Long-term exposure to SHS further diminishes dopamine receptor availability, with dopamine levels linked to heightened rates of mental health issues such as depression and anxiety. 7,8 Globally, SHS exposure poses a significant public health threat across diverse populations. ...
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Despite extensive global research on second-hand smoking (SHS) exposure, there is a noticeable lack of studies focusing on the knowledge and attitudes of university students in Bangladesh. This cross-sectional study aimed to address this gap by assessing the levels of knowledge and attitudes towards SHS exposure among university students in Bangladesh. Utilizing a convenience sampling technique, data were collected from 383 university students, encompassing socio-demographic information, as well as knowledge and attitude-related inquiries. Statistical analyses were conducted using SPSS software, including independent t-tests and analysis of variance (ANOVA) and multiple linear regression. The findings revealed that participants exhibited a moderate level of knowledge and attitude towards SHS exposure. Multiple linear regression identified age, gender, mother’s education, and self-rated health status as significant predictors of knowledge, explaining 12.9% of its variance (R² = 0.129, F = 6.117, P < .001). Furthermore, age, gender, and living with parents emerged as significant predictors of attitude, explaining 14.7% of its variance (R² = 0.147, F = 7.165, P < .001). The study highlights the need for interventions aimed at enhancing awareness and fostering positive attitudes towards SHS exposure among university students in Bangladesh. It is recommended that university authorities organize seminars and implement health education initiatives targeting vulnerable populations to address the findings and promote a smoke-free environment on campus.
... These results are in line with existing research that has demonstrated a higher risk of mood and anxiety disorders among smokers compared to non-smokers [149,154]. Canadian studies have specifically linked passive smoking to anxiety disorders, while other research has associated depression with passive smoking [155][156][157]. These findings underscore the importance of addressing smoking cessation and providing mental health support for arthritis management. ...
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Arthritis is associated with health challenges. Lifestyle traits are believed to influence arthritis development and progression; however, data to support personalized treatment regimens based on holistic lifestyle factors are missing. This study aims to provide a comprehensive list of associations between lifestyle traits and the health status of individuals with arthritis in the Canadian population, using binary logistic regression analysis on data from the Canadian Community Health Survey, which includes 104,359 respondents. Firstly, we explored the association between arthritis and various aspects of health status including self-reported lifestyle factors. Secondly, we examined the associations between self-reported dietary intake and smoking status with general, mental, and oral health, and sleep disturbance among individuals both with and without arthritis. Our analysis revealed that individuals with arthritis reported considerably poorer general, mental, and oral health, and poorer sleep quality compared to those without arthritis. Associations were also found between self-reported dietary intake and various measures of health status in individuals with arthritis. Smoking and exposure to passive smoking were associated not only with arthritis but also with compromised sleep quality and poorer general, mental, and oral health in people with and without arthritis. This study highlights the need for personalized and holistic approaches that may include a combination of dietary interventions, oral health improvements, sleep therapies, and smoking cessation for improved arthritis prevention and care.
... Większe prawdopodobieństwo wystąpienia depresji stwierdzono u kobiet, ale nie u mężczyzn. Badanie w populacji kanadyjskiej ujawniło, że narażenie na bierne palenie wśród osób niepalących korelowało z częstszymi zaburzeniami lękowymi, gorszą subiektywną oceną zdrowia psychicznego i poziomu stresu, nie miało natomiast związku z zaburzeniami nastroju [38]. Przegląd badań i wyniki badania populacyjnego w Chinach wykazały, że bierne palenie może być uważane za ważny czynnik ryzyka zaburzeń poznawczych u osób starszych [39]. ...
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Palenie tytoniu i uzależnienie od nikotyny są nadal jedną z głównych przyczyn szeregu poważnych i skracających życie schorzeń somatycznych. Jednocześnie są bardziej rozpowszechnione u chorych psychicznie niż w populacji ogólnej. W niniejszej pracy, która stanowi część pierwszą rekomendacji Polskiego Towarzystwa Psychiatrycznego, przedstawiono skalę zjawiska w populacji ogólnej i wśród osób z zaburzeniami psychicznymi, kryteria rozpoznawania uzależnienia i zespołu abstynencyjnego. Omówiono wpływ palenia tytoniu i ekspozycji na dym tytoniowy na rozwój i przebieg zaburzeń psychicznych, a także na przebieg leczenia zaburzeń psychicznych, w tym interakcje nikotyny z lekami psychotropowymi. Wielu pacjentów z zaburzeniami psychicznymi jest w stanie ograniczyć palenie lub uzyskać całkowitą abstynencję, jeśli zaoferuje im się adekwatną pomoc terapeutyczną. Wbrew powszechnej opinii, zaprzestanie palenia tytoniu i leczenie uzależnienia od nikotyny nie wpływa negatywnie na objawy zaburzeń psychicznych; stan psychiczny pacjentów może ulegać poprawie w efekcie terapii antynikotynowej. Najlepsze efekty pod względem utrzymania abstynencji daje zintegrowane z leczeniem psychiatrycznym podejście łączące farmakoterapię z interwencją psychoterapeutyczną.
... Pregnant women exposed to SHS had a higher anxiety or depression rate (57.4%) than those exposed to THS (50.3%), which was strongly related to psychological health problems. Preceding findings have shown that exposure to SHS can lead to mentally stressful living environments, while chronic stress or other comorbidities may increase the risk of prevalence of mental disorders [57,58], indicated a strong correlation between exposure to SHS and negative health effects (such as cancer, respiratory diseases), and all these diseases may lead to depression through direct and indirect multi-step processes. Besides, there was a strong evidence that major depression had close association with SHS exposure [59]. ...
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Background With the increase of the number of smokers, tobacco exposure among pregnant women is becoming more and more common. Pregnant women exposed to first-hand smoke and second-hand smoke are susceptible to physiological and psychological health issues has been proved in previous studies. Nevertheless, there are no enough studies focus on the impact of third-hand smoke during pregnancy. This study aimed to assess and compare health-related quality of life for pregnant women with exposure to first-hand smoke, second-hand smoke, third-hand smoke and non-exposure to tobacco in mainland China. Methods National-based cross-sectional study is based on a questionnaire survey which collects information including demographics, smoking behaviors and self-evaluation. All questionnaires were delivered and collected from August to September 2019. EuroQol group’s visual analog scale and EuroQoL Five-dimension Questionnaire were used to collect data in mainland China. Results Totally, 15,682 pregnant women were included in this study, among which non-exposure to smoke were 7564 (48.2%), exposed to first-hand smoke, second-hand smoke and third-hand smoke were 89 (0.6%), 2349 (15.0%), and 5680 (36.2%) respectively. Pregnant women without tobacco exposure had the highest EuroQol group’s visual analog scale score (mean value = 85.4[SD = 14.0]), while those with first-hand smoke had the lowest score (mean value = 77.4[SD = 22.2]). Among all five dimensions of EuroQoL Five-dimension Questionnaire, there were significant differences of EQ-index among groups with different tobacco exposure in usual activity and anxiety or depression dimensions (p < 0.001). Conclusions Third-hand smoke exposure had close relationship with low health-related quality of life in pregnant women. Moreover, second-hand smoke exposure significantly led more problems on mental dimension of pregnant women.
... Pregnant women exposed to SHS had a higher anxiety or depression rate (57.4%) than those exposed to THS (50.3%), which was strongly related to psychological health problems. Preceding findings have shown that exposure to SHS can lead to mentally stressful living environments, while chronic stress or other comorbidities may increase the risk of prevalence of mental disorders, [56,57] indicated a strong correlation between exposure to SHS and negative health effects (such as cancer, respiratory diseases), and all these diseases may lead to depression through direct and indirect multi-step processes. Besides, there was a strong evidence that major depression had close association with SHS exposure. ...
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Background With the increase of the number of smokers, tobacco exposure among pregnant women is becoming more and more common. Though that pregnant women exposed to first-hand smoke and second-hand smoke are susceptible to physiological and psychological health issues has been proved in previous studies, there are no enough studies focus on the impact of third-hand smoke. This study aimed to assess and compare health-related quality of life for pregnant women with exposure to first-hand smoke, second-hand smoke, third-hand smoke and non-exposure to tobacco in mainland China. Methods National-based cross-sectional study is based on a questionnaire survey which collects information including demographics, smoking behaviors and self-evaluation. All questionnaires were delivered and collected from August to September 2019. EuroQol group’s visual analog scale and EuroQoL Five-dimension Questionnaire were used to collect data in mainland China. Results Totally, 15682 pregnant women were included in this study, among which non-exposure to smoke were 7564 (48.2%), exposed to first-hand smoke, second-hand smoke and third-hand smoke were 89 (0.6%), 2349 (15.0%), and 5680 (36.2%) respectively. Pregnant women without tobacco exposure had the highest EuroQol group’s visual analog scale score (mean value=85.4[SD=14.0]), while those with first-hand smoke had the lowest score (mean value=77.4[SD=22.2]). Among all five dimensions of EuroQoL Five-dimension Questionnaire, there were significant differences of EQ-index among groups with different tobacco exposure in usual activity and anxiety or depression dimensions (p<0.001). Conclusions Third-hand smoke exposure had close relationship with low health-related quality of life in pregnant women. Moreover, second-hand smoke exposure significantly led more problems on mental dimension of pregnant women.
... It should be pointed out that the association between passive smoking and depression may be explained by several mechanisms. A previous study found that inhome exposure to secondhand smoke may be an indication of a stressful living environment (Asbridge, Ralph, & Stewart, 2013). Living in a stressful household can increase the risk of depression. ...
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Background: Passive smoking is a significant public health problem worldwide. The aim of this study was to examine the association between passive smoking and women’s depression. Methods: Data for this study were obtained from the China Health and Retirement Longitudinal Study (CHARLS), and panel data analysis was applied. Data from a total of 10,498 Chinese women were selected for analysis, including 2,919 who were interviewed in 2011, 3,490 in 2013, and 4,089 in 2015. Results: Passive smoking was found to be significantly associated with depression. Compared with those living in nonsmoking households, women who had lived with a smoking husband for over 20 years had significantly more depressive symptoms. In addition, compared with individuals with lower educational levels, and residing in nonsmoking households, those with more education were less likely to develop depression, although exposed to smoking. Conclusions: The results suggest that passive smoking within households is a risk factor for depression among Chinese women. Smoke-free policies should be promoted, to help push forward tobacco control in China. Provision of more educational opportunities for Chinese women should also be promoted, as these will also help to protect them against the negative effects brought on by passive smoking. Abbreviations: CHARLS: China health and retirement longitudinal study; CES-D: center for epidemiological studies depression Scale; SES: socio-economic status
... [2][3][4][5][6] Smokers in homes that are partial or fully smoke-free tend to smoke fewer cigarettes per day and have a higher motivation to quit smoking. 7,8 Meanwhile, nonsmoking members of such households report lower exposure to second-hand smoke, 9,10 higher overall perceived health and well-being, 11 and have lower intentions to become future smokers. 12 Although the literature has shown a consistent relationship between living in a smoke-free home and smoking behaviours among adults, the effect of smoke-free homes on adolescent smoking remains less clear, in part due to an adolescent's inability to control the implementation of smoke-free home rules and the strong influence that adult behaviour plays in modelling smoking behaviour for youth. ...
Article
Background: Research has shown that living in a smoke-free home has a positive effect on adolescents' perceived acceptance of smoking. However, the relationship between smoke-free homes and adolescent smoking behaviours remains unclear. The aim of this study was to examine the association between smoke-free homes and smoking susceptibility among high school students, and to determine whether these associations persist when analyses are stratified by familial smoking status. Methods: We conducted a random cross-sectional survey (2012/2013 Youth Smoking Survey) of primary, junior and high school students in Canada (n = 47 203). Multivariable logistic regression analyses were used to examine the associations between smoke-free homes and susceptibility to smoking among never-smoking high school students, with and without stratification by familial smoking. Results: Analyses showed that adolescents living in a smoke-free home had reduced odds of being susceptible to smoking (odds ratio [OR] 0.582, 95% confidence interval [CI] 0.428-0.791) compared with their peers living in households where smoking was permitted. When adolescents had other family members who were smokers, having a smoke-free home was not significantly associated with reduced smoking susceptibility (OR 0.878, 95% CI 0.721-1.071). Interpretation: Our results suggest that smoke-free homes may influence future smoking initiation. Optimal success in preventing youth smoking uptake necessitates having a coherent antismoking message between the home smoking environment and familial smoking behaviour.
... This increase in stress among smokers may have been associated with the effects of nicotine. Smokers undergo physical changes associated with smoking that are similar to those that occur when people experience stress [33][34][35], as nicotine leads to increased heart rate, blood pressure, and breathing rate [26]. Thus, the chronically high nicotine levels in the bodies of smokers compared to non-smokers may mean that smokers have a greater physical reaction to SHS exposure that makes them feel more stressed. ...
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Background Secondhand Smoking (SHS) has been suggested as a major health problem in the world and is known to cause various negative health effects that have in turn caused the deaths of almost 600,000 people per year. Evidence has suggested that SHS may have an effect on health problems and such findings have influenced the implementation of smoking-free areas. However, few studies have investigated the effects of SHS on stress which is considered major risk factor for mental health. Thus, the purpose of our study was to investigate the association between exposure to SHS and stress. Methods We performed a cross-sectional study using data from the Korea National Health and Nutrition Examination Survey (2007–2012). In our study, a total of 33,728 participants were included to evaluate the association between SHS exposure and stress based on smoking status. Association between SHS exposure and stress was examined using logistic regression models. Results A total of 12,441 participants (42.9 %) were exposed to SHS in the workplace or at home. In our study, exposure to SHS was significantly associated with higher stress compared to non-exposure, regardless of smoking status (smoker odds ratio [OR]: 1.22; ex-smoker OR: 1.25; never-smoker OR: 1.42). Our results showed that the effect of SHS on stress was greater when exposure took place both at home and in the workplace in smokers and never-smokers. Conclusions Exposure to SHS in the workplace and at home is considered to be a risk factor for high stress in both smokers and never-smoker. Therefore, strict regulations banning smoke which can smoking ban reduce SHS exposure are recommended in order to improve the populations’ health.
... Studies on the mental health effects of passive smoking are emerging; however, the findings are currently inconsistent. Studies have shown that passive smoking is associated with poor mental health at work (Nakata et al., 2008) and in private spaces (Asbridge et al., 2013;Michal et al., 2013). Objectively measured secondhand smoke (SHS) exposure through serum cotinine has been found to increase the risks of psychological distress, future psychiatric illnesses (Hamer et al., 2010), and depressive symptoms (Bandiera, 2011). ...
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Introduction Considerable concern persists on tobacco use during perinatal periods. No study has simultaneously investigated the longitudinal association of paternal smoking with maternal and paternal depressive and anxiety symptoms during perinatal periods. Methods In this prospective study, 533 couples (pregnant women and their husbands) completed 5 self-report instruments from early pregnancy until 6 months postpartum. Generalized estimating equations were used for the analyses. Results We found that fathers who smoked in the mother’s presence had higher depressive (regression coefficient=1.0, 95% confidence interval (CI) 0.3–1.8) and anxiety symptoms (3.0, 95% CI=1.2–4.7) during perinatal periods compared with nonsmoking fathers. Paternal smoking in the mother’s presence also increased maternal disturbances, especially for depression during pregnancy (1.2, 95% CI=0.1–2.3) and anxiety during the postpartum period (3.4, 95% CI=0.6–6.3). No significant association was found between paternal smoking but not in the mother’s presence and maternal emotional disturbances. Paternal smoking but not in the mother’s presence affected only paternal anxiety, especially in the postpartum period (regression coefficient 2.7, 95% CI 0.7–4.7) compared with nonsmokers. Limitations Self-report measures were used. The effects of maternal smoking could not be estimated because of the small sample of pregnant women who disclosed their smoking status. Conclusions These findings imply a necessity to combine strategies for smoking cessation with interventions for affective disturbances in fathers. We also stress the importance of at least restricting the father’s smoking in the presence of the pregnant wife during perinatal periods if smoking cessation is tentatively unattainable.
... This study suggested that smoking, either active or passive, had a linear positive association with different kinds of mental health problems. These findings are concordant with some previous studies [29,35,[42][43][44][45][46][47][48]. Association of cigarette smoking and various psychological problems such as depression, anxiety, aggression, or bullying has been reported before [29,34,45,49]. ...
Article
Mental health and smoking have been receiving increasing attention in adolescents all over the world. Although some studies have assessed the independent association of active/passive smoking with mental health, joint association of active and passive smoking with mental health remains unclear. This study was designed to evaluate the joint association of smoking status (active and passive smoking) with psychiatric distress and violent behaviors in Iranian children and adolescents. In this national survey, 13,486 students, aged 6-18 years, living in rural and urban areas of 30 provinces of Iran were selected via multistage, cluster sampling method. Psychiatric distress (including worthless, angriness, worrying, insomnia, confusion, depression, and anxiety), violence behaviors (including bullying, victim, and physical fight), and smoking status (nonsmoker, only passive smoker, only active smoker, and active and passive smoker) were assessed. The questionnaire was prepared based on the World Health Organization Global School-based Student Health Survey (WHO-GSHS). Data were analyzed by the Stata package. Psychiatric distress and violent behaviors had linearly positive association with smoking status (p trend < 0.001). Compared to "nonsmoker" group, participants who were exposed to passive smoking besides active tobacco use were at increased risk of having angriness (odds ratio (OR) 2.55, 95 % confidence interval (CI) 1.86-3.48), worrying (OR 1.66, 95 % CI 1.24-2.20), and anxiety (OR 1.99, 95 % CI 1.52-2.61) and victim (OR 1.77, 95 % CI 1.34-2.33) and bully behaviors (OR 3.08, 95 % CI 2.33-4.07). The current findings suggest that active and passive tobacco smoking has synergistic effect on psychiatric distress. Since majority of smokers with psychiatric distress do not receive mental health services or counseling on smoking, strategies to address mental health problems and smoking prevention should be included as a part of school health services.
Article
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.
Article
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.
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Objectives First-year college students had exposure to unhealthy lifestyle behaviors that correlate with a high prevalence of anxiety and depression. Regarding to the modifiable lifestyle behaviors factors, this study investigated the prevalence and correlation of multiple lifestyle behaviors, anxiety and depression in a sample of Chinese first-year college students. Methods Cross-sectional data were extracted from Residents eHealth app of health lifestyle behaviors survey from September to October 2019. Anxiety, depression, eating regular meals, consumption of snacks in-between meals, consumption of fruit, dessert and sugar-sweetened beverages, smoking and secondhand smoke exposure, consuming alcohol, physical activity, sedentary time were assessed by self-report. Socio-demographic including age, gender, education, family income, religion, and health condition were captured. Logistic regression was used to explore the association of multiple lifestyle behaviors, anxiety and depression. Results Totally 1017 participants were included in the study. The prevalence of anxiety and depression were 40.3% and 45.3%. In multivariable analyses, religion (believe in Buddhism:OR = 2.438, 95%CI: 1.097–5.421; believe in Christian: OR = 5.886, 95%CI: 1.604–21.597), gender (OR = 1.405, 95%CI: 1.001–1.971), secondhand smoke exposure (OR = 1.089, 95%CI: 1.001–1.184), and eating regular meals (OR = 0.513, 95%CI: 0.346–0.759) were associated with anxiety. Family income (OR = 0.732, 95%CI: 0.596–0.898), eating regular meals (OR = 0.641, 95%CI: 0.415–0.990), frequency of breakfast (OR = 0.813, 95%CI: 0.690–0.959), chronic disease (OR = 1.902, 95%CI: 1.335–2.712), and consumption of nocturnal snack (OR = 1.337, 95%CI: 1.108–1.612) were associated with depression. Conclusions These results highlighted the need for early lifestyle behavior intervention, especially modifying diet patterns considering the background of religion, health condition, and social-economic status in first-year college students to improve mental health.
Article
Objectives: This study aimed to explore the association between sleep problems and health-related quality of life (HRQoL) in Canadian adults with chronic diseases, and whether mental illness can mediate the association. Methods: Data were drawn from the Canadian Community Health Survey, 2015. A total of 10,900 participants aged ≥18 years and diagnosed with chronic diseases were enrolled in this study. Results: Of these participants, 23.6% (95% CI 22.1, 25.2) suffered from severe impairment of HRQoL. Extreme sleep durations, including both short (<5, 5 to <6, and 6 to <7 h) and long (9 to <10, and ≥10 h) sleep durations, were significantly associated with severe impairment of HRQoL (compared to 7 to <8 h). Insomnia was also independently associated with severe impairment of HRQoL when compared to those without insomnia. In the mediation analyses, mental illness was shown to partly mediate the associations of extreme sleep durations and insomnia with severe impairment of HRQoL. Conclusions: In conclusion, both extreme sleep durations and insomnia were independently associated with severe impairment of HRQoL in adults with chronic diseases, and mental illness partly mediated the association.
Thesis
INTRODUCTION : l’exposition professionnelle à l’amiante et l’intoxication tabagique sont 2 facteurs de risque sanitaires connus avec un retentissement psychologique négatif déjà constaté au sein d’une population de retraités du Régime Général de la Sécurité Sociale : l’impact psychologique de l’amiante était plus délétère que celui du tabac.L’OBJECTIF était de décrire la perception et le niveau de connaissances portant sur les risques sanitaires, ainsi que le retentissement psychique, de l’exposition professionnelle à l’amiante et du tabac, au sein d’une population différente au plan socio-professionnel, constituée de fonctionnaires de l’Education Nationale.MATERIEL ET METHODE : Enquête rétrospective portant sur 1088 fonctionnaires de l’Education Nationale de plus de 50 ans ayant exercé un emploi référencé comme comportant une possible exposition à l’amiante, au moyen d’un auto-questionnaire : le « Psychological Consequences Questionnaire », traduit et validé en français, permettant d’évaluer la détresse psychologique au moyen du score PCQ, considéré comme pathologique lorsqu’il est supérieur au 95ème percentile de la distribution des scores dans notre population d’étude.RESULTATS : Les fonctionnaires de l’Education Nationale ont tendance à sous-estimer leur exposition, mais à surestimer le risque amiante. Les réponses au questionnaire rapportent un PCQ pathologique chez 5.3% des sujets de l’étude. Si l’augmentation de l’âge parait augmenter le risque de PCQ pathologique, le sexe ne semble pas avoir d’impact. Les fumeurs et ex-fumeurs ont 2 à 3 fois plus de risques d’avoir un PCQ anormal que les non-fumeurs, et les fumeurs passifs constituent le groupe le plus susceptible d’avoir un PCQ pathologique. La perception d’un état de santé dégradé du fait de l’exposition à l’amiante et/ou au tabac, actuellement ou dans le futur, est également associée à un excès de risque de détresse psychologique dans les modèles multivariés.CONCLUSION : L’âge, l’état des connaissances vis-à-vis des risques sanitaires de l’amiante et du tabac, une perception péjorative des risques sanitaires liés à l’amiante, le statut tabagique lui-même, mais également un profil psychologique anxieux, semblent être des éléments à prendre en compte lors de l’information et la prise en charge des salariés ayant été exposés à l’amiante
Conference Paper
It has been observed that Nicotine Replacement Therapy (NRT) is one of the alternatives to control and reduce smoking addiction among smokers. Since the decision to choose the best NRT alternative involves uncertainty, ambiguity factors and diverse input datasets, thus, this paper proposes a fuzzy multi-criteria analysis (FMA) to overcome these issues. It focuses on how the fuzzy approach can unify the diversity of datasets based on NRT’s decision-making problem. The analysis done employed the advantage of the cost-benefit criterion to unify the mixture of dataset input. The performance matrix was utilised to derive the performance scores. An empirical example regarding the NRT’s decision-making problem was employed to illustrate the proposed approach. Based on the calculations, this analytical approach was found to be highly beneficial in terms of usability. It was also very applicable and efficient in dealing with the mixture of input datasets. Hence, the decision-making process can easily be used by experts and patients who are interested to join the therapy/cessation program.
Article
Tobacco smoking and depression are strongly associated, but the possible association between second-hand smoke (SHS) exposure and depression is unclear. This study aimed to examine the possible relation between SHS exposure and depressive symptoms among pregnant women. A cross-sectional survey was conducted in Shenzhen, China, using a multistage sampling method. The univariable and multivariable logistic regression models were used to explore the associations between SHS exposure and depressive symptoms. Among 2,176 pregnant women, 10.5% and 2.0% were classified as having probable and severe depressive symptoms. Both binary and multinomial logistic regression revealed that there were significantly increased risks of severe depressive symptoms corresponding to SHS exposure in homes or regular SHS exposure in workplaces using no exposure as reference. In addition, greater frequency of SHS exposure was significantly associated with the increased risk of severe depressive symptoms. Our findings suggest that SHS exposure is positively associated with depressive symptoms in a dose-response manner among the pregnant women.
Article
A growing body of evidence indicates a strong association between smoking and depression. However, little is known about the possible effects of second-hand smoke (SHS) exposure on depression. This study aimed to examine the potential dose-response relation between SHS exposure and depressive symptoms among non-smoking middle-aged women. A cross-sectional survey was conducted using a stratified three-stage sampling method. Depressive symptoms were measured by the Center for Epidemiologic Studies Depression Scale with a cut-off point of 16. Self-reported SHS exposure was defined as non-smokers׳ inhalation of the smoke exhaled from smokers on at least one day a week. The multivariable logistic regression analysis was completed with adjustment for potential confounders. Among 1280 middle-aged women, 19.4% were classified as having depressive symptoms. There was a 104% increased odds of depressive symptoms corresponding to SHS exposure in general (OR=2.04, 95% CI 1.48-2.79) using no exposure as reference. There were significant positive relations between SHS exposure in general and depressive symptoms in a dose-response manner. These significant trends were observed consistently whether SHS exposure occurred in homes or workplaces. Our findings suggest that long-term and regular SHS exposure is associated with a significant, dose-dependent increase in risk of depressive symptoms. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Article
Second-hand smoke (SHS) exposure has been associated with increased risks of respiratory and heart diseases. However, little is known about the potential effects of SHS on psychological distress. The aim of this study is to examine the association of SHS exposure at home with psychological distress in Spain. A cross-sectional survey about SHS exposure, socio-demographic and health related variables, and psychological distress, measured with the 12-item version of the General Health Questionnaire (GHQ-12) with a cut-off score ≥3, was conducted from 2011-2012 among a representative sample of the adult population (aged ≥15years) of Spain. From the total sample (n=21,007), we used the subsample of never-smokers (n=11,214). We computed the odds ratios (OR) and their 95% confidence intervals (95% CI) for scoring ≥3 on the GHQ by means of unconditional multiple logistic regression models adjusted for sex and age. In the subsample, 9.7% (n=1,090) responded that they were exposed to SHS at home. The prevalence of subjects scoring ≥3 on the GHQ was higher for the sample exposed to SHS (22.7%) than for the non-exposed sample (18.9%; OR: 1.39; CI: 1.19-1.62). This association was also present when stratified for sex, age, marital status, socio-economic status, perceived general health, presence of any chronic disease, and alcohol intake. Exposure to SHS at home is associated with psychological distress. Further investigation is necessary to determine if this association is causal. Avoiding SHS exposure at home could have beneficial effects on psychological distress. Copyright © 2015 Elsevier Ltd. All rights reserved.
Article
Exposure to second hand smoke (SHS) is associated with adverse health effects. This study was undertaken to assess comparative levels of exposure to SHS at home and work among nonsmokers aged ⩾12years. Data from National Health Examination Survey for 1999-2010 were analyzed to estimate exposure to SHS. Total number of subjects included in the study was 24,791. Those who self-reported not having used any tobacco products during the last five days were considered nonsmokers for the purpose of this study. Serum cotinine levels were used as the outcome variable to indicate the level of exposure to SHS. Adjusted serum cotinine levels for those with no exposure to SHS, exposure to SHS at work only, exposure to SHS at home only, and exposure to SHS at home and work were 0.047 (0.044-0.050)ng/mL, 0.055 (0.047-0.064)ng/mL, 0.522 (0.401-0.678)ng/mL, and 0.485 (0.280-0.0840)ng/mL respectively. Public efforts to reduce exposure to SHS at home should be strengthened. Copyright © 2015 Elsevier Ltd. All rights reserved.
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Cigarette smoking is associated with some anxiety disorders, but the direction of the association between smoking and specific anxiety disorders has not been determined. To investigate the longitudinal association between cigarette smoking and anxiety disorders among adolescents and young adults. The Children in the Community Study, a prospective longitudinal investigation. Community-based sample of 688 youths (51% female) from upstate New York interviewed in the years 1985-1986, at a mean age of 16 years, and in the years 1991-1993, at a mean age of 22 years. Participant cigarette smoking and psychiatric disorders in adolescence and early adulthood, measured by age-appropriate versions of the Diagnostic Interview Schedule for Children. Heavy cigarette smoking (>/=20 cigarettes/d) during adolescence was associated with higher risk of agoraphobia (10.3% vs 1.8%; odds ratio [OR], 6.79; 95% confidence interval [CI], 1.53-30.17), generalized anxiety disorder (20.5% vs 3.71%; OR, 5.53; 95% CI, 1.84-16.66), and panic disorder (7.7% vs 0.6%; OR, 15.58; 95% CI, 2.31-105.14) during early adulthood after controlling for age, sex, difficult childhood temperament; alcohol and drug use, anxiety, and depressive disorders during adolescence; and parental smoking, educational level, and psychopathology. Anxiety disorders during adolescence were not significantly associated with chronic cigarette smoking during early adulthood. Fourteen percent and 15% of participants with and without anxiety during adolescence, respectively, smoked at least 20 cigarettes per day during early adulthood (OR, 0.88; 95% CI, 0.36-2.14). Our results suggest that cigarette smoking may increase risk of certain anxiety disorders during late adolescence and early adulthood. JAMA. 2000;284:2348-2351.
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Secondhand smoke (SHS) exposure has been related to various somatic health outcomes, although very little is known about the association between SHS exposure and mental health. To assess the associations between mental health and SHS exposure, which was objectively measured using the salivary cotinine level as a circulating biochemical marker. Design, Setting, and In a cross-sectional and longitudinal study, a representative sample of 5560 nonsmoking adults (mean [SD] age, 49.8 [15.4] years; 45.5% men) and 2595 smokers (mean [SD] age, 44.8 [14.8] years; 50.2% men) without history of mental illness was drawn from the 1998 and 2003 Scottish Health Survey. A priori, study participants with cotinine values of 15.00 microg/L or higher (to convert to nanomoles per liter, multiply by 5.675) were assumed to be smokers and recategorized as such in all analyses. A score greater than 3 on the 12-item General Health Questionnaire was used as an indicator of psychological distress. Incident psychiatric hospital admissions over 6 years of follow-up were also recorded. Psychological distress was apparent in 14.5% of the sample. In logistic regression analyses of the cross-sectional data, after adjustments for a range of covariates, high SHS exposure among nonsmokers (cotinine level >0.70 and <15.00 microg/L) was associated with higher odds of psychological distress (odds ratio = 1.49; 95% confidence interval, 1.13-1.97) in comparison with participants with cotinine levels below the limit of detection (< or = 0.05 microg/L). In prospective analyses, risk of a psychiatric hospital admission was related to high SHS exposure (multivariate adjusted hazard ratio = 2.84; 95% confidence interval, 1.07-7.59) and active smoking (multivariate adjusted hazard ratio = 3.74; 95% confidence interval, 1.55-8.98). Exposure to SHS is associated with psychological distress and risk of future psychiatric illness in healthy adults. These concordant findings using 2 different research designs emphasize the importance of reducing SHS exposure at a population level not only for physical health but also for mental health.
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Male and female adult heavy smokers (n = 96) and nonsmokers (n = 123) were compared on the Depression Anxiety Stress Scales (DASS), Adult Attachment Scale (AAS), Fear of Intimacy Scale (FIS), Negative Mood Regulation (NMR) Scale and Affect Intensity Measure (AIM). Compared to nonsmokers, smokers scored significantly higher on DASS-Stress, DASS-Anxiety, and DASSDepression, and significantly lower on NMR, AAS-Depend and AAS-Close. Smokers also scored marginally higher on FIS. Results suggest mood and relationship dysfunction in smokers, similar to the findings of a previous investigation of detoxified inpatients undergoing treatment for substance (alcohol, heroin, or methamphetamine) dependence.
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Motor vehicles represent important microenvironments for exposure to secondhand smoke (SHS). While some countries and cities have banned smoking in cars with children present, more data are needed to develop the evidence base on SHS exposure levels in motor vehicles to inform policy and education practices aimed at supporting smoke-free motor vehicles when passengers are present. To assess exposure to secondhand tobacco smoke in motor vehicles using passive airborne nicotine samplers. 17 smokers and five non-smokers who commute to and from work in their own vehicle participated. Two passive airborne nicotine samplers were placed in each vehicle for a 24-hour period, one at the front passenger seat headrest and the other in the back seat behind the driver. At the end of the sampling period, airborne nicotine was analysed by gas chromatography. Median (IQR) air nicotine concentrations in smokers' vehicles were 9.6 mug/m(3) (5.3-25.5) compared to non-detectable concentrations in non-smokers' vehicles. After adjustment for vehicle size, window opening, air conditioning and sampling time, there was a 1.96-fold increase (95% CI 1.43 to 2.67) in air nicotine concentrations per cigarette smoked. Air nicotine concentrations in motor vehicles were much higher than air nicotine concentrations generally measured in public or private indoor places, and even higher than concentrations measured in restaurants and bars. These high levels of exposure to SHS support the need for education measures and legislation that regulate smoking in motor vehicles when passengers, especially children, are present.
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To study the prevalence of, and discuss factors contributing to, household second-hand smoke exposure in six counties in China, providing scientific support for the need to establish tobacco control measures in these areas. A cross-sectional survey was performed. Investigators conducted face-to-face interviews using a standardised questionnaire to collect information on demographics, passive smoking behaviours and knowledge, and attitudes towards tobacco control. The setting was six counties from the three provinces: Mianzhu and Xichong counties in Sichuan Province; Anyi and Hukou counties in Jiangxi Province; and Xinan and Yanshi counties in Henan Province. A total of 8142 non-smokers (aged 18-69) in 2004 were included in the data analysis. Household second-hand smoke exposure rate as defined as the proportion of household passive smokers in the non-smoker population was used as the measure of household second-hand smoke exposure. The analysis of 8142 non-smokers revealed that, in these selected counties, the household second-hand smoke exposure rate was 48.3%. Respondents had positive attitudes towards tobacco control. Of 6972 respondents, 84.4% supported all the three tobacco control policies (banning smoking in public places, banning the selling of cigarettes to minors, banning all cigarette advertisements). In 3165 families with smokers, 87.2% of respondents reported that smokers would smoke in front of them. In 2124 families with smokers and children, 76.5% of respondents reported that smokers would smoke in front of children. As many as 42.1% of non-smokers would offer cigarettes to their guests, and only 46.8% of respondents would ask smokers to smoke outdoors. Only 6.3% of families completely forbade smoking at home. Multivariate logistic regression analysis revealed high second-hand smoke exposure for the following demographic groups: Jiangxi Province inhabitants, females, those with low education level, farmers and married respondents. Household second-hand smoke exposure rates in the selected counties were high. A high percentage of respondents reported that smokers would smoke in front of them and children. The pressure from non-smokers against smoking was relatively low, although offering cigarette was prevalent. Households that were completely smoking-free were rare, Further studies on these correlated factors could help us establish effective measures to reduce household second-hand smoke exposure.
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There is a strong link between tobacco consumption and mood disorders. It has been suggested that afflicted individuals smoke to manage mood, however, there is evidence indicating that tobacco consumption can induce negative mood. This study was designed to investigate whether nicotine exposure during adolescence influences emotionality/behavioral functioning later in life. Adolescent (postnatal days, PD 30-44) male rats were treated with twice-daily injections of nicotine (0, 0.16, 0.32, or 0.64 mg/kg) for 15 consecutive days, and their behavioral reactivity to various behavioral paradigms (the elevated plus maze (EPM), sucrose preference, locomotor activity in the open field, and forced swim test (FST) was assessed 24 h (short term) or 1-month (long term) after exposure. Separate groups of adult rats received nicotine (0.32 mg/kg) to control for age-dependent effects. We report that nicotine exposure during adolescence-but not adulthood-leads to a depression-like state manifested in decreased sensitivity to natural reward (sucrose), and enhanced sensitivity to stress- (FST) and anxiety-eliciting situations (EPM) later in life. Our data show that behavioral dysregulation can emerge 1 week after drug cessation, and that a single day of nicotine exposure during adolescence can be sufficient to precipitate a depression-like state in adulthood. We further demonstrate that these deficits can be normalized by subsequent nicotine (0.32 mg/kg) or antidepressant (ie fluoxetine or bupropion; 10 mg/kg) treatment in adulthood. These data suggest that adolescent exposure to nicotine results in a negative emotional state rendering the organism significantly more vulnerable to the adverse effects of stress. Within this context, our findings, together with others indicating that nicotine exposure during adolescence enhances risk for addiction later in life, could serve as a potential model of comorbidity.
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Many smokers report smoking because it helps them modulate their negative affect (NA). The stress induction model of smoking suggests, however, that smoking causes stress and concomitant NA. Empirical support for the stress induction model has primarily derived from retrospective reports and experimental manipulations with non-representative samples of smokers. Moreover, prior studies have typically not considered contextual factors (e.g., daily stressors) that may impact the smoking-NA relationship. The aim of this study was to assess the stress induction model of smoking using a prospective design in a nationally representative sample of smokers while simultaneously examining the impact of daily stressors on the relationship between smoking and NA. We hypothesized that smoking and NA would be positively related, and this relationship would be intensified by exposure to daily stressors. A national sample of middle-aged smokers (N = 256) were called on eight consecutive evenings to assess stressor exposure and intensity. Participants also reported on their daily NA and indicated the number of cigarettes they smoked. Analyses were conducted using hierarchical linear modeling to determine the relationship between daily smoking, NA, and stress. Smoking more than usual was associated with increased NA on days when respondents were exposed to any stressors. Smoking more than usual had no effect on NA on days when no stressors were encountered. Moreover, the moderating effect of stressor exposure remained significant even after controlling for the number and intensity of daily stressors reported. While smokers report that smoking alleviates their NA, our study suggests that the exact opposite may occur, particularly on stressful days. When smokers smoke more than usual on days when the encounter stress, they are likely to feel emotionally worse off.
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Smoking is disproportionately prevalent among people with psychiatric illness. To investigate smoking as a risk factor for major depressive disorder. A population-based sample of women was studied using case-control and retrospective cohort study designs. Exposure to smoking was self-reported, and major depressive disorder diagnosed using the Structured Clinical Interview for DSM-IV-TR (SCID-I/NP). Among 165 people with major depressive disorder and 806 controls, smoking was associated with increased odds for major depressive disorder (age-adjusted odds ratio (OR)=1.46, 95% CI 1.03-2.07). Compared with non-smokers, odds for major depressive disorder more than doubled for heavy smokers (>20 cigarettes/day). Among 671 women with no history of major depressive disorder at baseline, 13 of 87 smokers and 38 of 584 non-smokers developed de novo major depressive disorder during a decade of follow-up. Smoking increased major depressive disorder risk by 93% (hazard ratio (HR)=1.93, 95% CI 1.02-3.69); this was not explained by physical activity or alcohol consumption. Evidence from cross-sectional and longitudinal data suggests that smoking increases the risk of major depressive disorder in women.
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Smokers often report that cigarettes help relieve feelings of stress. However, the stress levels of adult smokers are slightly higher than those of nonsmokers, adolescent smokers report increasing levels of stress as they develop regular patterns of smoking, and smoking cessation leads to reduced stress. Far from acting as an aid for mood control, nicotine dependency seems to exacerbate stress. This is confirmed in the daily mood patterns described by smokers, with normal moods during smoking and worsening moods between cigarettes. Thus, the apparent relaxant effect of smoking only reflects the reversal of the tension and irritability that develop during nicotine depletion. Dependent smokers need nicotine to remain feeling normal. The message that tobacco use does not alleviate stress but actually increases it needs to be far more widely known. It could help those adult smokers who wish to quit and might prevent some schoolchildren from starting.
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Studies of selected groups of persons with mental illness, such as those who are institutionalized or seen in mental health clinics, have reported rates of smoking to be higher than in persons without mental illness. However, recent population-based, nationally representative data are lacking. To assess rates of smoking and tobacco cessation in adults, with and without mental illness. Analysis of data on 4411 respondents aged 15 to 54 years from the National Comorbidity Survey, a nationally representative multistage probability survey conducted from 1991 to 1992. Rates of smoking and tobacco cessation according to the number and type of psychiatric diagnoses, assessed by a modified version of the Composite International Diagnostic Interview. Current smoking rates for respondents with no mental illness, lifetime mental illness, and past-month mental illness were 22.5%, 34.8%, and 41.0%, respectively. Lifetime smoking rates were 39.1%, 55.3%, and 59.0%, respectively (P<.001 for all comparisons). Smokers with any history of mental illness had a self-reported quit rate of 37.1% (P =.04), and smokers with past-month mental illness had a self-reported quit rate of 30. 5% (P<.001) compared with smokers without mental illness (42.5%). Odds ratios for current and lifetime smoking in respondents with mental illness in the past month vs respondents without mental illness, adjusted for age, sex, and region of the country, were 2.7 (95% confidence interval [CI], 2.3-3.1) and 2.7 (95% CI, 2.4-3.2), respectively. Persons with a mental disorder in the past month consumed approximately 44.3% of cigarettes smoked by this nationally representative sample. Persons with mental illness are about twice as likely to smoke as other persons but have substantial quit rates. JAMA. 2000;284:2606-2610.
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Psychoactive substance use is strongly associated with psychiatric morbidity in both adults and adolescents. To determine which of alcohol, nicotine and cannabisis mostclosely linked to psychiatric disorders in early adolescence. Data from 2624 adolescents aged 13-15 years were drawn from a national mental health survey of children. The relationship between psychiatric morbidity and smoking, drinking and cannabis use was examined by logistic regression analyses. Having a psychiatric disorder was associated with an increased risk of substance use. Greater involvement with any one substance increased the risk of other substance use. Analyses of the interactions between smoking, drinking and cannabis use indicated that the relationship between substance use and psychiatric morbidity was primarily explained by regular smoking and (to a lesser extent) regular cannabis use. In this sample, links between substance use and psychiatric disorders were primarily accounted for by smoking. The strong relationship is likely to be due to a combination of underlying individual constitutional factors and drug-specific effects resulting from consumption over the period of adolescent development and growth.
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To examine (1) whether dust and surfaces in households of smokers are contaminated with environmental tobacco smoke (ETS); (2) whether smoking parents can protect their infants by smoking outside and away from the infant; and (3) whether contaminated dust, surfaces, and air contribute to ETS exposure in infants. Quasi-experiment comparing three types of households with infants: (1) non-smokers who believe they have protected their children from ETS; (2) smokers who believe they have protected their children from ETS; (3) smokers who expose their children to ETS. Homes of smokers and non-smokers. Smoking and non-smoking mothers and their infants < or = 1 year. ETS contamination as measured by nicotine in household dust, indoor air, and household surfaces. ETS exposure as measured by cotinine levels in infant urine. ETS contamination and ETS exposure were 5-7 times higher in households of smokers trying to protect their infants by smoking outdoors than in households of non-smokers. ETS contamination and exposure were 3-8 times higher in households of smokers who exposed their infants to ETS by smoking indoors than in households of smokers trying to protect their children by smoking outdoors. Dust and surfaces in homes of smokers are contaminated with ETS. Infants of smokers are at risk of ETS exposure in their homes through dust, surfaces, and air. Smoking outside the home and away from the infant reduces but does not completely protect a smoker's home from ETS contamination and a smoker's infant from ETS exposure.
Article
Context Studies of selected groups of persons with mental illness, such as those who are institutionalized or seen in mental health clinics, have reported rates of smoking to be higher than in persons without mental illness. However, recent population-based, nationally representative data are lacking.Objective To assess rates of smoking and tobacco cessation in adults, with and without mental illness.Design, Setting, and Participants Analysis of data on 4411 respondents aged 15 to 54 years from the National Comorbidity Survey, a nationally representative multistage probability survey conducted from 1991 to 1992.Main Outcome Measures Rates of smoking and tobacco cessation according to the number and type of psychiatric diagnoses, assessed by a modified version of the Composite International Diagnostic Interview.Results Current smoking rates for respondents with no mental illness, lifetime mental illness, and past-month mental illness were 22.5%, 34.8%, and 41.0%, respectively. Lifetime smoking rates were 39.1%, 55.3%, and 59.0%, respectively (P<.001 for all comparisons). Smokers with any history of mental illness had a self-reported quit rate of 37.1% (P = .04), and smokers with past-month mental illness had a self-reported quit rate of 30.5% (P<.001) compared with smokers without mental illness (42.5%). Odds ratios for current and lifetime smoking in respondents with mental illness in the past month vs respondents without mental illness, adjusted for age, sex, and region of the country, were 2.7 (95% confidence interval [CI], 2.3-3.1) and 2.7 (95% CI, 2.4-3.2), respectively. Persons with a mental disorder in the past month consumed approximately 44.3% of cigarettes smoked by this nationally representative sample.Conclusions Persons with mental illness are about twice as likely to smoke as other persons but have substantial quit rates.
Conference Paper
The ascendance of emotion theory recent advances in cognitive science and neuroscience, and increasingly important findings from developmental psychology and learning make possible an integrative account of the nature and etiology of anxiety and its disorders. This model specifies an integrated set of triple vulnerabilities: a generalized biological (heritable) vulnerability, a generalized psychological vulnerability based on early experiences in developing a sense of control over salient events, and a more specific psychological vulnerability in which one learns to focus anxiety on specific objects or situations. The author recounts rite development of anxiety and related disorders based on these triple vulnerabilities and discusses implications for the classification of emotional disorders.
Article
This paper reviews research on attitudes and behaviours towards environmental tobacco smoke (ETS), with a special focus on child health and the indoor environment. Research needs and ways forward to encourage reductions in domestic ETS levels are discussed. Published material was identified through online literature searches (Medline, Toxline, Cancerlit, Biosis, Embase, Enviroline, Sociological Abstracts, Social Science Citation Index, Academic Index and Psychinfo). The literature search strategy employed search terms such as “passive smoking” or “environmental tobacco smoke” with “attitude” or “awareness” and other synonyms. Additional publications were identified by citation chasing and expert advice. Focusing on the UK, studies that provided survey-derived data about attitudes and behaviours in relation to ETS exposure in the indoor environment were selected for review. Published studies from other countries were also included when they provided information pertinent to this review. Most people are aware of the health risks associated with ETS exposure, and there is a high level of support for smoking restrictions in public places to protect non-smokers from ETS. However, although there is concern among both non-smoking and smoking parents about children and second-hand smoke, many people allow children to be exposed to ETS in the home. The review suggests that traditional health promotion campaigns have had only limited success in encouraging ETS risk reduction measures in the home. Because ETS is a public health priority, particularly in relation to child health, the barriers to the uptake of such measures need to be explored in detail to inform the future promotion of reductions in domestic levels of ETS.
Article
Background Epidemiologic studies have reported a lifetime association between smoking and panic disorder. In this study, we examine potential explanations for this association. Methods Analysis was conducted on data from 2 epidemiologic studies, the Epidemiologic Study of Young Adults in southeast Michigan (N = 1007) and the National Comorbidity Survey Tobacco Supplement (n = 4411). Cox proportional hazards models with time-dependent covariates were used to estimate the risk for onset of panic attacks associated with prior smoking and vice versa, controlling for history of major depression. The role of lung disease in the smoking–panic attacks association was explored. Results Daily smoking signaled an increased risk for first occurrence of panic attack and disorder; the risk was higher in active than past smokers. No significant risk was detected for onset of daily smoking in persons with prior panic attacks or disorder. Exploratory analyses suggest that lung disease might be one of the mechanisms linking smoking to panic attacks. Conclusions The evidence that the association between smoking and panic disorder might result primarily from an influence in one direction (ie, from prior smoking to first panic attack) and the possibility of a higher risk in active than past smokers suggest a causal hypothesis for the smoking–panic attacks relationship.
Article
Overview: This report presents the results of systematic reviews of effectiveness, applicability, other effects, economic evaluations, and barriers to use of selected population-based interventions intended to reduce tobacco use and exposure to environmental tobacco smoke. The related systematic reviews are linked by a common conceptual approach. These reviews form the basis of recommendations by the Task Force on Community Preventive Services (TFCPS) regarding the use of these selected interventions. The TFCPS recommendations are presented on page 67 of this supplement.
Article
Secondhand smoke is one of the most common toxic environmental exposures to children, and maternal health problems also have substantial negative effects on children. We are unaware of any studies examining the association of living with smokers and maternal health. To investigate whether non-smoking mothers who live with smokers have worse physical and mental health than non-smoking mothers who live in homes without smokers. Nationally representative data from the 2000-2004 Medical Expenditure Panel Survey were used. The health of non-smoking mothers with children <18 years (n = 18,810) was assessed, comparing those living with one or more smokers (n = 3,344) to those living in households with no adult smokers (n = 14,836). Associations between maternal health, household smoking, and maternal age, race/ethnicity, and marital, educational, poverty and employment status were examined in bivariable and multivariable analyses using SUDAAN software to adjust for the complex sampling design. Scores on the Medical Outcomes Short Form-12 (SF-12) Physical Component Scale (PCS) and Mental Component Scale (MCS) were used to assess maternal health. About 79.2% of mothers in the USA are non-smokers and 17.4% of them live with ≥1 adult smokers: 14.2% with 1 and 3.2% with ≥2 smokers. Among non-smoking mothers, the mean MCS score is 50.5 and mean PCS is 52.9. The presence of an adult smoker and increasing number of smokers in the home are both negatively associated with MCS and PCS scores in bivariable analyses (P < 0.001 for each). Non-smoking mothers with at least one smoker in the household had an 11% (95% CI = 0.80-0.99) lower odds of scoring at or above the mean MCS score and a 19% (95% CI = 0.73-0.90) lower odds of scoring at or above the mean PCS score compared to non-smoking mothers with no smokers in the household. There is an evidence of a dose response relationship with increasing number of smokers in the household for PCS (P < 0.001). These findings demonstrate a previously unrecognized child health risk: living with smokers is independently associated with worse physical and mental health among non-smoking mothers.
Article
To evaluate the association between secondhand smoke (SHS) exposure and depression. Tobacco smoking and depression are strongly associated, but the possible effects of SHS have not been evaluated. The 2005 to 2006 National Health and Nutrition Examination Survey (NHANES) is a cross-sectional sample of the noninstitutionalized civilian U.S. population. SHS exposure was measured in adults aged > or =20 years by serum cotinine and depressive symptoms by the Patient Health Questionnaire. Zero-inflated Poisson regression analyses were completed with adjustment for survey design and potential confounders. Serum cotinine-documented SHS exposure was positively associated with depressive symptoms in never-smokers, even after adjustment for age, race/ethnicity, gender, education, alcohol consumption, and medical comorbidities. The association between SHS exposure and depressive symptoms did not vary by gender, nor was there any association between SHS smoke exposure and depressive symptoms in former smokers. Findings from the present study suggest that SHS exposure is positively associated with depressive symptoms in never-smokers and highlight the need for further research to establish the mechanisms of association.
Article
Tobacco smoking is an extremely addictive and harmful form of nicotine (NIC) consumption, but unfortunately also the most prevalent. Although disproportionately high frequencies of smoking and its health consequences among psychiatric patients are widely known, the neurobiological background of this epidemiological association is still obscure. The diverse neuroactive effects of NIC and some other major tobacco smoke constituents in the central nervous system may underlie this association. This present paper summarizes the pharmacology of NIC and its receptors (nAChR) based on a systematic review of the literature. The role of the brain's reward system(s) in NIC addiction and the results of functional and structural neuroimaging studies on smoking-related states and behaviors (i.e. dependence, craving, withdrawal) are also discussed. In addition, the epidemiological, neurobiological, and genetic aspects of smoking in several specific neuropsychiatric disorders are reviewed and the clinical relevance of smoking in these disease states addressed.
Article
To examine the determinants that lead Canadian adults to consult family physicians, psychiatrists, psychologists, psychotherapists, and other health professionals for mental health reasons and to compare the determinants of service use across provider types. Data from the Canadian Community Health Survey: Mental Health and Well-Being were used for people aged 18 years and older (n = 35,236). A multivariate logistic regression was used to model outpatient consultations with different providers as a function of predictive determinants. Three types of variables were examined: need, enabling, and predisposing factors. Among need, the most common predictors of service use for mental health reasons were self-rated mental health, the presence of chronic conditions, depression and panic attacks, unmet mental health needs, psychological well-being, and the ability to handle daily demands. Among enabling factors, emotional and informational support and income were important predictors. Among predisposing factors, men were less likely to consult with a family physician and other resources but not with psychiatrists; and people with less education were less likely to consult psychologists and other health providers. Need factors were the most important predictors of both psychiatrist and combined family physician and psychiatrist consultation in the previous year. However, sex barriers remain and promotion campaigns in seeking mental health care should be aimed toward men. Further, education and income barriers exist in the use of specialty providers of psychotherapy and policies should thus focus on rendering these services more accessible to disadvantaged people.
Article
The present study examines second-hand smoke (SHS) exposure and the beliefs youth have about being exposed to SHS in their home and in cars and explores changes in exposure and beliefs over time. Nationally representative data from the 2006 Youth Smoking Survey (YSS) were used to examine youth exposure to smoking and beliefs about smoking in the home and car among 71,003 Canadian youth in grades 5-12. Gender-specific logistic regression models were conducted to examine if being exposed to smoking at home or in the car were associated with the beliefs youth have about either smoking around kids at home or smoking around kids in cars. In 2006, 22.1% of youth in grades 5-12 were exposed to smoking in their home on a daily or almost daily basis and 28.1% were exposed to smoking while riding in a car at least once in the previous week. The majority of youth reported that they do not think smoking should be allowed around kids at home (88.3%) or in cars (88.4%). Youth exposed to smoking in the home or in cars reported missing substantially more days of school in the previous month because of their health. Among both male and female youth, being an ever smoker, living in a house where someone smokes inside daily, and having ridden in a car with someone who was smoking cigarettes in the past seven days were all associated with being more likely to report that smoking should not be allowed around kids at home or in cars. Compared to their male counterparts, female youth with at least one parent who smokes were more likely to report that smoking should not be allowed around kids at home or in cars. As rates of SHS exposure in the home and car decreased between 2004 and 2006, the prevalence of youth who reported that they do not think smoking should be allowed around kids at home or in cars also decreased over the same period of time. These results highlight that Canadian youth are frequently exposed to SHS in their homes and in cars despite the fact that the vast majority of youth do not think smoking should be allowed around kids in those locations. Considering the health and social consequences associated with SHS exposure, it may be a timely opportunity to move forward with programs and policies designed to prevent individuals from smoking around youth in these locations.
Article
To examine long-term changes in environmental tobacco smoke (ETS) exposure in British men between 1978 and 2000, using serum cotinine. Prospective cohort: British Regional Heart Study. General practices in 24 towns in England, Wales and Scotland. Non-smoking men: 2125 studied at baseline [questionnaire (Q1): 1978-80, aged 40-59 years], 3046 studied 20 years later (Q20: 1998-2000, aged 60-79 years) and 1208 studied at both times. Non-smokers were men reporting no current smoking with cotinine < 15 ng/ml at Q1 and/or Q20. Serum cotinine to assess ETS exposure. In cross-sectional analysis, geometric mean cotinine level declined from 1.36 ng/ml [95% confidence interval (CI): 1.31, 1.42] at Q1 to 0.19 ng/ml (95% CI: 0.18, 0.19) at Q20. The prevalence of cotinine levels < or = 0.7 ng/ml [associated with low coronary heart disease (CHD) risk] rose from 27.1% at Q1 to 83.3% at Q20. Manual social class and northern region of residence were associated with higher mean cotinine levels both at Q1 and Q20; older age was associated with lower cotinine level at Q20 only. Among 1208 persistent non-smokers, cotinine fell by 1.47 ng/ml (95% CI: 1.37, 1.57), 86% decline. Absolute falls in cotinine were greater in manual occupational groups, in the Midlands and Scotland compared to southern England, although percentage decline was very similar across groups. A marked decline in ETS exposure occurred in Britain between 1978 and 2000, which is likely to have reduced ETS-related disease risks appreciably before the introduction of legislation banning smoking in public places.
Article
Emerging evidence suggests that exposure to environmental tobacco smoke (ETS) may be linked with behavior problems in childhood, but previous research has relied primarily on parent report of exposure, and results are inconclusive. To investigate the relationship between exposure to ETS and child behavior problems among children with asthma. The sample included 220 children who were enrolled in an asthma intervention trial and regularly exposed to ETS at home. Serum cotinine was used to measure exposure to tobacco smoke, and behavior problems were assessed by parent report on the Behavior Assessment System for Children. Covariates in adjusted analyses included: sex, age, race, asthma severity, asthma medication, maternal education, prenatal tobacco exposure, maternal depression, and Home Observation for Measurement of the Environment score. Child behavior problems increased with increasing exposure to ETS. A stratified analysis of boys and girls separately indicated higher exposure among girls, but behavior problems were statistically significantly associated with exposure only in boys. Increasing behavior problems included externalizing behavior problems (beta= 2.23, p =.02) such as hyperactivity and aggression, internalizing behavior problems (beta= 2.19, p= .01) such as depression, and behavior symptoms (beta= 2.55, p= .01). Among children with asthma, exposure to ETS is related to increased child behavior problems among boys.
Article
Few studies have analysed the impact of different socioeconomic indicators on the prevalence of children's environmental tobacco smoke (ETS) exposure at several indoor environments and on family's home smoking policy. Data on 12 422 pre-school children (48% female) from two cross-sectional surveys conducted during 2004-06 in Germany were analysed. Exposure assessment was based on parental report. Independent effects of socioeconomic indicators were determined by mutually adjustment in logistic regression analyses. Low parental education, unemployment, low household equivalent income, non-German nationality, single-parent family and family size were independently associated with children's ETS exposure at home and in cars. The strongest associations were observed for low parental education [at home: adjusted odds ratio (OR) 3.94; 95% confidence interval (CI) 3.46-4.49; in cars: 5.00; 3.84-6.50]. Indicators of material living conditions (relative poverty: 0.48; 0.39-0.57, parental unemployment: 0.55; 0.46-0.65), as well as single-parent family, non-German nationality and family size, but not parental education, were independently associated with ETS exposure at hospitality venues. Smoking households with low parental education, unemployment, poverty, single-parent family and non-German nationality were less likely to have the rule of exclusively smoking on the balcony or terrace. Low parental education and unemployment were negatively associated with no smoking in presence of the child in households with smoking inside the flat. Several dimensions of socioeconomic position have to be considered in explanations of social inequalities in children's ETS exposure and family's home smoking policy as well as in development of targeted interventions.
Article
To extend previous observations that secondhand tobacco smoke (SHS) is associated with nicotine markers in children, we investigated if SHS exposure is associated with self-reports of nicotine dependence (ND) symptoms among young never-smokers. Data on number of persons who smoke inside the home, number of days exposed to SHS in a motor vehicle in the past week, number of parents, siblings, and friends who smoke, and ND symptoms, were collected from 10-12 year-old students in self-report questionnaires. The association between SHS and ND symptoms among young never-smokers was assessed in logistic regression models. Sixty-nine of 1488 never-smokers (5%) reported one or more ND symptom. After controlling for sibling and peer smoking, and susceptibility to initiating smoking, exposure to SHS in a motor vehicle was independently associated with ND symptoms (OR, 95% CI=1.2, 1.0-1.4). The OR for number of persons who smoke inside the home was 1.1 (0.9-1.4). SHS exposure in motor vehicles may be associated with ND symptoms among young never-smokers. If replicated, this finding provides support for interventions that promote non-smoking in motor vehicles.
Article
We studied the responses of smokers and lifelong non-smokers to transdermal nicotine patches over 24 h in three groups of subjects: non-smokers on a 15 mg patch (n = 8), non-smokers on a 30 mg patch (n = 8) and smokers on a 30 mg patch (n = 8). Unexpectedly, the non-smokers appeared to absorb nicotine more rapidly. The increase in blood nicotine concentrations of non-smokers over the first 2 h of patch use was double that of the smokers, with mean increases of 4.5 (SD = 3.7), 10.9 (SD = 4.2) and 4.1 (SD = 2.7) ng/ml in the three groups, respectively (P less than 0.005). The smokers had no pleasant or unpleasant effects from the 30 mg patch (X Cmax 13.9 ng/ml, SD = 4.9; Tmax 8.75 h) but all eight non-smokers experienced mild nausea and lightheadedness (P less than 0.01) within the first hour, and seven dropped out (P less than 0.01) at 3-8 h due mainly to severe nausea, vomiting or headache (X Cmax 18.4 ng/ml, SD = 4.9; Tmax 5.25 h). Only one non-smoker dropped out on the 15 mg patch, but five had transient nausea in the first hour (X Cmax 7.9 ng/ml, SD = 3.0; Tmax 8.0). Our study provides evidence of chronic pharmacodynamic nicotine tolerance in smokers, but does not address whether this is acquired or innate. The higher rate of transdermal nicotine absorption in non-smokers is unexplained and requires replication.
Article
The interpretation and interpretability of epidemiologic studies of environmental tobacco smoke (ETS) depend largely on the validity of self-reported exposure. To investigate to what extent questionnaires can indicate exposure levels to ETS, an international study was conducted in 13 centers located in 10 countries, and 1,369 nonsmoking women were interviewed. The present paper describes the results of the analysis of self-reported recent exposure to ETS from any source in relation to urinary concentrations of cotinine. Of the total, 19.7 percent of the subjects had nondetectable cotinine levels, the median value was 6 ng/mg, and the cut-point of the highest decile was 24 ng/mg. The proportion of subjects misreporting their active smoking habit was estimated at between 1.9 and 3.4 percent, depending on whether cut-points of 50 or 100 ng/mg creatinine were used. Large and statistically significant differences were observed between centers, with the lowest values in Honolulu, Shanghai, and Chandigarh, and the highest in Trieste, Los Angeles, and Athens. Mean cotinine/creatinine levels showed a clear linear increase from the group of women not exposed either at home or at work, to the group of those exposed both at home and at work. Values were significantly higher for women exposed to ETS from the husband but not at work, than for those exposed at work but not from the husband. The results of linear regression analysis indicated that duration of exposure and number of cigarettes to which the subject reported being exposed were strongly related to urinary cotinine. ETS exposure from the husband was best measured by the number of cigarettes, while exposure at work was more strongly related to duration of exposure. After adjustment of number of cigarettes for volume of indoor places, a similar increase in cotinine (5 ng/mg) was predicted by the exposure to 7.2 cigarettes/8 h/40 m3 from the husband and 17.9 cigarettes/8 h/40 m3 at work. The results indicate that, when appropriately questioned, nonsmoking women can provide a reasonably accurate description of ETS exposure. Assessment of individual exposure to ETS should focus on daily duration and volume of indoor places where exposure occurred.
Article
Clonidine hydrochloride, an alpha 2-adrenergic receptor agonist that decreases noradrenergic function, was administered to 21 healthy subjects and 26 drug-free patients with agoraphobia and panic attacks. Clonidine produced significantly greater decreases in plasma MHPG levels and sitting and standing diastolic blood pressure and significantly smaller increases in growth hormone levels and self-rated drowsiness in the patients. These findings indicate that the regulation of noradrenergic activity is aberrant in some patients with panic disorder, since a previous study demonstrated that patients with panic disorder exhibit increased plasma MHPG levels, blood pressure, and behavioral responses to the alpha 2-adrenergic receptor antagonist yohimbine. The increased dynamic range of noradrenergic activity observed as an increased sensitivity to both clonidine and yohimbine may reflect abnormalities in the regulatory inputs to noradrenergic neurons, or dysfunction in the alpha 2-adrenergic receptor effector coupling mechanism or the intracellular effector system.
Article
Yohimbine, an alpha 2-adrenergic receptor antagonist that increases noradrenergic function, was administered to 20 healthy subjects and 39 drug-free patients with agoraphobia and panic attacks. Following drug administration, changes in plasma levels of the norepinephrine metabolite 3-methoxy-4-hydroxyphenylglycol (MHPG), BP, pulse rate, and subjective ratings of feelings and somatic symptoms were examined during a four-hour period. Yohimbine produced significantly greater increases in patient-rated anxiety, nervousness, palpitations, hot and cold flashes, restlessness, tremors, piloerection, and sitting systolic BP in the total patient group compared with healthy subjects. There were significant correlations between the yohimbine-induced rise in plasma MHPG level and patient-rated anxiety and nervousness and the frequency of reported panic attacks. Patients experiencing frequent panic attacks (greater than 2.5 per week) had a significantly greater plasma MHPG response to yohimbine than the healthy subjects and patients having less frequent panic attacks. These observations support a hypothesis of increased sensitivity to augmented noradrenergic function in anxiety states associated with panic, and they suggest that impaired presynaptic noradrenergic neuronal regulation may exist in patients with frequent panic attacks.
Article
Considerable evidence implicates the neurotransmitter gamma-aminobutyric acid (GABA) in the biochemical pathophysiology of mood disorders. Animal models of depression show regional brain GABA deficits and GABA agonists have antidepressant activity in these models. Somatic treatments for depression and mania upregulate the GABAB receptor, similar to the effect of GABA agonists. Clinical data indicate that decreased GABA function accompanies depressed or manic mood states. GABA agonists are effective antidepressant and antimanic agents. Low GABA levels are found in brain, cerebrospinal fluid and plasma of patients with depression and in plasma of patients with mania. Plasma GABA levels, which reflect brain GABA, are not normalized with treatment and clinical remission in depression, suggesting low GABA is not a marker for mood state. Some somatic treatments, including valproic acid and electroconvulsive shock, reduced plasma GABA and response to these correlates with higher levels of baseline plasma GABA. From these data, a GABA hypothesis for mood disorders is formulated. Low GABA function is proposed to be an inherited biological marker of vulnerability for development of mood disorders. Environmental factors, including stress and excessive alcohol use, may increase GABA, causing symptoms of depression or mania. Treatment, or the passage of time, then returns GABA to its presymptomatic baseline as the symptoms remit. This hypothesis, applicable to a subset of mood disordered persons, is testable.
Article
To examine cross-sectionally and prospectively relationships of cigarette smoking with major depressive disorder (MDD), controlling for comorbidity in a community sample of adolescents. A representative sample of 1,709 adolescents (aged 14 through 18 years) was assessed by using semistructured diagnostic interviews on two occasions, approximately 1 year apart. Logistic regression analyses were used to examine cross-sectionally and prospectively the relationships between smoking and each psychiatric disorder, while statistically controlling for the other disorders. Cross-sectional analyses revealed significant relationships of drug abuse/dependence and disruptive behavior disorders with adolescent smoking, even after the co-occurrence of all other disorders was controlled. Prospectively, smoking was found to increase the risk of developing an episode of MDD and drug abuse/dependence, after adjusting for other disorders. Finally, only lifetime prevalence of MDD remained a significant predictor of smoking onset, after controlling for other disorders. Gender did not moderate any of the relationships between psychopathology and smoking. The results suggest important relationships between cigarette smoking and psychiatric disorders among adolescents, particularly with regard to MDD, drug abuse/dependence, and disruptive behavior disorders. These findings have important clinical implications, both for psychiatric care and for smoking prevention and cessation efforts with adolescents.
Article
This study compared the effect of subcutaneous nicotine injections (2 x 0.3 mg and 2 x 0.6 mg) with saline on subjective and physiological measures in 18 never-smokers and 18 smokers (24-h nicotine deprived), under conditions of rest and cognitive testing. Prior to the injections the mood of the smokers had deteriorated to a level significantly below that of the never-smokers as a result of tobacco withdrawal. Cognitive tests caused reductions in calmness and increased alertness but there was no evidence of nicotine improving mood in either group under either condition. The 0.6 mg dose worsened mood in never-smokers and caused unpleasant symptoms (e.g. dizziness and arm pain) in both groups. Compared with smokers, never-smokers experienced stronger symptoms of nicotine toxicity and a greater reduction in alertness in response to the 0.6 mg dose, suggesting chronic tolerance to some nicotine effects in smokers. Nicotine produced similar increases in heart rate and decreases in finger pulse volume in both groups. Our results imply that if nicotine has a mood enhancing effect it occurs only after tolerance has been acquired to its primary adverse effects, and that its ability to reverse the mood deterioration caused by tobacco withdrawal is susceptible to situational factors such as our experimental conditions.
Article
This subanalysis of the Canadian Human Activity Pattern Survey examines environmental tobacco smoke (ETS) exposure in non-smoking respondents relative to age, sex, socioeconomic status and prevalence of asthma. 2,381 respondents (response rate 64.5%) from Toronto, Vancouver, Edmonton and Saint John completed a 24-hour recall time-activity diary. For each activity and location, respondents were asked, "was there any smoking during the activity?" Among non-smoking adults, youth, children and asthmatics, the rates of ETS exposure were 32%, 34%, 30% and 42% respectively. Regarding the location of exposure, adults reported ETS exposure in various locations (work, bars and restaurants), including home. Children experienced the most exposure at home, primarily between 4 p.m. and midnight. Adults reported ETS mainly in the living room (16%) and vehicles (13%); for children, the living room (22%) and the bedroom (13%) were the most common locations. Determining characteristic time and location patterns for ETS exposure underpins educational strategies to help non-smokers avoid ETS exposure.
Article
Recent research suggests that people who become smokers may be more sensitive to the positive effects of nicotine upon initial exposure than those who do not take up smoking. The present study was designed to extend these findings to a sample of college-age women never-smokers and light smokers. Subjects were asked to rate pleasurable and displeasurable sensations upon first smoking and to indicate the presence or absence of pleasurable rush or buzz, relaxation, dizziness, nausea, and cough. Pleasurable sensations were marginally greater in smokers; pleasurable rush or buzz and dizziness were significantly more likely to be reported by smokers. Relaxation, displeasurable sensations, nausea, and cough did not differ significantly between groups. Fagerstrom Test for Nicotine Dependence scores significantly predicted pleasurable but not displeasurable sensations; Center for Epidemiological Studies-Depression scores predicted neither. These findings lend further support to the following conclusions: (1) people who become cigarette smokers experience more pleasurable sensations upon initial exposure to tobacco than their never-smoking counterparts; and (2) unpleasant reactions to the first cigarette do not protect against subsequent smoking.
Article
Epidemiologic studies have reported a lifetime association between smoking and panic disorder. In this study, we examine potential explanations for this association. Analysis was conducted on data from 2 epidemiologic studies, the Epidemiologic Study of Young Adults in southeast Michigan (N = 1007) and the National Comorbidity Survey Tobacco Supplement (n = 4411). Cox proportional hazards models with time-dependent covariates were used to estimate the risk for onset of panic attacks associated with prior smoking and vice versa, controlling for history of major depression. The role of lung disease in the smoking-panic attacks association was explored. Daily smoking signaled an increased risk for first occurrence of panic attack and disorder; the risk was higher in active than past smokers. No significant risk was detected for onset of daily smoking in persons with prior panic attacks or disorder. Exploratory analyses suggest that lung disease might be one of the mechanisms linking smoking to panic attacks. The evidence that the association between smoking and panic disorder might result primarily from an influence in one direction (i.e., from prior smoking to first panic attack) and the possibility of a higher risk in active than past smokers suggest a causal hypothesis for the smoking-panic attacks relationship.
Article
This report presents the results of systematic reviews of effectiveness, applicability, other effects, economic evaluations, and barriers to use of selected population-based interventions intended to reduce tobacco use and exposure to environmental tobacco smoke. The related systematic reviews are linked by a common conceptual approach. These reviews form the basis of recommendations by the Task Force on Community Preventive Services (TFCPS) regarding the use of these selected interventions. The TFCPS recommendations are presented on page 67 of this supplement.
Article
The ascendance of emotion theory, recent advances in cognitive science and neuroscience, and increasingly important findings from developmental psychology and learning make possible an integrative account of the nature and etiology of anxiety and its disorders. This model specifies an integrated set of triple vulnerabilities: a generalized biological (heritable) vulnerability, a generalized psychological vulnerability based on early experiences in developing a sense of control over salient events, and a more specific psychological vulnerability in which one learns to focus anxiety on specific objects or situations. The author recounts the development of anxiety and related disorders based on these triple vulnerabilities and discusses implications for the classification of emotional disorders.
Article
To examine the association between exposure to environmental tobacco smoke (ETS) and demographic, lifestyle, occupational characteristics and self reported health conditions. Cross sectional study, using data from multiphasic health checkups between 1979 and 1985. Large health plan in Northern California, USA. 16 524 men aged 15-89 years and 26 197 women aged 15-105 years who never smoked. Sixty eight per cent of men and 64 per cent of women reported any current ETS exposure (at home, in small spaces other than home or in large indoor areas). The exposure time from all three sources of ETS exposure correlated negatively with age. Men and women reporting high level ETS exposure were more likely to be black and never married or separated/divorced, to have no college or partial college education, to consume three alcoholic drink/day or more and to report exposure to several occupational hazards. Consistent independent relations across sexes were found between any current exposure to ETS and a positive history of hay fever/asthma (odds ratio (OR)=1.22 in men, 1.14 in women), hearing loss (OR=1.30 in men, 1.27 in women), severe headache (OR=1.22 in men, 1.17 in women), and cold/flu symptoms (OR=1.52 in men, 1.57 in women). Any current ETS exposure was also associated with chronic cough (OR=1.22) in men and with heart disease (OR=1.10) in women. Self reported stroke was inversely associated with any current ETS exposure in men (OR=0.27). No associations were noted for cancer or tumour and for migraine. ETS exposure correlated with several personal characteristics potentially associated with adverse health outcomes. Although the study design precluded causal inference, ETS exposure was associated with several self reported acute and chronic medical conditions.
Article
This paper reviews research on attitudes and behaviours towards environmental tobacco smoke (ETS), with a special focus on child health and the indoor environment. Research needs and ways forward to encourage reductions in domestic ETS levels are discussed. Published material was identified through online literature searches (Medline, Toxline, Cancerlit, Biosis, Embase, Enviroline, Sociological Abstracts, Social Science Citation Index, Academic Index and Psychinfo). The literature search strategy employed search terms such as "passive smoking" or "environmental tobacco smoke" with "attitude" or "awareness" and other synonyms. Additional publications were identified by citation chasing and expert advice. Focusing on the UK, studies that provided survey-derived data about attitudes and behaviours in relation to ETS exposure in the indoor environment were selected for review. Published studies from other countries were also included when they provided information pertinent to this review. Most people are aware of the health risks associated with ETS exposure, and there is a high level of support for smoking restrictions in public places to protect non-smokers from ETS. However, although there is concern among both non-smoking and smoking parents about children and second-hand smoke, many people allow children to be exposed to ETS in the home. The review suggests that traditional health promotion campaigns have had only limited success in encouraging ETS risk reduction measures in the home. Because ETS is a public health priority, particularly in relation to child health, the barriers to the uptake of such measures need to be explored in detail to inform the future promotion of reductions in domestic levels of ETS.
Article
We examined prospectively determined bidirectional associations between smoking and panic and other anxiety disorders and their temporal ordering of onset in a representative community sample of adolescents and young adults. Baseline and 4-year follow-up data were used from the Early Developmental Stages of Psychopathology Study, a prospective longitudinal study of adolescents and young adults in Munich, Germany. We assessed smoking (occasional and regular), nicotine dependence, panic attacks, panic disorder, other anxiety disorders, and other mental disorders using the Munich-Composite International Diagnostic Interview. At baseline, panic attacks and panic disorder were strongly associated with occasional and regular smoking and nicotine dependence (odds ratio [OR] range, 3.0-28.0). In the prospective analyses, we found increased risk for new onset of panic attacks with prior regular smoking (OR, 2.9; 95% confidence interval [CI], 1.0-8.4) and nicotine dependence (OR, 3.6; 95% CI, 1.2-10.5). Prior nicotine dependence increased also the risk for onset of panic disorder (OR, 3.3; 95% CI, 1.0-10.5), whereas preexisting panic was not associated with subsequent smoking or nicotine dependence. When using Cox regression with time-dependent covariates, prior nicotine dependence was confirmed to be related to subsequent panic attacks (hazard ratio, 2.7; 95% CI, 1.7-4.2), but not panic disorder (hazard ratio, 1.7; 95% CI, 0.7-3.9). Rather, we found indications that prior panic attacks/disorder might also have an effect on secondary development of nicotine dependence. In young adults, prospective analyses revealed a fairly unique and specific, unidirectional relationship between prior smoking and increased risk for subsequent panic attacks/disorder. However, we could not exclude the existence of a second, less frequent, reverse pathway of prior panic and secondary nicotine dependence.
Article
While much is known about the impact of law and public policy, we know considerably less about their antecedents. Theories of policy adoption suggest that a variety of policy inputs help to shape legislative change. This research considers the enactment of municipal smoking bylaws in Canada between 1970 and 1995. The emergence of second-hand smoke (SHS) has been offered as a viable explanation for the increased enactment of local smoking restrictions. A number of indicators confirm the rising public health concern around SHS. Using Health Canada data on municipal smoking bylaw enactment in Canada, this paper employs an event history analysis to trace the role of four indicators of the increased recognition of SHS as a public health concern-scientific research, parliamentary debate, print media, and health advocacy. Findings indicate that the print media and health advocacy play the strongest role in explaining the increase in the adoption of municipal smoking bylaws in Canada. Results lend support to the quantitative study of the policy adoption process and to theories of policy making that consider multiple influences on policy adoption.
Article
The aim of this paper was to examine the association between major depression and cigarette smoking among young adults in a birth cohort before and after adjusting for confounding factors. Data were gathered over the course of the Christchurch Health and Development Study (CHDS). The CHDS is a longitudinal study of a birth cohort of 1265 New Zealand children studied to age 21. Data were gathered by interview on: (a) major depression over the period 16-21 years; (h) daily smoking and nicotine dependence over the period from 16-21 years. In addition, the study included extensive information on social, family, and behavioural factors in childhood and adolescence. Young people meeting DSM-IV criteria for major depression had elevated rates of daily smoking and nicotine dependence. These associations were reduced substantially by control for potential confounding child and adolescent factors. Nonetheless, even after such control, major depression was associated with increased rates of daily smoking (IRR = 1.19; 95% CI = 1.03, 1.39) and elevated rates of nicotine dependence (OR = 1.75; 95% CI = 1.13, 2.70). The results suggest that much of the association between smoking and depression reflects common confounding factors that are associated with both outcomes. Nonetheless, even after control for these factors there is evidence of a possible causal linkage between smoking and depression. The direction of causality between smoking and depression remains unknown.
Article
We examined the role of DSM-III-R psychiatric disorders in predicting the subsequent onset of daily smoking, smokers' progression to nicotine dependence, and the persistence of smoking. The Tobacco Supplement of the National Comorbidity Survey was administered to a representative subsample of 4414 persons 15-54 years of age. DSM-III-R psychiatric disorders and information on age of onset of psychiatric disorders, daily smoking, and smoking cessation were ascertained with the World Health Organization's Composite International Diagnostic Interview. Preexisting psychiatric disorders that have not remitted (i.e., active disorders) predicted an increased risk for the first onset of daily smoking and for smokers' progression to nicotine dependence. The increased risk applied across most of the disorders examined in the study, including major depression, anxiety disorders, and substance use disorders. Persons with four or more active disorders were at higher risk for daily smoking (2.1 vs. 1.4) and for nicotine dependence (2.9 vs. 1.4) than were persons with one active disorder. With few exceptions, remitted (i.e., past) disorders did not predict the subsequent onset of daily smoking. Preexisting psychiatric disorders did not influence smokers' potential for quitting; the persistence of smoking in the year preceding the interview was unrelated to history of psychiatric disorders. The results suggest the possibility of additional and previously unrecognized public health benefits of early treatment of mental disorders, in that persons with various mental disorders whose illness had remitted were not at increased risk for daily smoking, in contrast with persons with active disorders.
Article
Recent research has demonstrated that smokers are at an elevated risk for psychiatric disorders. This study extends the enquiry by examining: (1) the specificity of the psychiatric sequelae of smoking; and (2) the variability in the likelihood of these sequelae by proximity and intensity of smoking. Data come from the National Comorbidity Survey (NCS), a representative sample of the US population 15-54 years of age. The Smoking Supplement was administered to a representative subset of 4414 respondents. A modified World Health Organization-Composite International Diagnostic Interview was used to measure DSM-III-R disorders. Survival analysis with smoking variables as time-dependent covariates was used to predict the subsequent onset of specific psychiatric disorders. The estimated effects of daily smoking varied across disorders. In the case of mood disorders, daily smoking predicted subsequent onset, with no variation between current versus past smokers or by smoking intensity. In the case of panic disorder and agoraphobia, current but not past smoking predicted subsequent onset; furthermore, the risk of these disorders in past smokers decreased with increasing time since quitting. In the case of substance use disorders, current but not past smoking predicted subsequent onset, with no variation by time since quitting or smoking intensity. The data suggest that smoking cessation programmes would not prevent the onset of mood disorder, as ex-smokers do not differ from current smokers in their risk for these disorders. In comparison, daily smoking might be a causal factor in panic disorder and agoraphobia, conditions that might be preventable by smoking cessation. Additionally, current smoking might serve as a marker for targeting interventions to prevent alcohol and drug disorders.
Article
Research shows cigarette smoking does not provide mood control benefits, but rather nicotine dependency is associated with mood lability, leading to heightened feelings of stress and depression in many regular smokers. Beginning to smoke during adolescence prospectively leads to increased stress and depression; stopping smoking is followed by enduring mood improvements.
Article
The biological mechanisms underlying the link between smoking and panic attacks are unknown. Smoking might increase the risk of panic by impairing respiratory system function. We evaluated the effect of smoking on respiratory irregularity in patients with panic disorder (PD) and healthy comparison subjects and the role of the respiratory disorders in this effect. We applied the Approximate Entropy index (ApEn), a nonlinear measure of irregularity, to study breath-by-breath baseline respiratory patterns in our sample. Both smoker and nonsmoker patients had more irregular respiratory patterns than healthy subjects. Smoker patients showed higher ApEn indices of baseline respiratory rate and tidal volume than nonsmoker patients (R = 5.4, df = 2,55, p < .01), whereas smoking in healthy subjects did not influence the regularity of respiratory patterns. Respiratory disorders did not account for the influence of smoking on respiratory irregularity. Smokers had more severe panic attacks than nonsmokers. Smoking may impair vulnerable respiratory function and act as disruptive factor on intrinsic baseline respiratory instability in patients with PD, possibly influencing the onset or maintenance of the disorder.
Article
Evidence suggests that nicotine-dependent smokers are at increased risk for psychiatric comorbidity but general population data that included the number of nicotine dependence and withdrawal symptoms according to DSM-IV, the Fagerstrom Test for Nicotine Dependence (FTND), somatoform disorders and the number of psychiatric diagnoses are rare. The goal of the present study was to analyse relationships of smoking and nicotine dependence with psychiatric disease and whether psychiatric disease predicts the sustaining of smoking after three years. Cohort study with a random adult population sample in a northern German region (N = 4075) including a baseline measurement of ever daily smokers aged 18-64 (n = 2458), a first follow-up of the current smokers at baseline (n = 1552) after 30 months and a second follow-up after 36 months. Measures included DSM-IV diagnoses by the Composite International Diagnostic Interview, FTND, smoking cessation by interview. Current daily smokers showed higher odds of a substance use disorder other than nicotine dependence compared with never smokers (odds ratio, OR, 4.6; confidence interval, CI, 2.9-7.2), affective (OR 1.8; CI 1.4-2.5), anxiety (OR 1.6; CI 1.2-2.0) or somatoform disorder (OR 1.4; CI 1.0-1.8). DSM-IV nicotine dependence and the FTND were positively related with the number of psychiatric diagnoses. Psychiatric comorbidity did not predict the maintenance of smoking or quitting. Findings of increased rates of mental disorders among smokers and nicotine-dependent smokers in the adult general population are supported by this study. The number of nicotine dependence and withdrawal symptoms are related to mental disorders. In addition, somatoform disorders show relationships with smoking similar to relationships with depressive or anxiety disorders. The intention to stop smoking should be proactively supported among these comorbid patients.
Article
This article examines exposure to second-hand smoke (SHS) in 2003 in various settings by age and sex, and compares exposure indicators by province and health region. The data are from the 2000/01 and 2003 Canadian Community Health Survey, conducted by Statistics Canada. Rates of exposure to SHS among non-smokers are calculated by sex, age and location for the household population aged 12 or older. Rates of exposure at work are examined for employed non-smokers aged 15 or older. Smoking prevalence is expressed as a percentage of the household population aged 12 or older. In 2003, 33% of non-smokers reported that they were regularly exposed to SHS. The risk of exposure was greatest in public spaces, but regardless of setting, rates of exposure were higher for men than women. Exposure rates varied by age and peaked in young adulthood. However, at home and at work, the younger the non-smokers, the more likely they were to be exposed to SHS. Disparities in SHS exposure by province/territory and by health region were substantial.