Full length articleDepression among current, former, and never smokers from 2005 to 2013: The hidden role of disparities in depression in the ongoing tobacco epidemic
Introduction
The prevalence of current cigarette smoking among adults in the United States (U.S.) has decreased substantially over the past several decades (US Department of Health and Human Services, 2014) from a high of 42% in 1965 to approximately 25.5% in 1990 (American Lung Association, 2007). Current estimates indicate that approximately 18% of Americans self-identify as current smokers (Jamal et al., 2014), suggesting a comparatively slowed decline in the past two decades. Some data suggest there have been increases in quit attempts in recent years among some subgroups of smokers (e.g., adults aged 25–64), but not others, and overall the rate of quitting has remained relatively stable (CDC, 2011). More recent data suggest that tobacco control efforts have not equally benefitted all persons with large and increasing inequalities in tobacco use observed among vulnerable subgroups (Williams et al., 2013). Persons with mental health problems are one such subgroup.
Major depression is among the most common mental health conditions, with a lifetime prevalence in the general population of approximately 20% (Hasin et al., 2005). Depression is more than twice as common in smokers than in non-smokers (Weinberger et al., 2016). Meta-analyses of clinical studies have suggested that depression is associated with poorer smoking cessation outcomes (Hitsman et al., 2013) and both community-based and epidemiologic studies have found that depression is associated with decreased likelihood of remaining abstinent over extended periods of time (Weinberger et al., 2016, Zvolensky et al., 2015).
As such, one possible explanation for the lack of improvement in quit rates over time in the U.S. population is that smokers today are more likely to have attributes or conditions, like depression, that make them less likely to quit in response to public health tobacco control efforts, compared with smokers a decade ago. If this is the case, we would expect the prevalence of depression to be higher among smokers in 2013 compared with smokers in 2005. Further, the prevalence of depression is more common overall among those of lower income, younger age, and female gender (Hasin et al., 2005). Yet, the prevalence of smoking has declined more rapidly among those of higher income, older age, and male gender (Hibbs et al., 2016). As such, understanding the changes in depression among smokers over time within these groups will be useful in providing a clearer understanding of what underlies and drives overall trends, as well as highlight high-risk groups who may benefit from tailored intervention and prevention programs. To our knowledge, no prior study has estimated changes in the prevalence of depression among current, former and never smokers in the U.S. over the past decade.
Against this background, the objective of this study is to investigate the relationship between depression and cigarette smoking in the U.S. population, to estimate changes in the prevalence of depression among current smokers in the United States from 2005 to 2013, and to examine the trends in depression among smokers by age, gender and income.
Section snippets
Study population
Study data were drawn from The National Survey on Drug Use and Health (NSDUH) public data portal (http://www.icpsr.umich.edu/), for years 2005–2013. The National Survey on Drug Use and Health (NSDUH) provides annual cross-sectional national data on the use of tobacco, other substance use, and mental health in the U.S., and is described in depth elsewhere (SAMHSA 2013). A multistage area probability sample for each of the 50 states and the District of Columbia has been conducted, to represent
Past year depression
Depression modules were based on the fourth edition of the DSM-IV criteria for major depressive episode (MDE; APA 1994). MDE questions were adapted from the depression section of the National Comorbidity Survey-Replication (NCS-R; Hedden et al., 2012) for adults and of the National Comorbidity Survey-Adolescent (NCS-A) for adolescents. Separate depression modules were administrated to adults (aged 18 or older) and to adolescents (aged 12–17). Participants were classified as having had a
Prevalence of current, former and lifetime never smokers from 2005 to 2013
The prevalence of current smoking declined significantly from 29.24% in 2005–25.24% in 2013 (p < 0.0001; see Table 1). The prevalence of former smoking also decreased, albeit at a much slower rate from 37.09% to 36.64%, while the prevalence of lifetime never smoking increased significantly from 33.67% to 38.12% over this time span.
Prevalence of depression among current, former and lifetime never smokers from 2005 to 2013
The prevalence of depression increased overall in the population from 2005 to 2013 (see Table 2). Among current smokers, there was a marginally significant increase in
Discussion
The overarching goal of this study was to investigate the relationship between depression and cigarette use in the U.S. from 2005 and 2013 by smoking status overall and by age, gender and income. The study had three main findings. First, there was not a significant increase in depression among current smokers per se from 2005 to 2013. Depression increased among all groups from 2005 to 2013. Although depression increased among current smokers, the increases among former and never smokers were
Conflict of interest
No conflict declared.
Role of funding source
This study was supported by grant #DA-20892 (Dr. Goodwin) from NIH/NIDA.
Contributors
RDG conceived of the study and drafted the manuscript. LG and MJZ contributed the writing of the manuscript. MMW designed the statistical analytic strategy and MCH and MG conducted statistical analyses. DSH, LD, SG, AHW and JMW provided critical feedback on study design and interpretation of results. All authors have approved this version of the manuscript and its submission to Drug and Alcohol Dependence.
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