Associations between smoking cessation and anxiety and depression among U.S. adults☆
Introduction
The Centers for Disease Control and Prevention estimated that, in 2000, 8.6 million people in the United States were living with serious illnesses attributable to smoking (CDC, 2003). It has been well established that smoking is the leading cause of preventable death in the United States (USDHHS, 2004) and that smoking cessation can improve the health and well-being of those who currently smoke (USDHHS, 1990). However, because of the highly addictive properties of nicotine (Pontieri et al., 1996, Pontieri et al., 1998), smoking cessation is often difficult. This coupled with other co-morbid conditions such as depression may pose challenges for smokers attempting to quit.
Many studies have shown an association between smoking and depression (Farrell et al., 2001). Current major depression rates of 22% to 60% have been observed among current smokers (Covey, Glassman, & Stetner, 1998); whereas, it is estimated that 8.7% of the general U.S. population have current depression (Strine, Mokdad, Balluz, & Kroenke, 2008). Furthermore, data from the National Comorbidity Study collected from 1991 to 1992 indicated that 44.7% of persons with current major depression smoked cigarettes (Lasser et al., 2000), whereas 25.7% of the general population smoked cigarettes in 1991 (CDC, 1993). Not only is current depression observed more often among smokers, but a lifetime history of depression or history of depressive symptoms has been associated with smoking cessation failure (Covey et al., 2006, Killen et al., 2003). Previous research has shown that in 1991 only 26.0% of persons with current major depression had successfully quit smoking (Lasser et al., 2000); whereas 48.5% of all U.S. adults who had ever smoked (“ever smokers”) had successfully quit smoking (CDC, 1993).
Other studies, however, have suggested that depression is not an independent risk factor for smoking cessation failure (Hitsman et al., 2003, Killen et al., 2000, Niaura et al., 1999). In fact, previous research suggests other factors, such as anxiety, and co-morbid anxiety and current depression are more highly associated with smoking status than current depression alone (Mykletun, Overland, Aaro, Liabo, & Stewart, 2008). In support of these findings, previous research shows smokers report more general anxiety than nonsmokers (McCabe et al., 2004). Furthermore, other studies have found that a lifetime history of depression had little or no predictive value regarding smoking cessation, including a large meta-analysis of 15 studies conducted by Hitsman et al. (2003) which assessed the association between a lifetime history of depression and smoking cessation outcomes. Hitsman et al. (2003) did, however, identify a need for research concerning 1) the association between current depression and smoking status, 2) specific symptoms of depression that place smokers at elevated risk for cessation failure, and 3) the association between depression and smoking based on cross-sectional population data. To address the gaps in the scientific literature identified here, we analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS), a large, cross-sectional population data source, to assess the association between current and lifetime depression, lifetime anxiety, co-morbid lifetime anxiety and depression and smoking cessation. In addition, we examined specific symptoms of current depression among different stages of smoking cessation.
Section snippets
Methods
The BRFSS is an ongoing state-based, landline telephone survey used to collect information on health risk behaviors, preventive health practices, and access to and use of health care services primarily related to chronic conditions among U.S. adults aged 18 years or older. For this study, we used 2006 BRFSS data, including data collected with the “Anxiety and Depression” module administered to 248,800 respondents in 38 states, the District of Columbia (DC), and 2 U.S. territories (Puerto Rico
Demographics
The mean age of respondents who reported having smoked at least 100 cigarettes (“ever smokers”) was 47.8 years; 55.5% were men, and 44.5% were women; 31.7% had graduated from high school only, and 25.7% had graduated from college or technical school; 82.9% had health care coverage, 59.2% were married; 60.5% were employed for wages; and 74.5% were non-Hispanic whites. Among ever smokers, 20.5% reported a diagnosis of one chronic disease, and 7.5% reported a diagnosis of two or more chronic
Discussion
In this study, we addressed several of the aforementioned gaps in the scientific literature on smoking and depression. We found that among U.S. adults who had ever smoked (ever smokers), those who currently smoked and were unsuccessful in quitting smoking in the past year were more likely to be currently depressed and experienced more days of depressive symptoms on average than either those who had not attempted to quit in the previous year (non-quitters) and those who no longer smoke at all
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Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.