Vaping E-Cigarette and Smoking Conventional Cigarettes are Associated with Depression Regardless of Gender, Race, and Ethnicity: Analysis of the Health Information National Trends Survey (HINTS) 2022

Research Article

J Community Med Health Care. 2023; 8(1): 1062.

Vaping E-Cigarette and Smoking Conventional Cigarettes are Associated with Depression Regardless of Gender, Race, and Ethnicity: Analysis of the Health Information National Trends Survey (HINTS) 2022

Shervin Assari1,2,3*; Sharon Cobb3

1Department of Urban Public Health, Charles R Drew University of Medicine and Science, Los Angeles, CA

2Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA

3School of Nursing, Charles R Drew University of Medicine and Science, Los Angeles, CA

*Corresponding author: Shervin Assari Department of Urban Public Health, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA. Email: assari@umich.edu

Received: June 06, 2023 Accepted: July 08, 2023 Published: July 15, 2023

Abstract

Background: While previous research has explored the bidirectional relationships between smoking, vaping, and depression, limited attention has been given to examining potential gender-, race-, and ethnic- specific patterns in these associations.

Aims: This study aimed to investigate gender, race, and ethnic differences in the associations between smoking conventional and vaping e-cigarettes and depressive symptoms.

Methods: Data from the Health Information National Trends Survey (HINTS–2022) survey were analyzed, including a representative sample (probability sample) of US adults. Variables of interest included smoking status, e–cig use, depression (PHQ-4), and demographic characteristics. Binary logistic regression models were employed to assess the association between smoking and e-cig use (current and ever), and depression overall, adjusting for covariates (age, education, marital status, and employment). Statistical Package for the Social Sciences (SPSS) software was used for data analysis, using univariate, bivariate, and multivariable models. We tested potential interactions between race, ethnicity, gender, and depression.

Results: The study findings indicated significant associations between smoking, e-cig use, and depression. Individuals who were experiencing depression compared to those non-depressed were more likely to use conventional (p<0.05) and e-cig (p<0.05). However, no significant interactions were found for gender, race, or ethnicity.

Conclusions: This study suggests that the association between smoking, e-cig use, and depressive symptoms is not different by race, sex, and gender. These findings contribute to the existing literature, emphasizing the need for universal approaches to promote mental health as a tool to help individuals quit smoking and vaping, regardless of their gender, ethnicity, and race.

Background

In recent years, there has been a growing interest in understanding the relationship between smoking behavior and depressive symptoms [1]. Numerous studies have investigated the bidirectional nature of the association between depression and substance use [2], shedding light on the predictive effects of smoking on depression and vice versa [3]. However, very little research has explored group differences in the links between depressive symptoms and smoking [4]. In addition, there have been even less studies that have investigated potential gender, race, and ethnicity differences in the relationships between depression, smoking conventional cigarettes, and vaping electronic cigarettes (e-cigs) [5].

Gender, race, and ethnicity are crucial factors to consider when examining the comorbidity between smoking and depression [6]. People from diverse backgrounds may exhibit distinct motivations for substance use [7]. They may also have different risk factors and presentation of depression [8]. Males and females also differ in patterns of smoking behavior [9], coping mechanisms [10], and responses to depression [11]. For example, some research suggests that men and women may differ in the connection between depression and smoking cigarettes or vaping e-cigs [12].

While there is some evidence on the relationship between smoking and depression [6], few studies have explored gender, race, and ethnic differences in this regard. Furthermore, with the recent trends and the increasing popularity of e-cigs [13], there is a need to investigate any potential gender differences in the association between e-cig use and depressive symptoms [14]. Given the unique characteristics of use of e-cigs compared to conventional cigarettes, it is reasonable to expect groups differences in the link between depression and alternative nicotine delivery systems [15].

Aim

To fill this gap in the literature, and our past work on groups differences in the bidirectional links between depression and substance use [16], we aimed to compare gender, race, and ethnic groups for the association between smoking conventional cigarette, vaping e-cigs, and depression. By examining these group-specific patterns, we hope to gain a deeper understanding of how group membership impacts the need for depression screening and treatment as a join component of cessation programs for smoking of conventional cigarettes or vaping e-cig of diverse groups. The findings of this study may have significant implications for designing targeted and tailored interventions and prevention strategies that simultaneously address the smoking and depressive needs of diverse populations.

Methods

This cross-sectional study utilized data from the Health Information National Trends Survey (HINTS – 2022 [17]). HINTS is a nationally representative survey conducted in the United States designed to assess various aspects of health communication, cancer knowledge, health care use, smoking behavior, e-cigarette use, and depressive symptoms [17]. The survey is administered through computer-assisted telephone interviews, ensuring a standardized data collection process [17].

The study included a representative probability sample of US adults obtained from the HINTS survey. The sample consisted of both men and women, covering a diverse range of demographic characteristics. The participants were selected through a multistage sampling design, incorporating both landline and mobile phone numbers to ensure adequate representation across the population [17].

The variables of interest in this study included smoking status, e-cigarette use, depressive symptoms, demographic, and Socioeconomic Status (SES) characteristics. Smoking status was assessed using self-report measures, distinguishing between current smokers and non-smokers. Separate questions were asked for conventional and e-cigarettes. E-cigarette use was evaluated by identifying individuals who reported current or ever use of e-cigarettes [18]. Depressive symptoms were measured using the Patient Health Questionnaire-4 (PHQ-4) [19], a validated screening tool that assesses symptoms of depression. A threshold of 3 or more was considered mild-to-moderate, and a score of 7 or above was considered severe depression [20]. Demographic characteristics including race, ethnicity, and gender were moderators. Age and SES indicators included education, marital status, and employment were included as covariates in the analysis.

Statistical Package for the Social Sciences (SPSS) software was utilized for data analysis [21]. Univariate, bivariate, and multivariable models were employed to examine the relationships between the variables of interest and determine the significance of associations. For multivariable modeling, binary logistic regression models were employed to assess the associations between smoking conventional cigarettes or e-cigarette use and depressive symptoms. We ran binary logistic regression models overall without and with interactions terms between depression and race, ethnicity, and gender. The models were adjusted for covariates, including age, education, marital status, and employment. Substance use and depression were the outcome and predictor variables respectively. Odds Ratio, 95% CI, and p-values were reported. Statistical significance was set at p<0.05.

Results

Table 1 summarizes the data by demographic factors, socioeconomic factors, and ever and current use of e- cigarettes and conventional cigarettes. 6154 participants entered our analysis. Participants ranged in age from 18 to 99, with a mean (SD) age of 55.60 (17.4).

Citation: Assari S, Cobb S. Vaping E-Cigarette and Smoking Conventional Cigarettes are Associated with Depression regardless of Gender, Race, and Ethnicity: Analysis of the Health Information National Trends Survey (HINTS) 2022. J Community Med Health Care. 2023; 8(1): 1062.