Gender differences in the associations between tobacco smoke exposure and depressive symptoms among US adults: NHANES 2007-2018

Background: Findings concerning gender differences in the associations between tobacco smoke exposure (TSE) and depression are inconsistent. This study aimed to investigate the gender-specific associations between active and passive TSE with depressive symptoms in a large, nationally representative sample of U.S. adults.& nbsp;Methods: Data were from 27,175 adults aged & GE;20 years in the 2007-2018 National Health and Nutrition Examination Survey (NHANES). Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Multivariable logistic regression was used to adjust for possible confounders. Whether the TSE-depression relationships may differ by age, race/ethnicity, socioeconomic status, body mass index (BMI), and self-reported health status was examined.& nbsp;Results: After adjustment for lifestyle-and health-related variables, no significant associations between active (OR, 1.16 [95% CI, 0.87-1.55]) and passive TSE (OR, 0.84 [95% CI, 0.59-1.19]) and depressive symptoms were found among men. Among women, active TSE was associated with depressive symptoms (OR, 1.90 [95% CI, 1.51-2.39]), while the association for passive TSE was nonsignificant (OR, 1.11 [95% CI, 0.91-1.34]) after adjusting for lifestyle-and health-related variables. Interaction and subgroup analyses showed that self-reported health status could modify the relationship between passive TSE and depressive symptoms among women. Furthermore, a dose-response relationship between serum cotinine and depressive symptoms was found in women, but not in men.& nbsp;Conclusions: This study suggests a stronger TSE-depression association in women than in men. Understanding these gender-specific patterns and identifying the potential moderators of such relationships will enable better targeting of public health interventions.

Automated summary

This study found that there is a stronger association between tobacco smoke exposure (TSE) and depressive symptoms in women compared to men. Active TSE was significantly associated with depressive symptoms in women, while passive TSE was not. Self-reported health status was found to modify the relationship between passive TSE and depressive symptoms in women. Additionally, a dose-response relationship between serum cotinine and depressive symptoms was observed in women but not in men.