Gender and the tobacco–depression relationship: A sample of African American college students at a Historically Black College or University (HBCU)

Addictive Behaviors 30 (2005) 1437 – 1441

Short communication

Gender and the tobacco–depression relationship: A sample of African American college students at a Historically Black College or University (HBCU) Yan Wanga, Dorothy C. Brownea, Carla L. Storrb, Fernando A. Wagnera,T a Drug Abuse Research Program/Center for Health Disparities Solutions, Public Health Program, Morgan State University, 1700 E. Cold Spring Lane, Montebello Complex, D103 Baltimore, MD 21251, USA b Drug Abuse Research Program/Center for Health Disparities Solutions, Morgan State University, 1700 E. Cold Spring Lane, Montebello Complex, D103 Baltimore, MD 21251, USA

Abstract This study examined the relationship between tobacco use and depression and its possible variation by gender among African American young adults. A paper-and-pencil survey was administered to African American college students graduating in 2003 from a Historically Black College or University (HBCU). Tobacco use measures included lifetime involvement. Depression symptoms were assessed using a revised version of the CES-D. Male smokers were found to be four times more likely to be depressed than male non-smokers (OR=4.4; 95% CI, 1.4, 14.3; p=0.012). However, female smokers were not more likely to be depressed than female non-smokers (OR=1.0; 95% CI, 0.5, 2.1). Findings from this study suggest the need of gender-specific tobacco or depression interventions among HBCU students. D 2005 Elsevier Ltd. All rights reserved. Keywords: Depression; Tobacco use; Gender; African American

Gender is an important characteristic for both depression and tobacco use. Females are more likely to be depressed while less likely to use tobacco than males, suggesting that a T Corresponding author. Tel.: +1 443 885 4518; fax: +1 443 885 8262. E-mail address: [email protected] (F.A. Wagner). 0306-4603/$ - see front matter D 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.addbeh.2005.01.008

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gender-specific relationship may exist between tobacco use and depression (USDHHS, 2003; Weissman & Klerman, 1977). However, studies addressing gender variation in depression and tobacco use offer inconsistent findings (Breslau, Peterson, Schultz, Chilcoat, & Andreski, 1998; Costello, Erkanli, Federman, & Angold, 1999). Furthermore, few studies have focused primarily on African Americans. The purpose of study is to investigate the association between depression and tobacco use and its possible gender variation among African American college students graduating from a HBCU.

1. Methods The population is defined as African American college students graduating from a HBCU located in the Mid-Atlantic Region in 2003. With approval of the University Institutional Review Board, trained staff administered a paper-and-pencil questionnaire. Overall, 404 African American students participated with a 53% response rate; however, analyses were restricted to the 355 students with complete data on depression. Those excluded from the analyses were not different on other variables compared with those who remained in the study. The revised Center of Epidemiologic Studies Depression Scale (CES-D; Eaton, Muntaner, Smith, & Tien, 2004) was used to assess depression. Respondents were sorted into two groups: bno clinically significant depressionQ and belevated depressive symptomsQ. Lifetime tobacco use was assessed on the basis of the participants’ responses to question on tobacco use. Participants were categorized as bnon-userQ and bever-userQ including formeruser and current-user. Similarly alcohol use and marijuana use were categorized to bnonuserQ and bever-userQ. Other covariates included gender, age group, annual income and stress. The Perceived Stress Scale (PSS) was applied as a measurement of stress (Cohen, Kamarck, & Mermelstein, 1983). All the statistical analyses were conducted by STATA 8.0 statistical software. Multivariate logistic regressions with and without stratification by gender were performed to assess the relationship between depression and tobacco use controlling for potential confounders.

2. Results An estimated 33% of the males and 20% of the females ever used tobacco. Sample characteristics are presented in Table 1. An estimated 32% of the males and 46% of the females had elevated depressive symptoms. Crude OR estimates showed that tobacco use, female gender, stress status, lower income, and younger age were related to higher occurrence of depression. Only tobacco use, gender and stress status were related to depression after adjustment for other covariates. Introducing terms for an interaction between gender and tobacco use improved the model fit (LR Chi(1)=7.46, pb0.01). Table 2 presents logistic regression estimates stratified by gender and adjusted for other covariates. Among males, tobacco ever-users were estimated to be four times more likely to

Table 1 Selected sample characteristics and odds ratio estimates of elevated depressive symptoms from a logistic regression model (graduating college students at One Urban HBCU, n=355) Total n

Elevated depressive symptoms Col %

n

Row %

Crude ORa

95% CIa

p-valuea

Adjusted ORb

95% CIb

p-valueb

80 20 67 33

90 23 15 19

46 49 21 54

1.0 1.1 0.3 4.0

reference 0.6–2.2 0.2–0.6 1.3–11.7

0.688 b0.001 0.013

1.0 0.9 0.4 5.7

reference 0.4–2.0 0.2–0.9 1.7–19.3

0.845 0.016 0.005

Age group 23 years or younger Older than 23 years

269 83

76 24

123 26

46 31

1.0 0.5

reference 0.3–0.9

0.021

1.0 0.8

reference 0.4–1.4

0.363

Alcohol use Non-user Ever-user

78 272

22 78

28 120

36 44

1.0 1.4

reference 0.8–2.4

0.196

1.0 1.1

reference 0.6–2.2

0.676

Marijuana use Non-user Ever-user

192 159

55 45

79 68

41 43

1.0 1.1

reference 0.7–1.6

0.759

1.0 0.8

reference 0.4–1.3

0.373

Income per year More than $20,000 $20,000 or less

109 244

31 69

36 114

33 47

1.0 1.8

reference 1.1–2.9

0.017

1.0 1.7

reference 1.0–3.0

0.052

Stress Not stressed Stressed

269 86

76 24

85 65

32 76

1.0 6.7

reference 3.8–11.7

b0.001

1.0 6.4

reference 3.5–11.5

b0.001

a b

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Crude Odds ratios (ORs), 95% Confidence Interval (95% CI), and p-values are not adjusted for covariates. Adjusted ORs, 95% CI, and p-values were adjusted for all the covariates listed in the table.

Y. Wang et al. / Addictive Behaviors 30 (2005) 1437–1441

Gender and tobacco use Female non-user 197 Female ever-user 47 Male non-user 72 Male ever-user 35

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Table 2 Subgroup variation in the tobacco–depression relationship, by gender (graduating college students at One Urban HBCU, n=355) Tobacco use

Females (n=244)

Males (n=107)

Adjusted OR

95% CI

Non-user Ever-user

1.0 1.0

reference 0.5–2.1

p-value

Adjusted OR

95% CI

p-value

0.929

1.0 4.4

reference 1.4–14.3

0.012

Adjusted Odds Ratios (ORs) were adjusted for age group, income per year, alcohol use, marijuana use, and stress. CI is confidence interval.

be depressed than non-users (OR=4.4; 95% CI=1.4, 14.3; p=0.012). There was no association between depression and tobacco use among females (OR=1.0; 95% CI=0.5, 2.1).

3. Discussion Findings from this study indicate that the tobacco–depression association is different for male and female African American graduating college students at a HBCU, with a modest association seen only in males. Studies of larger and more diverse samples of African American young adults are needed to test more precisely whether this association is unique among college educated males. Additionally, in this cross-sectional study, we cannot assess the causal relationship between tobacco use and depression. Due to the limited sample size, we also could not consider current smokers and former smokers separately. Notwithstanding limitations, this study sheds new light on understanding the tobacco– depression relationship among African Americans. Three plausible hypotheses have been proposed by others to explain tobacco–depression relationship in general: (1) Depressed individuals may self-medicate with tobacco (Breslau & Peterson, 1996); (2) Nicotine use or withdrawal may increase vulnerability to depression (Glassman, 1993; Wu & Anthony, 1999); and (3) The association may be non-causal, resulting from a common third set of traits, such as genes or environmental factors. (Hughes, 1988; Kendler et al., 1993). However, no theory considers the gender variation of tobacco–depression relationship. One explanation for our results is that African American male smokers may have a lower threshold for depression than African American female smokers. If this result is replicated, it may have important implications as we seek optimal strategies to prevent depression or tobacco use at HBCUs. Depression prevention may need to be combined with tobacco prevention among males, but not necessarily among females.

Acknowledgements This work was supported by National Institute on Drug Abuse grant DA 12390 and U.S. National Center for Minority Health and Health Disparities grant MD002217-01. Funding from the Legacy Foundation also supported the study.

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References Breslau, N., & Peterson, E. L. (1996). Smoking cessation in young adults: Age at initiation of cigarette smoking and other suspected influences. American Journal of Public Health, 86, 210 – 214. Breslau, N., Peterson, E. L., Schultz, L. R., Chilcoat, H. D., & Andreski, P. (1998). Major depression and stages of smoking. A longitudinal investigation. Archives of General Psychiatry, 55(2), 161 – 166. Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385 – 396. Costello, E. J., Erkanli, A., Federman, E., & Angold, A. (1999). Development of psychiatric comorbidity with substance abuse in adolescents: Effects of timing and sex. Journal of Clinical Child Psychology, 28(3), 298 – 311. Eaton, W., Muntaner, C., Smith, C. B., & Tien, A. Y. (2004). Revision of the center of epidemiologic studies depression (CESD) scale. In M. Maruish (Ed.), The use of psychological testing for treatment planning and outcomes assessment. Mahwah, NJ7 Lawrence Erlbaum Associates. Glassman, A. H. (1993). Cigarette smoking: Implications for psychiatric illness. The American Journal of Psychiatry, 150, 546 – 553. Hughes, J. R. (1988). Clonidine, depression, and smoking cessation. Journal of the American Medical Association, 259(19), 2901 – 2902. Kendler, K. S., Neale, M. C., MacLean, C. J., Heath, A. C., Eaves, L. J., & Kessler, R. C. (1993). Smoking and major depression. A causal analysis. Archives of General Psychiatry, 50(1), 36 – 43. US Department of Health and Human Services (USDHHS), Substance Abuse and Mental Health Services Administration (2003). Results from the 2002 national survey on drug use and health: National findings. Rockville, MD, DHHS publication (SMA) 03-3836. Weissman, M. M., & Klerman, G. L. (1977). Sex differences and the epidemiology of depression. Archives of General Psychiatry, 34(1), 98 – 111. Wu, L. T., & Anthony, J. C. (1999). Tobacco smoking and depressed mood in late childhood and early adolescence. American Journal of Public Health, 89(12), 1837 – 1840.