Short CommunicationAssociation of second-hand smoke exposure at home with psychological distress in the Spanish adult population
Introduction
Second-hand smoke (SHS) exposure causes respiratory and heart diseases in non-smokers (U.S. Department of Health & Human Services, 2014). This robust evidence has encouraged many countries to implement smoke-free policies in public places and workplaces to protect the health of non-smokers. These smoke-free policies have beneficial consequences mainly on cardiovascular diseases and respiratory symptoms (Callinan et al., 2010, Tan and Glantz, 2012).
People with mental disorders have a higher prevalence of smoking than the general population (Lasser et al., 2000) and smoking has been clearly linked to mental disorders in many ways, as a consequence as well as a cause (Breslau et al., 1991, Khantzian, 1997, Morissette et al., 2007). Smoking has been linked with the onset of some mental disorders (Chaiton et al., 2009, Johnson et al., 2000, Morissette et al., 2007). Moreover, quitting smoking has been associated with reduced symptoms of several disorders, such as anxiety or depression, and with improvements in positive moods, stress, and quality of life (Taylor, Miller, Cameron, Fagans, & Das, 2005).
Despite the relationship between smoking and mental health disorders, the potential effects of SHS exposure on psychological distress have only recently been considered (Bandiera, 2011). Except for some speculation that appeared years ago (Wilson, 1975), there are few studies evaluating this emerging topic. If there is a causal association between SHS exposure and mental distress, the explanation for this is not clear but some hypotheses have been established: a) nicotine may mimic the physiological effects of anxiety by increasing the blood pressure and heart rate (Asbridge, Ralph, & Stewart, 2013); b) there may be neurobiological mechanisms involving neural pathways through the dopamine system (Bahk, Li, Park, & Kim, 2002). Long-term exposure to SHS may lead to a decrease in the dopamine receptor availability, as with first-hand smoking (Bandiera, 2011). Smokers genetically predisposed to a low resting intrasynaptic dopamine level have heightened smoking-induced dopamine release, which has been associated with greater depression and anxiety (Brody et al., 2009). This genetic predisposition may also be relevant to SHS exposure (Hamer, Ford, Stamatakis, Dockray, & Batty, 2011).
To date, no previous studies have associated SHS exposure with psychological distress in Spain, where national regulation protects population from SHS in public places since 2006 but smoking is still quite prevalent (26.9% in 2012) (Encuesta Nacional de Salud de España, ENSE).
The aim of this study was to examine the association between SHS exposure at home and psychological distress in a representative sample of the general population of Spain.
Section snippets
Study design and sample
The study is based on a cross-sectional analysis of the Spanish National Health Interview Survey of 2012 (Encuesta Nacional de Salud de España, ENSE) for the adult population with data collection from July 2011 to June 2012 (Ministerio de Sanidad, Servicios Sociales e Igualdad). The ENSE is conducted every five years and draws a nationally representative sample from the general population, aged ≥ 15 years and living in households. The data are collected through home-based interviews and include
Results
Among all never-smokers (n = 11,214), 61.8% were women and the average age was 47.9 (SD = 20.77) years; 49.1% were in the socio-economic groups V–VI (32.6% in the III–IV groups and 18.3% in the I–II groups); and 52.1% were married. Health was perceived as good or very good in 71.1% of the sample (20.6% as fair and 8.3% as poor or very poor), 43.2% reported having a chronic-long term disease, and 0.7% were risky drinkers (64.9% non-drinkers and 34.4% moderate drinkers). Of the respondents, 9.7% (n =
Discussion
Our results show that SHS exposure is associated with psychological distress, even after stratifying the results for several socio-demographic and health related variables. Nevertheless, this association is of less magnitude than other variables studied, including poor general health, chronic diseases, or advanced age.
Our data are in agreement with the little evidence currently available on this subject (Asbridge et al., 2013, Bandiera et al., 2010a, Bandiera et al., 2010b, Hamer et al., 2010,
Role of funding sources
This work was supported by the Thematic Network of Cooperative Research on Cancer (grant number RD12/0036/0053); by the Instituto de Salud Carlos III, Government of Spain, Ministry of Universities and Research (grant number 2009SGR192); and by the Directorate of Public Health, Ministry of Health (grant number GFH 20051) from the Government of Catalonia.
The Instituto de Salud Carlos III and the Ministry of Health from the Government of Catalonia had no role in the study design, collection,
Contributors
MB, JMMS, and EF designed the study, which was revised by AG, CM, MF, XS, APM and IG. MB and JMMS prepared the database and performed the statistical analyses. All authors contributed to the interpretation of the study findings. MB drafted the manuscript, and all authors helped revise it for relevant intellectual content. All authors approved the final version of the manuscript. EF is the guarantor.
Conflict of interest
All authors declare that they have no conflicts of interest.
References (41)
- et al.
Private space second-hand smoke exposure and the mental health of non-smokers: A cross-sectional analysis of Canadian adults
Addictive Behaviors
(2013) - et al.
Dopamine D1 and D2 receptor mRNA up-regulation in the caudate–putamen and nucleus accumbens of rat brains by smoking
Progress in Neuro-Psychopharmacology & Biological Psychiatry
(2002) What are candidate biobehavioral mechanisms underlying the association between secondhand smoke exposure and mental health?
Medical Hypotheses
(2011)- et al.
Effect of a history of major depressive disorder on smoking-induced dopamine release
Biological Psychiatry
(2009) - et al.
Regular exercise, anxiety, depression and personality: A population-based study
Preventive Medicine
(2006) - et al.
Exercise treatment for depression: Efficacy and dose response
American Journal of Preventive Medicine
(2005) - et al.
Adolescents validly report their exposure to secondhand smoke
Journal of Clinical Epidemiology
(2010) - et al.
Association of secondhand smoke exposure with mental health in men and women: Cross-sectional and prospective analyses using the U.K. health and lifestyle survey
European Psychiatry
(2013) - et al.
Assessment of exposure to secondhand smoke by questionnaire and salivary cotinine in the general population of Barcelona, Spain (2004–2005)
Preventive Medicine
(2009) - et al.
Active and passive smoking and depression among Japanese workers
Preventive Medicine
(2008)
Secondhand smoke and nicotine exposure: A brief review
Addictive Behaviors
Prevalence of mental disorders in the general population of Catalonia. Team of the health survey of Catalonia
Gaceta Sanitaria
Secondhand smoke exposure and depressive symptoms
Psychosomatic Medicine
Secondhand smoke policy and the risk of depression
Annals of Behavioral Medicine
Nicotine dependence, major depression, and anxiety in young adults
Archives of General Psychiatry
Legislative smoking bans for reducing secondhand smoke exposure, smoking prevalence and tobacco consumption
Cochrane Database of Systematic Reviews
A systematic review of longitudinal studies on the association between depression and smoking in adolescents
BMC Public Health
Spain: Beyond the ‘Spanish model’ to a total ban
Tobacco Control
Salivary cotinine concentrations in daily smokers in Barcelona, Spain: A cross-sectional study
BMC Public Health
The validity of two versions of the GHQ in the WHO study of mental illness in general health care
Psychological Medicine
Cited by (15)
The design of a mental health service platform for college students based on multi-modal information
2023, Microprocessors and MicrosystemsCitation Excerpt :Many things have an impact on patients or learners’ mental health. The studies that have already been conducted in teenagers have focused on socioeconomic and other variables that are connected to lifestyle and affective connections [41-48]. Mental health disorders i.e. CMD (Common Mental Disorders) like anxiety and depression are different from a feeling of stress, anger, fear or sadness that someone can experience in daily life.
Smoking, alcohol consumption and mental health: Data from the Brazilian study of Cardiovascular Risks in Adolescents (ERICA)
2019, Addictive Behaviors ReportsCitation Excerpt :An alternative explanation would be the bidirectional association, in that the two conditions influence each other (Audrain-McGovern et al., 2009; Chaiton et al., 2009). The positive association between psychological distress and passive smoking found on ERICA is consistent with findings on population ≥15 years in Spain, where the prevalence of individuals exposed to secondhand smoke with a score ≥3 in the GHQ-12 (22.7%) was higher than that of non-exposed individuals (18.9%; OR: 1.39; CI: 1.19–1.62)(Ballbe, Martinez-Sanchez, Gual, et al., 2015). Data from the Scottish Health Survey (2008–2011) also showed an association between secondhand smoke and mental health.
Exploring the association between urban sprawl and mental health
2018, Journal of Transport and HealthCitation Excerpt :The scoring system assigns to each individual a value between 0 (minimum risk of mental health problems) to 12 (maximum risk of mental health problems) ( Table 3). In the Spanish version of the GHQ-12, the validated cut-off point on the GHQ-12 scale, which determines those at risk of psychological distress, is ≥ 3 (Ballbè et al., 2015). GHQ-12 shows good reliability in the various studies performed, with alpha Cronbach ranging from 0.82 to 0.86 (Goldberg et al., 2017).
Atlas of axial spondyloarthritis in Spain 2017: Study design and population
2019, Reumatologia ClinicaCitation Excerpt :GHQ-12: developed by Goldberg and Williams in 1988, this questionnaire assesses the severity of psychological distress during the weeks prior to participation, with the objective of detecting psychological morbidity and possible cases of psychiatric disorders.16,17 The validated cut-off point on the GHQ scale for the Spanish version of the questionnaire is ≥3, indicating that individuals with a score of ≥3 may be experiencing psychological distress.18 The GHQ-12 shows good reliability in the various studies carried out with Cronbach's alphas ranging from 0.82 to 0.86.19
Tobacco smoking, second-hand smoking exposure in relation to psychotic-like experiences in adolescents
2024, Early Intervention in Psychiatry