Elsevier

Addictive Behaviors

Volume 50, November 2015, Pages 84-88
Addictive Behaviors

Short Communication
Association of second-hand smoke exposure at home with psychological distress in the Spanish adult population

https://doi.org/10.1016/j.addbeh.2015.06.020Get rights and content

Highlights

  • The potential effects of SHS on psychological distress have been scarcely addressed.

  • The study is conducted on a representative sample of the adult population of Spain.

  • Prevalence of psychological distress is higher in those exposed to SHS at home.

  • Avoiding SHS exposure at home may have beneficial effects on psychological distress.

Abstract

Introduction

Second-hand smoke (SHS) exposure has been associated with increased risks of respiratory and heart diseases. However, little is known about the potential effects of SHS on psychological distress. The aim of this study is to examine the association of SHS exposure at home with psychological distress in Spain.

Methods

A cross-sectional survey about SHS exposure, socio-demographic and health related variables, and psychological distress, measured with the 12-item version of the General Health Questionnaire (GHQ-12) with a cut-off score ≥ 3, was conducted from 2011–2012 among a representative sample of the adult population (aged ≥ 15 years) of Spain. From the total sample (n = 21,007), we used the subsample of never-smokers (n = 11,214). We computed the odds ratios (OR) and their 95% confidence intervals (95% CI) for scoring ≥ 3 on the GHQ by means of unconditional multiple logistic regression models adjusted for sex and age.

Results

In the subsample, 9.7% (n = 1,090) responded that they were exposed to SHS at home. The prevalence of subjects scoring ≥ 3 on the GHQ was higher for the sample exposed to SHS (22.7%) than for the non-exposed sample (18.9%; OR: 1.39; CI: 1.19–1.62). This association was also present when stratified for sex, age, marital status, socio-economic status, perceived general health, presence of any chronic disease, and alcohol intake.

Conclusions

Exposure to SHS at home is associated with psychological distress. Further investigation is necessary to determine if this association is causal. Avoiding SHS exposure at home could have beneficial effects on psychological distress.

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.

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