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Increasing Depression and Substance Use Among Former Smokers in the United States, 2002–2016

  • Keely Cheslack-Postava
    Affiliations
    Department of Psychiatry, Columbia University, New York, New York

    Research Foundation for Mental Hygiene, New York State Psychiatric Institute, New York, New York
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  • Melanie M. Wall
    Affiliations
    Department of Psychiatry, Columbia University, New York, New York

    Research Foundation for Mental Hygiene, New York State Psychiatric Institute, New York, New York

    Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
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  • Andrea H. Weinberger
    Affiliations
    Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York

    Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
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  • Renee D. Goodwin
    Correspondence
    Address correspondence to: Renee D. Goodwin, PhD, Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, 55 W 125th Street, New York NY 10027.
    Affiliations
    Institute for Implementation Science in Population Health, City University of New York, New York, New York

    Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York

    Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, New York
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      Introduction

      Mental health and substance use problems are associated with smoking relapse among former smokers. Yet, little is known about the prevalence of mental health and substance use among former smokers in the U.S. In addition, it is unknown whether the prevalence of these conditions has changed over time as former U.S. smokers have grown to outnumber current U.S. smokers. This study, which was conducted in 2018 and 2019, examined the prevalence and trends over time in depression (2005–2016), marijuana use (2002–2016), and alcohol use problems (2002–2016) among former U.S. smokers.

      Methods

      The National Survey on Drug Use and Health is an annual, nationally representative, cross-sectional study. Data from U.S. individuals who were aged ≥18 years in 2002–2016 were included. Former smokers were defined as having smoked ≥100 lifetime cigarettes and no past-year cigarettes.

      Results

      From 2005 to 2016, the prevalence of major depression increased from 4.88% to 6.04% (AOR=1.01, 95% CI=1.00, 1.03, p=0.04). From 2002 to 2016, past-year marijuana use rose from 5.35% to 10.09% (AOR=1.08, 95% CI=1.07, 1.09, p<0.001) among former smokers. Past-month binge alcohol use also increased from 17.22% to 22.33% (AOR=1.03, 95% CI=1.02, 1.04, p<0.001), although the prevalence of past-year alcohol abuse or dependence did not change.

      Conclusions

      Depression and substance use, which are factors associated with increased risk for cigarette use relapse, appear to be increasing over time among former U.S. smokers. Increased awareness of these trends may be important for clinical and public health efforts to direct attention to conditions potentially threatening sustained abstinence among former smokers.
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