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Secondhand Smoke Exposure and Depressive Symptoms

From the Department of Epidemiology and Public Health (F.C.B., K.L.A., A.J.C.-M., L.E.F., K.M., N.A.D., W.G.L., E.P.D., D.J.L.) and the Department of Psychiatry and Behavioral Sciences (J.E.L.), University of Miami, Miller School of Medicine, Miami, Florida; and Department of Environmental and Occupational Health (B.S.), Florida International University, Robert Stempel School of Public Health, Miami, Florida.

Address correspondence and reprint requests to David J. Lee, Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, P.O. Box 016069 (D-4-11) Miami, FL 33101. E-mail: dlee{at}med.miami.edu

Objective: To evaluate the association between secondhand smoke (SHS) exposure and depression. Tobacco smoking and depression are strongly associated, but the possible effects of SHS have not been evaluated.

Methods: The 2005 to 2006 National Health and Nutrition Examination Survey (NHANES) is a cross-sectional sample of the noninstitutionalized civilian U.S. population. SHS exposure was measured in adults aged 20 years by serum cotinine and depressive symptoms by the Patient Health Questionnaire. Zero-inflated Poisson regression analyses were completed with adjustment for survey design and potential confounders.

Results: Serum cotinine-documented SHS exposure was positively associated with depressive symptoms in never-smokers, even after adjustment for age, race/ethnicity, gender, education, alcohol consumption, and medical comorbidities. The association between SHS exposure and depressive symptoms did not vary by gender, nor was there any association between SHS smoke exposure and depressive symptoms in former smokers.

Conclusions: Findings from the present study suggest that SHS exposure is positively associated with depressive symptoms in never-smokers and highlight the need for further research to establish the mechanisms of association.

Key Words: secondhand smoke • depressive symptoms • tobacco policy • mental health policy

Abbreviations: NHANES = National Health and Nutrition Examination Survey; SHS = secondhand smoke; CDC = Centers for Disease Control and Prevention; OR = odds ratio; GABA = -aminobutyric acid.