Associations between Smoking, Drinking and Depression among Korean Adults: The 5th Korea National Health and Nutrition Examination Survey

Sun Mi Park; Mi Ah Han; Jong Park; So Yeon Ryu; Seong Woo Choi; Hwan Ho Shin; Mi Hyun Joo

doi:10.15384/kjhp.2016.16.2.111

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Park, Han, Park, Ryu, Choi, Shin, and Joo: Associations between Smoking, Drinking and Depression among Korean Adults: The 5th Korea National Health and Nutrition Examination Survey

Original Article

Korean J Health Promot 2016;16(2):111-118.

Published online: 20 January 2016

DOI: https://doi.org/10.15384/kjhp.2016.16.2.111

Associations between Smoking, Drinking and Depression among Korean Adults: The 5th Korea National Health and Nutrition Examination Survey

Sun Mi Park¹, Mi Ah Han¹, Jong Park¹, So Yeon Ryu¹, Seong Woo Choi¹, Hwan Ho Shin^1,², Mi Hyun Joo^1,²

¹Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, Korea

²Department of Public Health, Graduate School of Chosun University, Gwangju, Korea

Corresponding author: Mi Ah Han, MD, PhD Department of Preventive Medicine, College of Medicine, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju 61452, Korea Tel: +82-62-230-6481, Fax: +82-62-225-8293 Email: mahan@chosun.ac.kr

Received 16 December 2015 Accepted 5 February 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

The prevalence of depression has been steadily increasing. This study aim to identify associations between smoking, drinking and depression in Korean adults.

Methods

The study subjects were 17,871 adults aged 19 or over who participated in the 5th Korea National Health and Nutrition Examination Survey (2010–2012). We performed multiple logistic regression to identify whether smoking and drinking were independently significant variables to depression after adjusting for the confounding variables.

Results

The proportion of having any depressive episodes was a total of 13.4% with 9.1% of male and 16.6% of female, respectively. Among all of smoking behaviors, higher cigarette consumption was only associated with depression in men. However, for women ever-smoking (adjusted odds ratio [aOR]=1.63, 95% confidence interval [CI]=1.38–1.92), ex-smoking (aOR=1.38, 95% CI=1.10–1.54), current smoking (aOR=1.89, 95% CI=1.53–2.94) and younger initiation of smoking (aOR=2.34, 95% CI=1.73–3.16) had significantly higher odds for depression. Moreover, and higher cigarette consumption (20 or more per day) showed significantly higher odds ratios for depression both in men (aOR=1.21, 95% CI=1.01–1.54) and women (aOR=2.41, 95% CI=1.32–4.41). For alcoholic drinking behaviors, frequent binge drinking (1 per week: aOR=1.46, 95% CI=1.16–1.85, most everyday: aOR=1.79, 95% CI=1.14–2.80) was an independent risk factor for depressive symptoms in female.

Conclusions

Smoking and drinking behaviors were independently associated with depression especially in female. Smoking and drinking management may benefit depression control as well as health promotion.

Keywords: Alcohol drinking, Depression, Nutritional surveys, Smoking

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Table 1.

Subjects' characteristics by sex

Characteristics	Total	Male	Female	P^a
Characteristics	(n = 17,871)	(n = 7,573)	(n = 10,298)	P^a
Age, y				<0.001
19–44	7,080 (39.6)	2,954 (39.0)	4,126 (40.1)
45–64	6,525 (36.5)	2,785 (36.8)	3,740 (36.3)
≥65	4,266 (23.9)	1,834 (24.2)	2,432 (23.6)
Economic status				<0.001
Low	3,462 (19.6)	1,332 (17.8)	2,130 (20.9)
Middle-low	4,554 (25.8)	1,940 (25.9)	2,614 (25.7)
Middle-high	4,814 (27.2)	2,116 (28.2)	2,698 (26.5)
High	4,849 (27.4)	2,108 (28.1)	2,741 (26.9)
Education				<0.001
≤Elementary school	4,586 (25.7)	1,332 (17.6)	3,254 (31.7)
Middle school	1,942 (10.9)	890 (11.8)	1,052 (10.2)
High school	5,935 (33.3)	2,695 (35.7)	3,240 (31.5)
≥College	5,363 (30.1)	2,635 (34.9)	2,728 (26.6)
Occupation				<0.001
Yes	10,513 (59.0)	5,657 (74.9)	4,856 (47.3)
No	7,316 (41.0)	1,895 (25.1)	5,421 (52.7)
Marital status				<0.001
Yes	15,399 (86.2)	6,382 (84.3)	9,017 (87.6)
No	2,466 (13.8)	1,189 (15.7)	1,277 (12.4)
Exercise				<0.001
No	9,689 (54.2)	3,502 (46.3)	6,187 (60.1)
Yes	8,172 (45.8)	4,067 (53.7)	4,105 (39.9)
Number of chronic disease				<0.001
No	11,092 (62.1)	4,849 (64.0)	6,243 (60.6)
1	3,667 (20.5)	1,619 (21.4)	2,048 (19.9)
≥2	3,112 (17.4)	1,105 (14.6)	2,007 (19.5)
Stress				<0.001
Low	13,140 (73.5)	5,819 (76.8)	7,321 (71.1)
High	4,726 (26.5)	1,754 (23.2)	2,972 (28.9)

Data are expressed as n (%).

^a Calculated by chi-square tests.

Table 2.

Smoking and drinking behavior by sex

Characteristics	Total	Male	Female	P^a
Smoking behavior
Lifetime smoking experience				<0.001
Never smoker	10,564 (59.1)	1,391 (18.4)	9,173 (89.1)
Ever-smoker	7,306 (40.9)	6,181 (81.6)	1,125 (10.9)
Current smoking behavior				<0.001
Never smoker	10,564 (59.1)	1,391 (18.4)	9,173 (89.1)
Ex-smoker	3,632 (20.3)	3,071 (40.6)	561 (5.4)
Current smoker	3,673 (20.6)	3,109 (41.0)	564 (5.5)
Smoking initiation at				<0.001
Never smoker	10,564 (59.1)	1,391 (18.4)	9,173 (89.1)
≥19 yo	4,803 (26.9)	3,942 (52.1)	861 (8.4)
<19 yo	2,504 (14.0)	2,240 (29.6)	264 (2.6)
Cigarette consumption per day				<0.001
No^b	14,196 (79.4)	4,462 (58.9)	9,734 (94.5)
<20	2,223 (12.4)	1,715 (22.6)	508 (4.9)
≥20	1,452 (8.2)	1,396 (18.5)	56 (1.6)
Alcohol drinking behavior
Lifetime drinking experience				<0.001
Never drinker	2,499 (14.0)	379 (5.0)	2,120 (20.6)
Ever-drinker	15,371 (86.0)	7,193 (95.0)	8,178 (79.4)
Drinking initiation at				<0.001
Never drank	2,500 (14.0)	379 (5.0)	2,121 (20.6)
≥19 yo	10,776 (60.3)	4,035 (53.3)	6,741 (65.5)
<19 yo	4,595 (25.7)	3,159 (41.7)	1,436 (13.9)
Drinking frequency				<0.001
None^c	5,095 (28.6)	1,237 (16.4)	3,858 (37.6)
<4 per month	8,993 (50.6)	3,452 (45.8)	5,541 (54.1)
≥2 per week	3,701 (20.8)	2,851 (37.8)	850 (8.3)
Binge drinking				<0.001
None^c	5,095 (28.5)	1,237 (16.4)	3,858 (37.5)
No	4,467 (25.0)	1.351 (17.9)	3,116 (30.2)
≤1 per month	5,092 (28.5)	2.515 (33.3)	2,577 (25.0)
1 per week	2,473 (13.8)	1,839 (24.3)	634 (6.2)
Almost everyday	735 (4.1)	621 (8.2)	114 (1.1)

Data are expressed as n (%).

^a Calculated by chi-square tests.

^b Including never and former smokers.

^c Non-drinker during the past year.

Table 3.

Proportions and aOR(95% CI) for depression by smoking behavior

Characteristics	Male		Female
Characteristics	Depression^a	aOR (95% CI)^b	Depression^a	aOR (95% CI)^b
Total	686 (9.1)		1,706 (16.6)
Lifetime smoking experience
Never smoker	104 (7.5)	1	1,418 (15.5)	1
Ever-smoker	582 (9.4)	1.12 (0.88–1.41)	288 (25.6)	1.63 (1.38–1.92)
Current Smoking status
Never smoker	104 (7.5)	1	1,418 (15.5)	1
Ex-smoker	261 (8.5)	1.03 (0.80–1.34)	120 (21.4)	1.38 (1.10–1.73)
Current smoker	321 (10.3)	1.19 (0.93–1.53)	168 (29.8)	1.89 (1.53–2.94)
P for trend		<0.001		<0.001
Smoking initiation at
Never smoker	104 (7.5)	1	1,418 (15.5)	1
≥19 yo	380 (9.6)	1.19 (0.96–1.46)	205 (23.8)	1.46 (1.21–1.75)
<19 yo	202 (9.0)	1.00 (0.77–1.30)	83 (31.4)	2.34 (1.73–3.16)
P for trend		0.217		<0.001
Cigarette consumption per day
No^c	365 (8.2)	1	1.538 (15.8)	1
<20	155 (9.0)	1.10 (0.89–1.36)	146 (28.7)	1.77 (1.42–2.21)
≥20	166 (11.9)	1.21 (1.01–1.54)	22 (39.3)	2.41 (1.32–4.41)
P for trend		<0.001		<0.001

Abbreviations: aOR, adjusted odds ratio; CI, confidence interval.

^a Including depressed for more than 2 weeks. Data are expressed as number (%).

^b Adjusted for economic status, education, occupation, marital status, exercise, chronic disease, stress and current smoking status.

^c Including never and former smokers.

Table 4.

Proportions and aOR (95% CI) for depression by alcohol drinking behavior

Characteristics	Male		Female
Characteristics	Depression^a	aOR (95% CI)^b	Depression^a	aOR (95% CI)^b
Total	686 (9.1)		1,706 (16.6)
Lifetime drinking experience
Never-drank	40 (10.6)	1	390(18.4)	1
Ever-drinker	646 (9.0)	0.75 (0.55–1.02)	1,316(16.1)	0.95 (0.83–1.08)
Drinking initiation at
Never drank	40 (10.6)	1	390(18.4)	1
≥19 yo	370 (9.2)	0.84 (0.58–1.21)	1.068(15.8)	0.96 (0.83–1.11)
<19 yo	276 (8.7)	0.75 (0.52–1.10)	248(17.3)	1.20 (0.97–1.48)
P for trend		0.936		0.004
Drinking frequency
None^c	124 (10.0)	1	672(17.4)	1
<4 per month	287 (8.3)	0.94 (0.74–1.21)	850(15.3)	1.00 (0.88–1.31)
≥2 per week	273 (9.6)	1.00 (0.78–1.29)	176(20.7)	1.10 (0.92–1.33)
P for trend		0.883		0.919
Binge drinking
None^c	124 (10.0)	1	672(17.4)	1
No	121 (9.0)	0.99 (0.75–1.32)	449(14.4)	0.91 (0.79–1.51)
≤1 per month	194 (7.7)	0.84 (0.64–1.09)	406(15.8)	1.08 (0.92–1.26)
1 per week	170 (9.2)	1.05 (0.81–1.42)	141(22.2)	1.46 (1.16–1.85)
Almost everyday	75 (12.1)	1.14 (0.81–1.60)	38(33.3)	1.79 (1.14–2.80)
P for trend		0.535		0.042

Abbreviations: aOR, adjusted odds ratio; CI, confidence interval.

^a Including depressed for more than 2 weeks. Data are expressed as number (%).

^b Adjusted for economic status, education, occupation, marital status, exercise, chronic disease, stress and current smoking status.

^c Nondrinker during the past year.

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