Elsevier

Addictive Behaviors

Volume 35, Issue 11, November 2010, Pages 1040-1043
Addictive Behaviors

Short Communication
Moderation of gender on smoking and depression in Chinese Americans

https://doi.org/10.1016/j.addbeh.2010.06.021Get rights and content

Abstract

This study examined the moderating role of gender in the association between smoking status and depression in a nationwide convenience sample of Chinese American current, former, and never smokers (N = 1393). Participants were recruited in smoker–supporter dyads. Multilevel modeling was used to take into account the dyadic nature of the data. Depressive symptoms were measured by a 10-item CES-D (Center of Epidemiological Studies-Depression Scale). Results showed significant effects of smoking status by gender interaction and smoking status on depression after adjusting for acculturation and social support. Among Chinese females, current smokers reported elevated depression level than both former and never smokers. Among Chinese males, current smokers reported more depressive symptoms when compared to former smokers only. Chinese females reported higher depression level than males among current smokers; no gender difference in depression was observed among former or never smokers. The association between smoking and depression is moderated by gender among Chinese Americans where substantial gender difference in smoking prevalence exists. Findings highlight the importance of addressing depression in treating tobacco use among Chinese American smokers, especially among females.

Research Highlights

► The smoking and depression association differed by gender in Chinese Americans. ► Gender difference in depression was observed in Chinese current smokers only. ► In females, current smokers were more depressed than never and former smokers. ► Male current smokers had more depressive symptoms than male former smokers only. ► Depression can be a key issue in Chinese American smokers especially in females.

Introduction

The association between smoking and depression is well documented in various populations including Asian populations (Khaled et al., 2009, Kinnunen et al., 2006, McClave et al., 2009, Pratt & Brody, 2010). In Japan, Nakata et al. (2008) found that current smoking and passive smoking at work were both associated with elevated depressive symptoms. In Hong Kong, smoking was linked to higher levels of depression in Chinese adolescents and elderly (Lam et al., 2004, Lam et al., 2005). Among Chinese Americans, elevated depressive symptoms were observed among smokers who reported high temptation to smoke when experiencing negative emotions and significant nicotine withdrawal at previous quit attempts (Tsoh, Lam, Delucchi, & Hall, 2003).

Mixed findings have been reported on the moderating role of gender in the association between smoking and depression cross-culturally. Two studies conducted in Western populations found that smoking was associated with depressive symptoms in females only (Poulin, Hand, Boudreau, & Santor, 2005) or more so in females than in males (Husky, Mazure, Paliwal, & McKee, 2008). However, other studies have reported contradictory findings including the absence of moderation by gender (Khaled et al., 2009) or an interaction with males smokers reporting elevated depression (Korhonen et al., 2007). Among Chinese Americans, Tsoh et al. (2003) showed that female smokers reported elevated depressive symptoms as compared to male smokers. Yet Lam et al., 2004, Lam et al., 2005 did not find gender differences in the association between smoking and depression among Hong Kong adolescents and elderly.

The present study examined whether gender moderated the association between smoking and depression in Chinese Americans. Three research questions were investigated: (1) Do current smokers report more depressive symptoms than former and never smokers? (2) Do females report more depressive symptoms than males? (3) Does the association between smoking and depression differ by gender?

Section snippets

Participants

Participants included 1393 Chinese Americans (43.8% females) who completed the baseline survey of a nationwide, family assisted smoking cessation study online or by mail. General eligibility criteria for participating in the study were: (1) 18 years old or above, (2) self-identified as ethnic Chinese, (3) resided in the United States, and (4) could read Chinese and/or English. Participants were recruited in smoker–supporter pairs. Smoker participants had to smoke at least 5 cigarettes in the

Results

Table 1 presents participant characteristics by gender and by smoking status. As an assessment of nonindependence between a smoker and his/her supporter, the Intraclass Correlation Coefficient (ICC) for the participation role in this study was 0.22, with a confidence interval ranging from .15 to .29, F(744,660) = 1.57, p < 0.001. The ICC indicated that CES-D scores within a dyad were correlated, suggesting the need to conduct multilevel analysis to take into account the interdependence between

Discussion

This study examined the interaction between gender and smoking status on depressive symptoms in a nationwide convenience sample of Chinese American current, former, and never smokers. We found that gender moderated the association between smoking and depression in Chinese Americans. In Chinese females, current smoking was associated with a higher depression level than either former or never smoking. In Chinese males, current smoking was associated with a higher depression level in comparison to

Role of Funding Sources

This research project was supported by the American Cancer Society Grant (TURSG-03-102-01 PBP) and a NIDA center grant (P50 DA 009253). The preparation of this manuscript was supported by the 2007 Summer Research Training Program at the University of California San Francisco and the Asian American Network for Cancer Awareness, Research and Training through the National Cancer Institute Cooperative Agreement U01/CA114640.

Contributors

Dr. Janice Tsoh was the Principal Investigator of the parent study who formulated the research questions and conceptualized the design of the current study. Jeremy Luk conducted literature searches and provided summaries of previous research studies. Data analysis was conducted by both authors. Jeremy Luk wrote the first draft of the manuscript and both authors contributed to and have approved the final manuscript.

Conflict of Interest

None.

Acknowledgments

Charlene Au, Christen Chen, Alicia Leung, Jason Liu, Mary Poon, Collins Tse, Jessie Wang, Vivian Wang, Ying Wei, Koko Fung, Helen Lee and Andrew Wen served as research assistants who recruited participants and assisted in data collection.

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