Depression, cannabis use and binge drinking are on the rise among US former smokers

A new study in the American Journal of Preventive Medicine cautions that these risk factors increase the risk of relapse among former smokers


Ann Arbor, August 20, 2019

A new study in the American Journal of Preventive Medicine, published by Elsevier, found that the prevalence of depression, cannabis use and alcohol abuse increased among former smokers from 2005 to 2016 in the United States. Therefore, increases in these risk factors for relapse among former smokers could threaten progress in reducing the prevalence of cigarette use.

“It’s good news that as tobacco control efforts have been successful at reducing smoking, the proportion of former smokers among the US population is increasing. However, as our study demonstrates, more of them are now suffering from depression and engaging in problematic substance use,” said lead investigator Renee D. Goodwin, PhD, Institute for Implementation Science in Population Health, The City University of New York; the Mailman School of Public Health, Columbia University; and the Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA.

Conducted in 2018-19, the study investigated the prevalence of depression, cannabis use, and alcohol misuse among former smokers ages 18 and older in the US from 2005 to 2016. Data were drawn from the National Survey on Drug Use and Health, an annual, nationally representative cross-sectional study. More than 67,000 individuals, aged 18 and over, participated in the study. It is the first national US study to focus on the prevalence and time trends of depression, marijuana use, and problematic alcohol use among former smokers.

During the study period, the incidence of major depression increased from 4.88 percent to 6.04 percent; cannabis use during the previous year rose from 5.35 percent to 10.09 percent; and alcohol binge drinking during the previous month went up from 17.22 percent to 22.33 percent among former smokers.

The results show that the profile of former smokers has changed over the study period. An increasing percentage of the US population who were ever smokers, no longer smoke (49.7 percent in 2016, compared to 44.4 percent in 2002). Former smokers are slightly more likely to be male than female, married, and of non-Hispanic white ethnicity. In 2016 compared to 2002, former smokers were more likely to be older than 65, never married, have some college education, and incomes over $75 thousand a year. More than half of them had also quit smoking for three years or more. Factors that may have affected the results are the increasing legalization, decreasing perception of risk associated with use and the reduced stigma of cannabis, which may sometimes be used by smokers trying to quit tobacco. However, the investigators note that when former smokers use it, they increase their likelihood of returning to tobacco.

“Because previous research has demonstrated that these factors put former smokers at greater risk of relapsing with tobacco (and relapse is a risk that lingers for decades), our study should signal an alarm for public health leaders and healthcare providers. The findings represent a looming threat to the progress that has been made in reducing the prevalence of cigarette use,” Dr. Goodwin cautioned.

Dr. Goodwin noted that the findings should have bearing on ongoing tobacco control policy decisions, “Since it has been shown that depression and substance use may compromise abstinence, anyone designing community-based public information campaigns and engaged in clinical interactions with former smokers should be made aware that modifiable predictors of relapse are increasing among former smokers. As such, screening for these issues and referral to treatment should be high priorities. These are important steps for assuring growing and sustained abstinence among the US population, a trend with significant health and societal benefits.”

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Notes for editors
The article is “Increasing Depression and Substance Use Among Former Smokers in the United States, 2002–2016,” by Keely Cheslack-Postava, PhD, Melanie M. Wall, PhD, Andrea H. Weinberger, PhD, and Renee D. Goodwin, PhD (https://doi.org/10.1016/j.amepre.2019.05.014). It will appear in the American Journal of Preventive Medicine, volume 57, issue 4 (October 2019) published by Elsevier.

The study was funded by a grant from NIH/NIDA to Dr. Goodwin (DA20892).

Full text of this article is available to credentialed journalists upon request; contact Jillian B. Morgan at +1 734 936 1590 or ajpmmedia@elsevier.com. Journalists who wish to interview the authors should contact Stephanie Berger, Director of Communications for Media Relations, Columbia University Mailman School of Public Health, at +1 212 305 4372, +1 917 734 8973 (mobile), or sb2247@columbia.edu.

About the American Journal of Preventive Medicine
The American Journal of Preventive Medicine is the official journal of the American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. The journal features papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. The journal also publishes official policy statements from the two co-sponsoring organizations, health services research pertinent to prevention and public health, review articles, media reviews, and editorials. www.ajpmonline.org

About Elsevier
Elsevier is a global information analytics business that helps scientists and clinicians to find new answers, reshape human knowledge, and tackle the most urgent human crises. For 140 years, we have partnered with the research world to curate and verify scientific knowledge. Today, we’re committed to bringing that rigor to a new generation of platforms. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, 39,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX, a global provider of information-based analytics and decision tools for professional and business customers. www.elsevier.com

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