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      The impact of quitting smoking on depressive symptoms: findings from the International Tobacco Control Four-Country Survey : Quitting smoking and depressive symptoms

      1 , 1 , 1 , 2
      Addiction
      Wiley

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          Abstract

          <div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="section-title" id="d8111678e130">Aims</h5> <p id="P1">To determine whether abstinence or relapse on a quit attempt in the previous year is associated with current depressive symptoms. </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="section-title" id="d8111678e135">Design</h5> <p id="P2">Prospective cohort with approximately annual waves. Mixed effect logistic regressions tested whether Time 2 (T2) quitting status was associated with reporting symptoms at T2, and whether Time 1 (T1) symptoms moderated this relationship. </p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="section-title" id="d8111678e140">Setting</h5> <p id="P3">Waves 5 to 8 of the Four Country International Tobacco Control Study: a quasi-experimental cohort study of smokers from Canada, USA, UK and Australia. </p> </div><div class="section"> <a class="named-anchor" id="S4"> <!-- named anchor --> </a> <h5 class="section-title" id="d8111678e145">Participants</h5> <p id="P4">6978 smokers who participated in telephone surveys.</p> </div><div class="section"> <a class="named-anchor" id="S5"> <!-- named anchor --> </a> <h5 class="section-title" id="d8111678e150">Measurements</h5> <p id="P5">T1 and T2 depressive symptoms in the last 4 weeks assessed with two screening items from the PRIME-MD questionnaire. Quitting status at T2: 1) No attempt since T1; 2) Attempted and relapsed; 3) Attempted and abstinent at T2. </p> </div><div class="section"> <a class="named-anchor" id="S6"> <!-- named anchor --> </a> <h5 class="section-title" id="d8111678e155">Findings</h5> <p id="P6">Compared with no attempt, relapse was associated with reporting T2 symptoms (OR=1.46, 95% CI:1.33,1.59). Associations between T2 quitting status and T2 symptoms were moderated by T1 symptoms. Relapse was positively associated with T2 symptoms for those without T1 symptoms (OR=1.71, 95% CI:1.45,2.03) and those with T1 symptoms (OR=1.45, 95% CI:1.23,1.70). Abstinence was positively associated for those without T1 symptoms (OR=1.37, 95% CI:1.10,1.71) and negatively associated for those with T1 symptoms (OR=0.74, 95% CI:0.59,0.94). Age significantly moderated these associations. Relapse did not predict T2 symptoms for those aged 18 to 39 irrespective of T1 symptoms. The negative effect of abstinence on T2 symptoms for those with T1 symptoms was significant only for those aged 18 to 39 (OR = 0.61, 95% CI = 0.40, 0.94) and 40 to 55 (OR = 0.58, 95% CI = 0.40, 0.84). The positive effect of abstinence on T2 symptoms for those without T1 symptoms was significant only for those aged over 55 (OR = 1.97, 95% CI = 1.35, 2.87). </p> </div><div class="section"> <a class="named-anchor" id="S7"> <!-- named anchor --> </a> <h5 class="section-title" id="d8111678e160">Conclusions</h5> <p id="P7">Most people who stop smoking appear to be at no greater risk of developing symptoms of depression than if they had continued smoking. However, people over age 55 who stop smoking may be at greater risk of developing symptoms of depression than if they had continued smoking. </p> </div>

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          Most cited references25

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          Utility of a New Procedure for Diagnosing Mental Disorders in Primary Care

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              Methods of the International Tobacco Control (ITC) Four Country Survey.

              This paper outlines the design features, data collection methods and analytic strategies of the International Tobacco Control (ITC) Four Country Survey, a prospective study of more than 2000 longitudinal respondents per country with yearly replenishments. This survey possesses unique features that sets it apart among surveys on tobacco use and cessation. One of these features is the use of theory-driven conceptual models. In this paper, however, the focus is on the two key statistical features of the survey: longitudinal and "quasi-experimental" designs. Although it is often possible to address the same scientific questions with a cross-sectional or a longitudinal study, the latter has the major advantage of being able to distinguish changes over time within individuals from differences among people at baseline (that is, differences between age and cohort effects). Furthermore, quasi-experiments, where countries not implementing a given new tobacco control policy act as the control group to which the country implementing such a policy will be compared, provide much stronger evidence than observational studies on the effects of national-level tobacco control policies. In summary, application of rigorous research methods enables this survey to be a rich data resource, not only to evaluate policies, but also to gain new insights into the natural history of smoking cessation, through longitudinal analyses of smoker behaviour.
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                Author and article information

                Journal
                Addiction
                Addiction
                Wiley
                09652140
                August 2016
                August 2016
                April 15 2016
                : 111
                : 8
                : 1448-1456
                Affiliations
                [1 ]Cancer Council Victoria; Victoria Australia
                [2 ]Department of Psychology; University of Waterloo; Ontario Canada
                Article
                10.1111/add.13367
                4940259
                26918680
                cebdecd1-463c-453a-82d1-f313a16ebe1a
                © 2016

                http://doi.wiley.com/10.1002/tdm_license_1.1

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