Abstract
Purpose
Though prior studies have observed significant association between e-cigarette use and mental health outcomes including depression in the general population, the relationship between e-cigarette use and clinical depression in the cancer survivor subpopulation is unknown. The purpose of this study was to examine the cross-sectional association between e-cigarette use and self-reported clinical depression among cancer survivors.
Methods
Pooled data from the 2017 and 2018 Behavioral Risk Factor Surveillance Survey were used. Multivariable logistic regression was used to analyze the independent association between e-cigarette use and self-reported clinical depression in a sample of 7,498 cancer survivors.
Results
Among cancer survivors in this study, 22.1% reported a history of clinical diagnosis of depression. The overall prevalence rates for current and former e-cigarette use were 2.6% and 10.5%, respectively. Analysis showed 51.3% of current users, 40% of former users, and 19.1% of those who had never used e-cigarettes self-reported a history of clinical depression. In the multivariable analysis, the odds of self-reported clinical depression were significantly higher for survivors who were current users (OR = 2.85; 95% CI: 1.38–5.90) and former users (OR = 1.63; 95% CI: 1.05–2.55) compared to never e-cigarette users.
Conclusion
Findings from this study suggest a statistically significant association between e-cigarette use and depression in cancer survivors. Future studies should focus on examining the longitudinal association between e-cigarette use and depression in cancer survivors.
Implications for Cancer Survivors
Study findings reemphasized the need for interventions to support cancer survivors with evidence-based treatments for depression as well as the need for clinicians to screen for psychological distress and/or e-cigarette use and make appropriate recommendations.
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Data availability
The data for this study is publicly available at https://www.cdc.gov/brfss/index.html.
References
Siegal RL, Miller KD, Jemal A. Cancer statistics. Cancer J Clin. 2020. https://doi.org/10.3322/caac.21590.
Risk Factors: Age. National Cancer Institute. https://www.cancer.gov/about-cancer/causes-prevention/risk/age. Updated March 5, 2021. Accessed June 7, 2021.
American Cancer Society. Cancer treatment & survivorship facts & figures 2019–2021. Atlanta: American Cancer Society; 2019.
Winer E, Gralow J, Diller L, et al. Clinical cancer advances 2008: major research advances in cancer treatment, prevention, and screening–a report from the American Society of Clinical Oncology [published correction appears in J Clin Oncol. 2009 Jun 20;27(18):3070-1]. J Clin Oncol. 2009;27(5):812–26. https://doi.org/10.1200/JCO.2008.21.2134.
Brandenbarg D, Maass SWMC, Geerse OP, et al. A systematic review on the prevalence of symptoms of depression, anxiety and distress in long-term cancer survivors: implications for primary care. Eur J Cancer Care (Engl). 2019;28(3):e13086. https://doi.org/10.1111/ecc.13086.
Yan R, Xia J, Yang R, et al. Association between anxiety, depression, and comorbid chronic diseases among cancer survivors. Psychooncology. 2019;28(6):1269–77. https://doi.org/10.1002/pon.5078.
Seitz DC, Besier T, Debatin KM, et al. Posttraumatic stress, depression and anxiety among adult long-term survivors of cancer in adolescence. Eur J Cancer. 2010;46(9):1596–606. https://doi.org/10.1016/j.ejca.2010.03.001.
Hawkins NA, Soman A, Buchanan Lunsford N, Leadbetter S, Rodriguez JL. Use of medications for treating anxiety and depression in cancer survivors in the United States. J Clin Oncol. 2017;35(1):78–85. https://doi.org/10.1200/JCO.2016.67.7690.
Mirbolouk M, Charkhchi P, Kianoush S, et al. Prevalence and distribution of e-cigarette use among U.S. adults: behavioral risk factor surveillance system, 2016. Ann Intern Med. 2018;169(7):429–38. https://doi.org/10.7326/M17-3440.
Obisesan OH, Mirbolouk M, Osei AD, et al. Association between e-cigarette use and depression in the behavioral risk factor surveillance system, 2016–2017. JAMA Network Open. 2019;2(12). https://doi.org/10.1001/jamanetworkopen.2019.16800.
Sanford NN, Sher DJ, Xu X, Aizer AA, Mahal BA. Trends in smoking and e-cigarette use among us patients with cancer, 2014–2017. JAMA Oncol. 2019. https://doi.org/10.1001/jamaoncol.2018.6858.
Antwi GO, Lohrmann DK, Jayawardene W, Chow A, Obeng CS, Sayegh AM. Associations between e-cigarette and combustible cigarette use among U.S. cancer survivors: implications for research and practice. J Cancer Surviv. 2019;13(2):316–25. https://doi.org/10.1007/s11764-019-00753-1.
Leventhal AM, Strong DR, Sussman S, Kirkpatrick MG, Unger JB, Barrington-Trimis JL, Audrain-McGovern J. Psychiatric comorbidity in adolescent electronic and conventional cigarette use. J Psychiatry Res. 2016;2016(73):71–8. https://doi.org/10.1016/j.jpsychires.2015.11.008.
Goniewicz ML, Gupta R, Lee YH, et al. Nicotine levels in electronic cigarette refill solutions: a comparative analysis of products from the U.S., Korea, and Poland. Int J Drug Policy. 2015;26(6):583–8.
Saeed OB, Chavan B, Haile ZT. Association between e-cigarette use and depression in US adults [published online ahead of print, 2020 Jan 14]. J Addict Med. 2020. https://doi.org/10.1097/ADM.0000000000000604.
Centers for Disease Control and Prevention. The Behavioral Risk Factor Surveillance System (BRFSS) OVERVIEW: BRFSS. 2018. https://www.cdc.gov/brfss/annual_data/2018/pdf/overview-2018-508.pdf. Published July 2019. Accessed June 7, 2021.
US Centers for Disease Control and Prevention. Weighting the BRFSS Data. https://www.cdc.gov/brfss/annual_data/2018/pdf/weighting-2018-508.pdf. Accessed September 26, 2020.
Leventhal AM, Zvolensky MJ. Anxiety, depression, and cigarette smoking: a transdiagnostic vulnerability framework to understanding emotion-smoking comorbidity. Psychol Bull. 2015;141(1):176–212. https://doi.org/10.1037/bul0000003.
Dawkins L, Acaster S, Powell JH. The effects of smoking and abstinence on experience of happiness and sadness in response to positively valenced, negatively valenced, and neutral film clips. Addict Behav. 2007;32(2):425–31. https://doi.org/10.1016/j.addbeh.2006.05.010.
Paterson NE. The neuropharmacological substrates of nicotine reward: reinforcing versus reinforcement-enhancing effects of nicotine. Behav Pharmacol. 2009;20(3):211–25. https://doi.org/10.1097/FBP.0b013e32832c7083.
Lechner WV, Janssen T, Kahler CW, Audrain-McGovern J, Leventhal AM. Bi-directional associations of electronic and combustible cigarette use onset patterns with depressive symptoms in adolescents. Prev Med. 2017;96:73–8. https://doi.org/10.1016/j.ypmed.2016.12.034.
Fluharty M, Taylor AE, Grabski M, Munafò MR. The association of cigarette smoking with depression and anxiety: a systematic review. Nicotine Tob Res. 2017;19(1):3–13. https://doi.org/10.1093/ntr/ntw140.
Park EM, Rosenstein DL. Depression in adolescents and young adults with cancer. Dialogues Clin Neurosci. 2015;17(2):171–80.
Biddle S. Physical activity and mental health: evidence is growing. World Psychiatry. 2016;15(2):176–7. https://doi.org/10.1002/wps.20331.
Clement S, Schauman O, Graham T, et al. What is the impact of mental health-related stigma on help seeking? A systematic review of quantitative and qualitative studies. Psychol Med. 2015;45(1):11–27. https://doi.org/10.1017/S0033291714000129.
Lazar M, Davenport L. Barriers to health care access for low income families: a review of literature. J Community Health Nurs. 2018;35(1):28–37. https://doi.org/10.1080/07370016.2018.1404832.
Kaiser Family Foundation. Gender differences in health care, status, and use: spotlight on men’s health. http://files.kff.org/attachment/slides-gender-differences-in-health-care-status-and-use-spotlight-on-mens-health. Accessed November 19, 2020.
Stiles B. Can vaping lead to lung disease? Health Matters. https://healthmatters.nyp.org/can-vaping-lead-to-lung-disease/. Accessed December 15, 2019.
Muthumalage T, Lamb T, Friedman MR, Rahman I. E-cigarette flavored pods induce inflammation, epithelial barrier dysfunction, and DNA damage in lung epithelial cells and monocytes. Sci Rep. 2019;9:19035. https://doi.org/10.1038/s41598-019-51643-6.
Soulakova JN, Hartman AM, Liu B, Willis GB, Augustine S. Reliability of adult self-reported smoking history: data from the tobacco use supplement to the current population survey 2002–2003 cohort. Nicotine Tob Res. 2012;14(8):952–60. https://doi.org/10.1093/ntr/ntr313.
Hatziandreu EJ, Pierce JP, Fiore MC, Grise V, Novotny TE, Davis RM. The reliability of self-reported cigarette consumption in the United States. Am J Public Health. 1989;79(8):1020–3. https://doi.org/10.2105/ajph.79.8.1020.
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Conceptualization and design: Godfred Antwi and Darson Rhodes.
Data preparation and analysis: Godfred Antwi.
Interpretation of data: Godfred Antwi and Darson Rhodes.
Manuscript writing: Godfred Antwi and Darson Rhodes.
Manuscript editing and review: Godfred Antwi and Darson Rhodes.
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Antwi, G.O., Rhodes, D.L. Association between e-cigarette use and depression in US cancer survivors: a cross-sectional study. J Cancer Surviv 17, 1452–1460 (2023). https://doi.org/10.1007/s11764-022-01176-1
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DOI: https://doi.org/10.1007/s11764-022-01176-1