kjhp Korean Journal of Health Promotion Korean J Health Promot 2234-2141 2093-5676 The Korean Society of Health Promotion and Disease Prevention 10.15384/kjhp.2016.16.2.111 kjhp-16-111 Original Article Associations between Smoking, Drinking and Depression among Korean Adults: The 5th Korea National Health and Nutrition Examination Survey ParkSun Mi 1 HanMi Ah 1 ParkJong 1 RyuSo Yeon 1 ChoiSeong Woo 1 ShinHwan Ho 1 2 JooMi Hyun 1 2 Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, Korea Department 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 01 2016 20 01 2016 16 2 111 118 16122015 05022016 Copyright © 2016 The Korean Society of Health Promotion and Disease Prevention 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. 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.

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Subjects' characteristics by sex

Characteristics Total Male Female Pa
(n = 17,871) (n = 7,573) (n = 10,298)
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 (%).

Calculated by chi-square tests.

Smoking and drinking behavior by sex

Characteristics Total Male Female Pa
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
Nob 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
Nonec 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
Nonec 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 (%).

Calculated by chi-square tests.

Including never and former smokers.

Non-drinker during the past year.

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

Characteristics Male Female
Depressiona aOR (95% CI)b Depressiona 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        
Noc 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.

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

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

Including never and former smokers.

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

Characteristics Male Female
Depressiona aOR (95% CI)b Depressiona 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        
Nonec 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        
Nonec 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.

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

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

Nondrinker during the past year.