Food and Behaviour Research

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Secondhand Smoking and Depressive Symptoms Among In-School Adolescents

Jacob L, Smith L, Jackson SE, Haro JM, Shin JI, Koyanagi A (2020) Am J Prev Med.  2020 Feb.  pii: S0749-3797(20)30032-5. doi: 10.1016/j.amepre.2019.12.008. [Epub ahead of print] 

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Smoking has been linked with depressive symptoms in adolescents, but data on secondhand smoking and depressive symptoms in low- and middle-income countries are scarce. Thus, this study analyzes the association between secondhand smoking and depressive symptoms among in-school adolescents from 22 low- and middle-income countries.


Data from the 2003-2008 Global School-Based Student Health Survey were analyzed in June 2019. Data on past-week exposure to secondhand smoke and past-year depressive symptoms were collected. The association between secondhand smoke and depressive symptoms was studied using multivariable logistic regressions and meta-analyses.


The sample consisted of 37,505 adolescents aged 12-15 years who never smoked. The prevalence of depressive symptoms increased from 23.0% in adolescents with no secondhand smoking to 28.9% in those with secondhand smoking every day in the past week. After adjusting for sex, age, food insecurity, and country, there was a dose-response relationship between secondhand smoking and depressive symptoms in the overall sample (0 days: reference; 1-2 days: OR=1.06, 95% CI=0.95, 1.18; 3-6 days: OR=1.38, 95% CI=1.20, 1.58; 7 days: OR=1.63, 95% CI=1.44, 1.86). The country-wise analysis showed that secondhand smoking on at least 3 days (versus <3 days) in the past week was associated with a 1.48-fold increase in the odds of depressive symptoms (95% CI=1.39, 1.59), with a low level of between-country heterogeneity (I2=4.2%).


There was a positive association between secondhand smoking and depressive symptoms among in-school adolescents from low- and middle-income countries. Further research should investigate causality and assess whether prevention of exposure to secondhand smoke can have a positive effect on the mental well-being of adolescents.


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