Depression and smoking cessation in older adults: a longitudinal study.
OBJECTIVE: To explore the relationship of smoking cessation and depression. DESIGN: Cohort study with 3 years of follow-up. SETTING: North Carolina community of the Established Populations for the Epidemiologic Studies of the Elderly. PARTICIPANTS: Stratified cluster sample of adults age 65 years and older, with an oversampling of African Americans. MAIN MEASURES: Depressive symptoms using a modified Center for Epidemiologic Studies Depression (CES-D) scale; smoking cessation using change in self-reported smoking. RESULTS: Current smokers had the highest prevalence of clinically significant CES-D scores (11.2%), followed by never smokers (9.6%) and former smokers (7.1%). After 3 years, 128 (25%) of 511 baseline current smokers had quit. Among women with a clinically significant CES-D score, 55% quit smoking, compared with only 25% among those with a normal score (P < 0.05). Depressive symptoms were significantly associated with nearly fourfold increased odds of smoking cessation among women (relative odds [RO] 3.7, 95% confidence interval [CI] 1.2, 11.0; P < 0.05), but not among men (RO 0.6, 95% CI 0.2, 2.0, not significant), after adjusting for potential confounding. CONCLUSIONS: Depressive symptoms may directly increase the likelihood of smoking cessation among older women. When predicting smoking cessation, depression and gender should be considered in combination since to consider them separately may be misleading. This challenges prior reports that depressed smokers are less likely to quit smoking than nondepressed smokers.
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