성인 남성에서 일반담배와 전자담배 이중사용과 우울 증상의 연관성 분석: 국민건강영양조사 자료 이용 = The Association between Depressive Mood and Conventional and Electronic Cigarette Dual Use in Adult Male: Using Korea National Health and Nutrition Examination Survey

다국어 초록 (Multilingual Abstract)

Background: Depression is well known to be associated with nicotine dependence. Recent studies reported higher depressive score is associated with use of e-cigarettes, however, little study showed the association between depression and both cigarette dual use. The purpose of this study is to evaluate the association between depressive mood and conventional and electronic cigarette dual use among male adults.
Methods: Data of 7,459 male adults from sixth and seventh Korea National Health and Nutrition Examination Survey (2014, 2016, and 2018) were analyzed. Patient Health Questionnaire-9 (PHQ-9), current smoking status, and electronic cigarette use status were evaluated among them. The association between depressive mood and electronic cigarette use were assessed after adjusting age, education, income, alcohol, and perceived stress level using multivariate logistic regression analysis. The risk of depressive mood for dual users were also assessed. STATA 11.0 (Stata Corp., College Station, TX, USA) were used.
Results: The both group of e-cigarette current user or ex-user reported higher depressive scores (PHQ-9) than never-user group (never-user group 1.94±0.05, ex-user group 2.57±0.13, current user group 2.69±0.22, P<0.001). In the multivariate logistic analysis, 1 point increase of depressive mood score was associated with risk of e-cigarette current use (odds ratio [OR], 1.062; 95% confidence interval [CI], 1.021-1.105) among total male adult group or conventional & electronic tobacco dual use (OR, 1.054; 95% CI, 1.012-1.098) among current smokers.
Conclusions: Depressive scores were positively associated with e-cigarette use or both conventional or e-cigarette use. It is necessary to evaluate and treat smoker’s depressive mood for tobacco control.

국문 초록 (Abstract)

연구배경: 우울증은 흡연과 연관성을 보이는 중요한 정신건강 상태로 니코틴 의존도와 연관성이 있다고 알려져 있다. 최근 몇몇 연구에서 니코틴이 포함된 전자담배 사용자에서 우울감이 높다고 보고하였으나, 일반담배와 전자담배의 이중사용자(dual user)와 연관성에 대해서 잘 알려져 있지 않다. 이에 국민건강영양조사 자료를 이용하여 성인 남성에서 우울감과 전자담배 사용 및 이중사용과의 연관성에대해 조사하였다.
방법: 국민건강영양조사 중 우울증 선별도구인 PHQ-9를조사한 제6기 2년차(2014년)과 제7기 1년차, 3년차(2016, 2018년) 자료를 이용하여 총 7,459명 성인 남성에서 우울점수와 전자담배와의 연관성을 보았다. 전체 성인 남성을 전자담배 사용 상태에 따라 전자담배 비사용군, 현재 사용군, 과거 사용군 세 군으로 나누어서 우울점수 및 사회경제적요인, 음주, 운동 등 건강행태에 대해 기술통계를 확인하였다. 또한 현재 흡연자를 전자담배 사용에 따라 전자담배를사용한 적 없는 현재 흡연자, 과거에 사용한 현재 흡연자 및이중사용자 세 군으로 나누어서 우울점수를 비교하였다. 다변량 로지스틱 회귀분석에서 연령, 교육 정도 등 혼란변수를 보정하여 우울점수가 전자담배 사용 상태와 연관성을 보이는지 평가하였다. 전자담배를 사용한 적 없는 현재 흡연자와 비교하여 우울점수에 따라 이중사용의 연관성이 높아지는지 살펴보았다. 통계분석은 STATA 11.0 (Stata Corp.) 을 이용하였다.
결과: 전자담배 사용에 따른 우울점수를 비교하면 전자담배 비사용군 1.94±0.05, 전자담배 과거 사용군 2.57±0.13, 전자담배 현재 사용군 2.69±0.22 (P<0.001)로, 전자담배 사용경험이 있는 경우 우울점수가 높았다. 전체 대상자에 대한다변량 로지스틱 회귀분석에서 우울점수가 1점 높아질수록전자담배 현재 사용 가능성이 높았다(OR, 1.062; 95% CI, 1.021-1.105). 현재 흡연자와 이중사용자의 우울점수를 단순비교하면 유의한 차이를 보이지 않지만, 현재 흡연자에 대한 다변량분석 결과에서 우울점수가 1점 높아질수록 이중사용의 가능성이 높았다(OR, 1.054; 95% CI, 1.012-1.098).
결론: 우울점수나 높을수록 전자담배를 사용할 가능성이높을 뿐 아니라 현재 흡연자에 비해서 일반담배와 전자담배이중사용과도 연관성이 높았다. 우울 증상이 이중사용과도연관되었을 가능성이 있으므로 이에 대한 관리가 필요하다.

참고문헌 (Reference)

1 함상근, "궐련 단독사용자와 비교한 이중사용자의 금연 행동: 국민건강영양조사 자료 이용" 대한금연학회 10 (10): 80-88, 2019

2 Han C, "Validation of the patient health questionnaire-9 Korean version in the elderly population : the Ansan geriatric study" 49 (49): 218-223, 2008

3 Cummins SE, "Use of e-cigarettes by individuals with mental health conditions" 23 Suppl 3 (23 Suppl 3): iii48-iii53, 2014

4 Kasza KA, "Tobacco-product use by adults and youths in the United States in 2013 and 2014" 376 (376): 342-353, 2017

5 King JL, "Tobacco product use and mental health status among young adults" 77 : 67-72, 2018

6 Piercy KL, "The physical activity guidelines for Americans" 320 (320): 2020-2028, 2018

7 Aubin HJ, "Smoking, quitting, and psychiatric disease : a review" 36 (36): 271-284, 2012

8 Sweet L, "Quitting behaviors among dual cigarette and e-cigarette users and cigarette smokers enrolled in the tobacco user adult cohort" 21 (21): 278-284, 2019

9 Leventhal AM, "Psychiatric comorbidity in adolescent electronic and conventional cigarette use" 73 : 71-78, 2016

10 Owusu D, "Patterns and trends of dual use of e-cigarettes and cigarettes among U. S. adults, 2015-2018" 16 : 101009-, 2019

11 Grant BF, "Nicotine dependence and psychiatric disorders in the United States : results from the national epidemiologic survey on alcohol and related conditions" 61 (61): 1107-1115, 2004

12 Dunbar MS, "Frequency of e-cigarette use, health status, and risk and protective health behaviors in adolescents" 11 (11): 55-62, 2017

13 Hartmann-Boyce J, "Electronic cigarettes for smoking cessation" 10 : Cd010216-, 2020

14 Schroeder MJ, "Electronic cigarettes and nicotine clinical pharmacology" 23 Suppl 2 (23 Suppl 2): ii30-ii35, 2014

15 Wiernik E, "Electronic cigarette use is associated with depressive symptoms among smokers and former smokers : cross-sectional and longitudinal findings from the constances cohort" 90 : 85-91, 2019

16 Spindle TR, "Electronic cigarette use and uptake of cigarette smoking : a longitudinal examination of U. S. college students" 67 : 66-72, 2017

17 Lee JA, "Electronic cigarette use among Korean adults" 61 (61): 151-157, 2016

18 Kim CY, "Dual use of electronic and conventional cigarettes is associated with higher cardiovascular risk factors in Korean men" 10 (10): 5612-, 2020

19 Morrell HE, "Depression vulnerability predicts cigarette smoking among college students : gender and negative reinforcement expectancies as contributing factors" 35 (35): 607-611, 2010

20 Blagev DP, "Clinical presentation, treatment, and short-term outcomes of lung injury associated with e-cigarettes or vaping : a prospective observational cohort study" 394 (394): 2073-2083, 2019

21 Bao W, "Changes in electronic cigarette use among adults in the United States, 2014-2016" 319 (319): 2039-2041, 2018

22 Lechner WV, "Bi-directional associations of electronic and combustible cigarette use onset patterns with depressive symptoms in adolescents" 96 : 73-78, 2017

23 Marsden DG, "Associations between frequency of cigarette and alternative tobacco product use and depressive symptoms : a longitudinal study of young adults" 99 : 106078-, 2019

24 Lee Y, "Association of depression and suicidality with electronic and conventional cigarette use in South Korean adolescents" 54 (54): 934-943, 2019

25 Azagba S, "Adolescent dual use classification and its association with nicotine dependence and quit intentions" 65 (65): 195-201, 2019

26 Hajek P, "A randomized trial of e-cigarettes versus nicotine-replacement therapy" 380 (380): 629-637, 2019

27 Leung J, "A longitudinal study of the bi-directional relationship between tobacco smoking and psychological distress in a community sample of young Australian women" 42 (42): 1273-1282, 2012

28 Snell LM, "A longitudinal analysis of nicotine dependence and transitions from dual use of cigarettes and electronic cigarettes : evidence from Waves 1-3 of the PATH study" 81 (81): 595-603, 2020

29 Lim AC, "A brief smoking cessation intervention for heavy drinking smokers : treatment feasibility and acceptability" 9 : 362-, 2018

30 Jeong JH, "11% of adults experience e-cigarettes. Most men in t heir 30s and women in their 20s" JoongAng Il bo