The Association between Depressive Mood and Conventional and Electronic Cigarette Dual Use in Adult Male: Using Korea National Health and Nutrition Examination Survey

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.