SMOKING, NICOTINE DEPENDENCE, AND DEPRESSIVE SYMPTOMS IN THE CARDIA STUDY - EFFECTS OF EDUCATIONAL STATUS

The present study was designed to determine whether depressive symptom s are independently associated with smoking and nicotine dependence am ong cigarette smokers, using 1990-1991 data from the Coronary Artery R isk Development in Young Adults (CARDIA) Study, A total of 3,933 parti cipants (788 black men, 1,090 black women, 974 white men, and 1,081 wh ite women) aged 23-35 years were included. Analyses were stratified by race and sex. Depressive symptoms were measured by means of the Cente r for Epidemiologic Studies Depression (CES-D) Scale. Nicotine depende nce was defined as smoking one's first cigarette of the day within 30 minutes of awakening, Analysis of covariance was used to control for p otential covariates (age, body mass index, alcohol consumption, and ed ucation), In unadjusted comparisons, smokers had more depressive sympt oms than never smokers in all groups except white men; this relation s howed little change after adjustment for age, body mass index, and alc ohol consumption, However, after adjustment for education in addition to the above variables, these differences became attenuated and were s ignificant only among white women (adjusted CES-D score difference = 1 .9, p < 0.02), When analyses were further stratified by nicotine depen dence, dependent smokers had higher CES-D scores than never smokers in all groups. The differences again became attenuated when education wa s added to the model, and were significant only among black women (adj usted CES-D score difference = 2.3, p < 0.01), These results indicate that although smoking in general and nicotine-dependent smoking in par ticular are related to symptoms of depression, controlling for educati onal level attenuates these relations.