How does smoking tobacco and cannabis affect depression risk?
People who use both cannabis and tobacco have significantly higher rates of depression and anxiety than those who use either substance alone or not at all, according to a new study by UC San Francisco researchers.
The study, published Sept. 13, 2023 in the online journal PLOS ONE, comes amid expanding legalization of cannabis products, resulting in more dual use with tobacco nationwide. Earlier studies relied on data collected before the legalization trend, prompting the need for a new analysis.
Understanding the association between the use of both drugs and mental health could lead to more effective prevention and treatment options, the paper’s authors said.
“We provide mental health treatment, but it’s not linked with support for cannabis and tobacco cessation,” said the paper's lead author, Nhung Nguyen, PhD, assistant professor in the Division of General Internal Medicine at Zuckerberg San Francisco General Hospital and Trauma Center and a researcher with UCSF’s Center for Tobacco Control Research and Education. “We cannot provide tobacco cessation without addressing mental health or without considering cannabis use. These comorbidities are closely linked to tobacco use.”
A harmful combination
In conducting this study, the researchers were able to tap into an existing data source: the COVID-19 Citizen Science Study – a mobile app developed by UCSF researchers that contained a wealth of data, including mental health status and substance use, collected from participants around the country through online surveys.
They analyzed responses from 53,843 Americans from March 2020 to April 2022 who answered questions about tobacco and cannabis use over a 30-day period, and paired this with monthly assessments of the participants’ mental health status
Among people who used both substances, 26.5% reported anxiety and 28.3% reported depression. Percentages of anxiety and depression were only 10.6% and 11.2% in people who used neither substance. Those who only used tobacco had higher rates of anxiety and depression than those who did not.
The study did not delve into whether mental health conditions are exacerbated or triggered by tobacco or cannabis use or vice versa.
"Some believe that cannabis might mitigate against the ill effects of tobacco,” said the paper’s senior author, Gregory Marcus, MD, MAS, professor of medicine and associate chief of research for the Division of Cardiology, “But, these data suggest the combination is particularly harmful to mental health.”
Authors: Additional UCSF authors include Pamela Ling, MD, MPH, Noah Peyser, PhD, Jeffrey Olgin, MD, Mark Pletcher, MD, MPH, Alexis Beatty, MD, MAS, and Madelaine Modrow, MPH.
Funding and disclosures: The research is supported by the California Tobacco-Related Disease Research Program (grants T31FT1564 and T32KT5071) and the National Center for Advancing Translational Sciences, National Institutes of Health, through UCSF Clinical and Translational Science Institute (grant UL1 TR001872-06). The authors have no conflicts of interest to disclose.
About UCSF: The University of California, San Francisco (UCSF) is exclusively focused on the health sciences and is dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. UCSF Health, which serves as UCSF's primary academic medical center, includes top-ranked specialty hospitals and other clinical programs, and has affiliations throughout the Bay Area. UCSF School of Medicine also has a regional campus in Fresno. Learn more at https://ucsf.edu, or see our Fact Sheet.
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JOURNAL
PLoS ONE
ARTICLE PUBLICATION DATE
13-Sep-2023
Stigmatization of smoking-related diseases is a barrier to care and the problem may be on the rise
Researchers begin to embrace language guidance to reduce stigma in lung cancer research
Reports and ProceedingsIMAGE: NATHAN HARRISON, FLINDERS UNIVERSITY, IN AUSTRALIA view more
CREDIT: NATHAN HARRISON, FLINDERS UNIVERSITY, IN AUSTRALIA
[Singapore -- 10:35 a.m. SGT--September 10, 2023) –The stigma that patients face when diagnosed with lung cancer is associated with poorer psychosocial outcomes, including distress and isolation, delayed help-seeking, and concerns about the quality of care, according to research presented today at the International Association for the Study of Lung Cancer (IASLC) 2023 World Conference on Lung Cancer in Singapore.
The study, conducted by a team of researchers led by Nathan Harrison, a behavioral scientist and PhD student from Flinders University, in Australia, aimed to identify and synthesize existing interventions to combat stigma associated with lung cancer and smoking-related respiratory diseases, including chronic obstructive pulmonary disease (COPD).
Meanwhile, IASLC Patient Advocate Jill Feldman presented data at the same press briefing that showed a significant percentage of lung cancer researchers have embraced the IASLC Language Guide. The lung cancer community recognizes that some commonly used words and phrases used in medicine may be contributing to the lung cancer stigma problem. As a result, advocates are working collaboratively with clinicians and scientists toward changing the language used when discussing topics regarding smoking, tobacco use, and related topics.
In 2021, IASLC published the IASLC Language Guide detailing preferred language and phrasing for all oral and written communications, including presentations at IASLC conferences. Feldman’s analysis of 519 presentations at the IASLC World Conference on Lung Cancer 2022 in Vienna found that 177 presentations discussed smoking status, 77 presenters used non-stigmatizing language, while 100 presenters used the stigmatizing term "smoker." Thus, in only one year of implementation, a significant number of presenters had already adopted the recommended changes that play an important role in creating a patient and advocate-friendly environment at IASLC meetings and activities.
Stigma linked to smoking-related respiratory diseases often leads to externalized devaluation, such as discrimination or judgmental comments, and internalized self-blame or shame.
As denormalization strategies have been central to population-level tobacco control responses that discourage smoking, evidence suggests that stigma around lung cancer and respiratory diseases may be on the rise. To address this issue, developing stigma-reducing interventions for affected individuals has been identified as a priority.
Harrison and his colleagues conducted a systematic review that identified 10 studies, describing nine distinct interventions from 427 records, aimed at reducing stigma related to lung cancer and smoking-related respiratory diseases. Most interventions focused on guiding behavior change through group programs, providing formal psychotherapeutic intervention, or offering information/instruction and reference materials to individuals. These interventions primarily targeted symptomatic individuals or higher-risk groups in high-income countries.
The researchers searched four electronic databases (PsycINFO, CINAHL, PubMed, and Scopus), focusing on lung cancer, COPD, and stigma-related terms, for relevant records published up to December 2022. Eligible studies described an intervention designed to reduce externalized or internalized stigma associated with smoking-related respiratory disease and were assessed using JBI critical appraisal tools as appropriate for the varied (case report, qualitative, quasi-experimental, and randomized controlled trial) study designs.
Notably, the study revealed that most of the identified interventions reported achieving reductions in stigma. Both remote and digital intervention delivery showed similar effects to traditional in-person modes, indicating promise in increasing accessibility for individuals with comorbidities or respiratory disease-related functional impairments.
“We need to further develop and evaluate stigma-reducing interventions with larger samples in diverse socio-cultural contexts,” Harrison said. “Additionally, including validated stigma assessments in a wider variety of interventional studies could help identify more effective techniques for targeted stigma reduction.”
About the IASLC:
The International Association for the Study of Lung Cancer (IASLC) is the only global organization dedicated solely to the study of lung cancer and other thoracic malignancies. Founded in 1974, the association's membership includes more than 8,000 lung cancer specialists across all disciplines in over 100 countries, forming a global network working together to conquer lung and thoracic cancers worldwide. The association also publishes the Journal of Thoracic Oncology, the primary educational and informational publication for topics relevant to the prevention, detection, diagnosis, and treatment of all thoracic malignancies. Visit www.iaslc.org for more information.
About the WCLC:
The WCLC is the world’s largest meeting dedicated to lung cancer and other thoracic malignancies, attracting more than 7,000 researchers, physicians, and specialists from more than 100 countries. The goal is to increase awareness, collaboration, and understanding of lung cancer, and to help participants implement the latest developments across the globe. The conference will cover a wide range of disciplines and unveil several research studies and clinical trial results. For more information, visit https://wclc2023.iaslc.org.
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