Associations between smoking, tobacco types, and depression in middle-aged and elderly Chinese individuals: a cross-sectional analysis from the CHARLS study.

Authors

Guozhong Chen, Hongmiao Tao

Published in

Substance abuse treatment, prevention, and policy. Volume 21. Issue 1. Jul 29, 2026. Epub Jul 29, 2026.

Abstract

Depression is a major public health issue with a profound impact on quality of life and mortality. Tobacco smoke is a leading risk factor for various health conditions. However, the relationship between smoking, types of tobacco and depression remains underexplored, especially in middle-aged and elderly populations in China. This study mainly examines the associations between smoking status, types of tobacco products, and depression in middle-aged and elderly individuals in China.
Data were derived from all five waves (2011-2020) of the China Health and Retirement Longitudinal Study (CHARLS) in a pooled cross-sectional design. A total of 34,215 observations from adults aged 45 years and older were analysed. Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale (CES-D-10), with a score of 10 or higher indicating elevated depressive symptoms. Smoking status was categorized into current smokers, ex-smokers, and non-smokers, and tobacco types included conventional cigarettes, self-rolled cigarettes, pipes, and others (cigars and hookahs). Multivariable logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) for the associations of smoking and tobacco type with depressive symptoms. Generalized estimating equations and mixed-effects models were used as sensitivity analyses to account for repeated observations from the same individuals.
The prevalence of depressive symptoms (CES-D-10 ≥ 10) was 34.06%. Current smokers had an OR of 1.25 (95% CI: 1.15, 1.35; p < 0.001) and ex-smokers an OR of 1.15 (95% CI: 1.06, 1.25; p < 0.001) relative to non-smokers. Among tobacco types, self-rolled cigarette smokers (OR: 1.53; 95% CI: 1.35, 1.74; p < 0.001) and pipe smokers (OR: 1.56; 95% CI: 1.35, 1.81; p < 0.001) showed the strongest associations, followed by users of cigars and hookahs (OR: 1.39; 95% CI: 1.15, 1.68; p < 0.001) and conventional cigarettes (OR: 1.10; 95% CI: 1.02, 1.19; p = 0.010).
In this middle-aged and elderly Chinese population, smoking and all examined tobacco types were associated with a higher prevalence of depressive symptoms, with the strongest associations observed for self-rolled and pipe tobacco. Because the design is cross-sectional, these findings indicate associations rather than causal effects, and underscore the need to integrate mental-health considerations into tobacco-control efforts, including attention to traditional and non-cigarette tobacco products.
Not applicable.

PMID:
42850646
Bibliographic data and abstract were imported from PubMed on 09 Oct 2026.

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