Depression and anxiety symptoms, health behavior–related personal factors, and tobacco smoking problem: a secondary data analysis

Background Smoking is a growing public health problem that has a significant impact on psychosocial functioning and quality of life. The presence of certain personal factors on health-promoting behavior influences mental well-being and less dependence on tobacco in the population. Objetive The purpose of this study is to explore the association between tobacco abuse, affective disorders (depression and anxiety) and personal factors related to health behavior. We also aimed to analyze how affective problems can mediate the association between personal factors related to health behavior and tobacco abuse. Methods Descriptive, bivariate, multivariate and mediation analyzes of data from 391 participants of 35–74 years old in primary health care centers located in Aragón (Spain) were performed between July 2021 and July 2022. The primary variable was tobacco consumption, evaluated qualitatively (presence or absence) and quantitatively, as consumption measured through the number of cigarettes. Results Higher patient activation and health literacy were associated with lower odds of tobacco smoking problem and lower daily cigarette consumption. Conversely, being without a partner and having more severe depressive symptoms were associated with higher odds of tobacco smoking problem and higher daily cigarette consumption. The mediation analyses suggested indirect statistical associations involving depressive symptoms in the relationships between health literacy, patient activation, and tobacco smoking outcomes. However, given the cross-sectional design, these findings should not be interpreted as evidence of causal or temporal mediation. Conclusion The severity of depressive and anxiety symptoms and personal factors are related to tobacco smoking problem. These associations may be relevant for informing future preventive strategies aimed at reducing smoking rates in the population. However, longitudinal and intervention studies are needed to clarify the temporal and causal relationships among personal health-related factors, depressive symptoms, and tobacco smoking outcomes. Clinical Trial Registration Identifier, ISRCTN12820058. https://doi.org/10.1186/ISRCTN12820058