Tobacco-Use Susceptibility and Ever-Use Categories in Relation to Depressive Symptoms Among Undergraduates at a Chinese University: A Cross-Sectional Study
Cross-sectional study finds increasing depressive symptoms across tobacco susceptibility categories in undergraduates, suggesting mental health gradients accompany smoking risk.
Key Points
To investigate the cross-sectional relationships between categories of tobacco-use susceptibility, depressive symptoms, and life satisfaction among university undergraduates.
A cross-sectional survey was administered to 415 undergraduates (75.4% female) in southeastern China in December 2025.
Participants were categorized into firmly non-susceptible never users, susceptible never users, and ever users.
Statistical evaluations utilized trend tests, adjusted multivariable regression with HC3 robust standard errors, and descriptive bootstrap decomposition.
Mean CES-D-10 scores rose across non-susceptible never users (9.29), susceptible never users (11.55), and ever users (13.06; trend p < 0.001), with probable depression prevalence increasing from 46.5% to 60.7% and 68.1% (p = 0.002).
Each one-category increase was associated with a 1.74-point higher adjusted CES-D-10 score (HC3 95% CI: 0.76 to 2.73) and 65% higher adjusted odds of probable depression (OR = 1.65, 95% CI: 1.17 to 2.33).
Ever users who remained susceptible scored 4.82 points higher on the CES-D-10 (HC3 95% CI: 2.63 to 7.00) than firmly non-susceptible never users, and indirect association with lower life satisfaction through depressive symptoms was -0.071 (bootstrap 95% CI: -0.124 to -0.027).