{
  "abstract": "Background and objective\n\nDepression 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.Methods\n\nData 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.Results\n\nThe 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).Conclusions\n\nIn 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.Clinical trial number\n\nNot applicable.",
  "abstract_shown": true,
  "affiliations": [
    "School of Public Administration, Hangzhou Normal University, No. 2318, Yuhangtang Road, Hangzhou, Zhejiang Province, China. chenguozhong007@163.com.",
    "School of Medicine, Jinhua University of Vocational Technology, No. 888 Haitang West Road, Jinhua, Zhejiang Province, 321017, China. thm761023@163.com."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 2,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Guozhong Chen"
    },
    {
      "affs": [
        1
      ],
      "name": "Hongmiao Tao"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/34dfx89npv2kn.bib",
  "cited_by": 0,
  "doi": "10.1186/s13011-026-00750-5",
  "fulltext_url": "https://europepmc.org/articles/PMC13651406",
  "id": "34dfx89npv2kn",
  "issns": [
    "1747-597X"
  ],
  "landing_url": "https://europepmc.org/article/MED/42850646",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2737|Smoking Behavior and Cessation"
    ]
  ],
  "openalex": "W7171546638",
  "pdf_url": "https://europepmc.org/articles/PMC13651406?pdf=render",
  "pmcid": "PMC13651406",
  "pmid": "42850646",
  "published": "2026-07-29",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/34dfx89npv2kn.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:10Z",
      "native_id": "MED:42850646",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42850646"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2737|Smoking Behavior and Cessation",
      "subfield": "physiology"
    }
  ],
  "title": "Associations between smoking, tobacco types, and depression in middle-aged and elderly Chinese individuals: a cross-sectional analysis from the CHARLS study.",
  "title_text": "Associations between smoking, tobacco types, and depression in middle-aged and elderly Chinese individuals: a cross-sectional analysis from the CHARLS study.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:18:10Z",
  "url": "https://research.draconitic.com/paper/34dfx89npv2kn",
  "venue": "Substance abuse treatment, prevention, and policy",
  "versions": []
}