Perceived stress and smoking across 41 countries: A global perspective across Europe, Africa, Asia and the Americas

• Published in: Scientific reports Vol. 7; no. 1; pp. 7597 - 8
• Main Authors: Stubbs, Brendon, Veronese, Nicola, Vancampfort, Davy, Prina, A. Mathew, Lin, Pao-Yen, Tseng, Ping-Tao, Evangelou, Evangelos, Solmi, Marco, Kohler, Cristiano, Carvalho, André F., Koyanagi, Ai
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 08.08.2017; Nature Publishing Group; Nature Portfolio
• Subjects: 692/308/174; 692/499; Adult; Africa - epidemiology; Aged; Americas - epidemiology; Asia - epidemiology; Cigarettes; Cross-Sectional Studies; Developing Countries; Drug addiction; Europe - epidemiology; Female; Humanities and Social Sciences; Humans; Income - statistics & numerical data; Logistic Models; Male; Middle Aged; multidisciplinary; Multivariate Analysis; Perception; Poverty - statistics & numerical data; Public health; Science; Science (multidisciplinary); Smoking; Smoking Cessation - statistics & numerical data; Stress; Stress, Psychological - epidemiology; Stress, Psychological - physiopathology; Tobacco Smoking - epidemiology; Tobacco Smoking - psychology; Americas; Asia; Europe; Africa
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-017-07579-w

Within recent years, there has been a seismic shift in smoking rates from high-income to low- and middle-income countries (LMICs). Evidence indicates that perceived stress may comprise a barrier for smoking cessation, but little is known about the association of perceived stress and smoking in LMICs. We conducted a cross-sectional, community-based study comprising 217,561 people [mean age 38.5 (SD = 16.1) years, 49.4% males]. A perceived stress score [range 2 (lowest-stress) 10 (highest-stress)] was computed from the Perceived Stress Scale. Multivariable logistic regression analyses were conducted. In the overall sample, a one-unit increase in perceived-stress resulted in a 5% increased odds of smoking (OR = 1.05; 95%CI = 1.03–1.06). Increased stress was associated with smoking in Africa (OR = 1.06; 95%CI = 1.04–1.09), Americas (OR = 1.03; 95%CI = 1.01–1.05), and Asia (OR = 1.06; 95%CI = 1.04–1.08), but not Europe (OR = 0.99; 95%CI = 0.95–1.02). Increasing levels of perceived stress were significantly associated with heavy smoking (≥30 cigarettes per day) among daily smokers (OR = 1.08; 95%CI = 1.02–1.15). A country-wide meta-analysis showed that perceived stress is associated with daily smoking in most countries. Prospective studies are warranted to confirm/refute this relationship, which may have meaningful public health implications.