UvA-DARE ( Digital Academic Repository ) Depressive symptoms and smoking among young Turkish and Moroccan ethnic minority groups in the Netherlands : a cross-sectional study

Background: Although evidence indicates a strong association between depressive symptoms and smoking among host and migrant adults, less is known about this relationship among young ethnic minority groups in Europe. This paper aims to assess the relationship between depressive symptoms and smoking among young Turkish and Moroccan migrants in the Netherlands. Methods: Multiple logistic regression analyses was used to analyze cross-sectional data from a sample of 364 Turkish and Moroccan migrants aged 15 to 24 years. The Center for Epidemiologic Studies Depression Scale (CESD) was used to measure the presence of clinically significant depressive symptoms. Smoking behavior was measured by a number of questions. Results: Of the respondents, 22% were smokers and 33% had depressive symptoms. The prevalence of depressive symptoms was significantly higher in smokers (42.9%) than in nonsmokers (29.5%). Respondents with depressive symptoms had increased odds of smoking even after adjusting for socioeconomic and cultural factors (OR = 2.68, 95% CI = 1.45-4.97). Conclusions: Depressive symptoms were significantly associated with smoking behavior in young Turkish and Moroccan migrants. In addition to other acknowledged factors, depressive symptoms should also be considered in relation to the smoking behavior of this group. Intervention programs for smoking behavior should take depressive symptoms into account for young Turkish and Moroccan migrants. Introduction Smoking behavior is associated with mental health disorders, particularly depressive symptoms [1-4]. Smoking prevalence is higher among individuals with depressive symptoms than it is among those with no depressive symptoms [5]. Different causal pathways between depressive symptoms and smoking have been reported. Previous studies have found the use of nicotine to increase positive affect and/or decrease negative affect [6,7]. On the other hand, there is evidence showing that smoking triggers first-ever incidence of depression [8]. Some studies direct attention to a third independent factor: genetic predisposition to both smoking and depressive symptoms [9]. An important target group for preventing smokingrelated diseases is young adults, who are at risk of smoking and developing tobacco-related diseases [10,11]. Young adulthood has been seen as an important transition period from occasional smoking to regular smoking, and smoking behavior is probably established during this time [12]. Young adults also act as role models for adolescents. Moreover, although they attempt to quit smoking more often than older adults, they are less likely to succeed. Thus, it is important to develop smoking intervention programs specific to young adults [13]. In addition, young adults not only have high smoking rates, they also have a high prevalence of mental health disorders. A population-based study in the Netherlands indicated that the highest prevalence rates of substance use disorders are among 18to 25-year-olds [14]. Data from population-based studies in the US and Australia supported the highest comorbidity rates between * Correspondence: cerentan@yahoo.com Department of Public Health, Academic Medical Center, University of Amsterdam P.O. Box 22660, 1100 DD Amsterdam, The Netherlands Acartürk et al. Substance Abuse Treatment, Prevention, and Policy 2011, 6:5 http://www.substanceabusepolicy. com/content/6/1/5 © 2011 Acartürk et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. smoking and mental health disorders in the young adult group [15]. Findings in the Netherlands showed that one out of five young adults have substance use disorders, and that they have the highest risk of having had two or more mental health disorders in the previous twelve months [14]. Although depressive disorders are associated with smoking initiation and daily smoking, it also negatively affects smoking cessation and relapse [16]. Most of the knowledge related to depressive disorders and smoking comes from adult samples. Within the young adult group, young ethnic minorities may have a high risk of both smoking and depressive symptoms [17]. There are indications that some adult ethnic minority groups have high levels of depressive symptoms and high smoking prevalence rates compared to the host population. A recent population-based study in the Netherlands found a higher prevalence of depression among Turkish-Dutch (14.9%) and Moroccan-Dutch (6.6%) people compared to their native Dutch counterparts (4.4%) [18]. Little is known about the relationship between depressive symptoms and smoking among young ethnic minority and migrant groups in Europe. Many of the studies on ethnic differences in the association between smoking and depressive symptoms have been conducted in American and European adult samples. Young adults from ethnic minorities are of particular interest in this respect. They appear more likely to develop risk behaviors and mental health problems. These risks could be related to the high levels of acculturative stress associated with prejudice, discrimination, and/or the dual pressure of maintaining their culture of origin as well as adapting to the culture of majority [19]. Although both smoking and depressive symptoms may be highly prevalent among ethnic minorities during young adulthood, there is limited knowledge about the association between depressive symptoms and smoking in young adult migrants. Young ethnic minorities with acculturative stress who are in the critical years of young adulthood may be more vulnerable to depressive symptoms and smoking. It is important to study the association between depressive symptoms and smoking in this group to better understand the mechanisms, which will contribute to the development of culturally sensitive intervention programs. For this reason, in the present study we aimed to investigate the association between depressive symptoms and smoking behavior in young Turkish and Moroccan ethnic minority groups aged 15 to 24 years in the Netherlands. To arrive at a comprehensive overview, we used the same model to examine the effects of socioeconomic status and cultural factors. Methods