Tobacco Smoking Found by Israelis and Serbs to Promote Depression

January 8, 2020

3 min read

Due to overwhelming scientific evidence in recent decades, even smokers recognize the fact that tobacco use and exposure causes disease – from a wide variety of cancers, respiratory disease, heart attacks and stroke to reduced fertility, miscarriage, premature birth, stillbirth and an increase in cot death of babies. 

Now, researchers in Jerusalem and in Serbia have shown that cigarette smoke damages mental health as well. Prof. Hagai Levine at the Hebrew University of Jerusalem-Hadassah Braun School of Public Health and Community Medicine has published findings related to the mental health risks triggered by smoking.  

The study, just published in the open-access journal PLOS ONE under the title “Tobacco smoking and health-related quality of life among university students: mediating effect of depression.” included Levine’s colleagues assistant Prof. Tatjana Gazibara at the University of Belgrade and graduate student Marija Milic from the University of Pristina in Kosovo. Together, they surveyed more than 2,000 students enrolled at Serbian universities with differing socio-political and economic environments.  

This research was conducted in the framework of Milic’s International Master of Public Health thesis at the School of Public Health and Community Medicine in Jerusalem under Levine’s and Gazibara’s guidance. 

The Republic of Serbia is an upper middle-income country that is nevertheless still in the process of political and economic transition. In addition, Serbia is located in the Eastern Europe, a region with an overall high prevalence of tobacco smoking of more than 25%. In Serbia, about one-third of all students smoke cigarettes. The University of Belgrade has around 90,000 students, while the University of Pristina is a higher education institution of principal importance for the Serb population after the armed conflict at the beginning of the 21st century in Kosovo. 

The researchers found that students who smoked suffered from clinical depression at rates that were twice to three times higher than did their non-smoking peers.  Specifically, at the University of Pristina, 14% of smokers suffered from depression, compared to just four percent of their non-smoking peers; at Belgrade University, the numbers were 19% to 11%, respectively.  

In addition, no matter what their economic or socio-political backgrounds, students who smoked also had higher rates of depressive symptoms and lower mental health scores (such as, vitality and social functioning) than did non-smoking students.  

Studies around the world show that some 90% of current smokers start smoking before adulthood, and that depression is among the strongest factors contributing to smoking initiation and substance use among university students. At a global level, depression has been considered as a common mental health disorder among university students

“Our study adds to the growing body of evidence that smoking and depression are closely linked,” stated Levine, an epidemiologist and long-time Israeli opponent of tobacco use. “While it may be too early to say that smoking causes depression, tobacco does appear to have an adverse effect on our mental health.”

Here in Israel, the timing of the study publication coincides with a milestone event in the country’s war on tobacco – an amendment to Israel’s Law on Restriction on Advertising and Marketing of Tobacco and Smoking Products went into effect.  It established a countrywide ban on store displays of tobacco products and an increase in the size of cigarette box warnings from 30% to 65%. It also requires all tobacco and e-cigarette products to be sold in uniform packaging – in a brown-green hue that is regarded as “the ugliest color in the world,” with uniform logos and no individual logos or company branding.

While these are important steps, in light of the new study, Levine calls on policymakers to take into account the damaging effects of smoking on mental health effects, as well.  “I urge universities to advocate for their students’ health by creating ‘Smoke-Free Campuses’ that not only ban smoking on campus but tobacco advertising, too.” 

Combined with policies that prevent, screen and treat mental health problems, including addiction, these steps would go a long way towards combating the harmful effects that smoking has on our physical and mental states, Levine concluded. 



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