The relationship between smoking and psychological distress among the White Applachian population: Using the 2007 HINTS survey

Open Access
Krebs, Nicolle M
Graduate Program:
Public Health Sciences
Master of Science
Document Type:
Master Thesis
Date of Defense:
March 13, 2013
Committee Members:
  • Eugene Joseph Lengerich, Thesis Advisor
  • Joshua Ethan Muscat, Thesis Advisor
  • John Peter Richie Jr., Thesis Advisor
  • smoking
  • pyschological distress
  • Appalachia
This study aims to examine the relationship between smoking behavior and serious psychological distress (SPD) in Appalachia, a region characterized as being “stressed” by the Appalachian Regional Commission, versus the rest of the U.S. outside of this region. A nationally representative, cross-sectional dataset from the 2007 Health Information National Trends Survey (HINTS) was used, which contained a newly created Appalachia variable. The sociodemographic factors (age, sex, income, and education), known smoking status (never smokers, former smokers, and current smokers) number of cigarettes smoked per day (CPD), smoking intensity (light, moderate, and heavy), and quit attempts among current smokers were all self-reported by the participants. SPD was used as the main outcome measure utilizing the clinically validated instrument, Kessler six-item Distress Scale (K6). Bivariate analyses and logistic regressions were used to examine associations between smoking behaviors in individuals with and without SPD. Interactions between the smoking variable of interest and Appalachia residence were used to detect if place of residence was a significant effect modifier in these associations. The results show that people who currently smoke were more likely to have SPD (POR: 1.9, 95% CI: 1.15-3.20) and smoke more cigarettes per day (POR: 1.02, 95% CI: 1.01-1.04), however place of residence was not a significant modifying factor for either (p= 0.56 and p=0.62, respectively). No significant associations were found with smoking intensity and quit attempt status. Although the findings here are analogous to the strong evidence between current smoking and CPD with SPD, they do not provide significant evidence to the association being modified by residing in the Appalachia region.