3. Association of psychological distress with smoking cessation, duration of smoking abstinence and use of other nicotine-containing products: A cross-sectional population survey in Great Britain

Tobacco smoking is strongly associated with poor mental health and smoking cessation with improvements in mental health symptoms. There is a lack of evidence on the relationship of these improvements with duration of abstinence and any differences by continued use of nicotine in other forms. Research questions: 1) Is there a difference in prevalence of past-month distress as a function of smoking status ((current, ex-smokers (<6 months, 6-12 months, >1 year), never smokers))? 2) Among ex-smokers, is there a difference in prevalence of past-month distress between those currently using non-combustible nicotine-containing products (e-cigarettes, NRT, heated tobacco, nicotine pouches) compared with those not using nicotine?

Data from monthly cross-sectional surveys in 2020/21 in Great Britain. Prevalence of past-month distress was calculated. 1) Logistic regressions using distress as outcome and smoking status as explanatory variable (n=21,503 adults), 2) Logistic regressions using distress as outcome and use of other nicotine-containing products as explanatory variable (n=7,480 adult ex-smokers). Both 1) and 2) adjusted for socio-demographics and ever diagnosis of a mental health condition.

1) Among current smokers, 43.4% experienced distress; prevalence was similar among ex-smokers of <6 months ((42.7%, adjOR (95% CI)=0.79 (0.59-1.06) and 6-12 months ((44.8%, adjOR (95% CI)=1.04 (0.79-1.37)); prevalence of distress was lower among ex-smokers of >1 year ((25.5%, adjOR (95% CI)=0.72 (0.65-0.79)) and never smokers ((27%, adjOR (95% CI)=0.68 (0.63-0.74)). 2) Ex-smokers who used nicotine-containing products were more likely to experience distress than those who were abstinent from nicotine ((37.8% vs 25.2%, adjOR (95% CI)=1.14-1.95)).

Improvements in psychological distress after smoking cessation may appear only after a substantial length of smoking abstinence. Causality and direction of any causality of an association between continued nicotine use after cessation with higher distress needs to be explored.