title: Patterns of clinically significant symptoms of depression among heavy users of alcohol and cigarettes.
abstract: BACKGROUND
  Depression is among the most prevalent and treatable diseases, and it is associated with cigarette smoking and heavy alcohol use. This study estimates the prevalence of depression, its variation among demographic subgroups, and its association with heavy alcohol use and cigarette smoking in California.
  
  
  METHODS
  The 2006 California Behavioral Risk Factor Surveillance System (BRFSS) includes the 8-item Patient Health Questionnaire, a standardized instrument used to measure depressive symptoms. We used findings from the 2006 BRFSS to calculate the prevalence of depression in California; we used logistic models to explore the relationships between depression, alcohol use, and smoking.
  
  
  RESULTS
  We found that 9.2% of adults in California had clinically significant depressive symptoms. Logistic models indicated that daily smokers were more than 3 times more likely to have clinically significant depressive symptoms than were nonsmokers, and heavy drinkers were approximately 3 times more likely to have clinically significant depressive symptoms than were nondrinkers.
  
  
  CONCLUSIONS
  Because heavy alcohol use and daily smoking are each associated with depression, people who do both may be at an increased risk for depression. This is a public health issue because people who drink alcohol often also smoke and vice versa. Intervention efforts might target persons who are users of both these drugs, and practitioners should be aware that smokers who are heavy alcohol users are at an increased risk for depression.
authors.affiliation: Survey Research Group Section, Cancer Surveillance and Research Branch, California Department of Public Health, 1700 Triute Rd, Sacramento, CA 95815-1402, USA. jepstein@ccr.ca.gov
authors.forename: Joan Faith
authors.initials: JF
authors.lastname: Epstein
authors.forename: Marta
authors.initials: M
authors.lastname: Induni
authors.forename: Tom
authors.initials: T
authors.lastname: Wilson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology*; D002140:California / Q000453:epidemiology; D003863:Depression / Q000150:complications / Q000453:epidemiology*; D005260:Female; D015438:Health Behavior; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D050177:Overweight; D015995:Prevalence; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*; D011795:Surveys and Questionnaires