The association between smoking behaviour and depressive symptoms in adolescence: the role of biology and of societal influences

Tobacco use is common among people who suffer from depressive symptoms. This cooccurrence is associated with several negative health outcomes. The present thesis will contribute to the understanding of if, how, and in which contexts this specific association occurs in early adolescence. We investigated the longitudinal association between tobacco use and depressive symptoms, the potential biological mechanisms behind this association and the extent to which the social context modifies the co-occurrence of these two major health determinants. Data are obtained from the KUPOL study, a population-based cohort of Swedish adolescents. The evaluation of the social context also includes data from the Italian BE-TEEN study. Study I. The possible association between smoking or snus use and depressive symptoms was examined in 3,195 KUPOL study participants. Smoking behaviour was associated with an increased risk of the onset of depressive symptoms among adolescents. Study II. We explored the possible involvement of activation of the hypothalamic-pituitaryadrenocortical axis, measured through salivary cortisol concentration, in the pathway from cigarette smoking to depressive symptoms in 409 KUPOL study participants. There was no evidence for an association between cigarette smoking and the hypothalamic-pituitaryadrenocortical axis levels of activity, and the latter did not predict an increased risk of the onset of depressive symptoms. Study III. Salivary cortisol concentration as a predictor of the onset of tobacco use was investigated in 381 KUPOL study participants. Morning cortisol concentration was associated with an increased risk of smoking and snus initiation as well as duration of use. These findings suggest an association between activation of the hypothalamic-pituitary-adrenocortical axis and tobacco use. Study IV. We evaluated the presence of the association between smoking and depressive symptoms in a restrictive (Sweden) and in a non-restrictive (Italy) tobacco control environment including 3,283 Swedish and 1,947 Italian participants. Cross-sectional associations between smoking and depressive symptoms were found in both the restrictive and non-restrictive tobacco control environments, with the strongest association in the former. Conclusions. This thesis indicates that smoking behaviour is a predictor of the development of depressive symptoms in adolescence. The pathways behind this longitudinal association are not clear. Seemingly, the hypothalamic-pituitary-adrenocortical axis is not implicated in the process from smoking to depressive symptoms. However, findings indicate that the initial activation of the hypothalamic-pituitary-adrenocortical axis may be linked to smoking onset. This opens up for new research avenues on dysregulation of the response to stressors, such as adverse life events, and smoking onset at a young age. Finally, translating this emerging knowledge into prevention programmes may help to develop context-specific interventions and to direct efforts towards specific subgroups of adolescents at high risk of tobacco use and depressive problems

The burden of chronic diseases and cost-of-care in subjects with HIV infection in a Health District of Northern Italy over a 12-year period compared to that of the general population

The increase in life expectancy of HIV-infected patients has driven increased costs due to life-long HIV treatment and concurrent age-related comorbidities. This population-based study aimed to investigate the burden of chronic diseases and health costs for HIV(+) subjects compared to the general population living in Brescia Local health Agency (LHA) over a 12-year period

The predictive role of NLR and PLR for solid non-AIDS defining cancer incidence in HIV-infected subjects: a MASTER cohort study

Patients’ characteristics according to lost to follow-up at 3-years. Table S2. Distribution of non-AIDS defining cancer. Table S3. Multivariate analysis: time dependent Cox regression model. Variables included in the full model. (DOCX 20 kb

Cortisol Concentration as Predictor of Tobacco Initiation in Adolescents: Results From a Population-Based Swedish Cohort.

Abstract Purpose Stress potentiates the smoking reward, decreases the ability to resist smoking, and increases the risk of smoking relapse in adulthood. This study aimed to clarify if salivary cortisol, as an indicator of stress, may be prospectively associated with the onset and phenotype of tobacco use in adolescents. Methods This study was based on a cohort of Swedish adolescents, among whom saliva specimens were collected from a nested sample. We included adolescents with salivary cortisol measurements and without a history of tobacco use (n = 381, aged 13–14 years). Quartiles of morning and afternoon cortisol concentration and cortisol area under the curve were considered as predictors. We categorized tobacco use according to the product mainly used: cigarette smoking, snus use, or either type of tobacco. For each product use, two outcomes were considered: initiation and duration of use. Poisson regression models were used to calculate rate ratios. Results A quartile increase in morning cortisol levels and cortisol area under the curve was consistently associated with a 1.2- to 1.4-fold increased risk of initiation of cigarette smoking snus use, or any tobacco use. Similar results were obtained examining the dose–response relationship and using the duration of use as outcome. No associations were apparent between afternoon cortisol concentration and any of the outcomes. All associations were similar between sexes. Conclusions Morning cortisol concentration, an indicator of hypothalamic–pituitary–adrenal axis activation, is prospectively associated with tobacco use in adolescents. Whether this activation indicates the cumulative effect of stressors during the life course remains to be elucidated

No association of cigarette smoking and depressive symptoms with cortisol concentration in adolescents. Results from a population-based Swedish cohort.

Several studies have shown that smoking increases the risk of depressive symptoms, and suggested a possible role of the hypothalamic-pituitary-adrenal axis in the smoking-depression pathway. This study aimed to assess if smokers have higher cortisol levels than non-smokers, and if higher cortisol levels are associated with depressive symptoms. Saliva samples were collected from a subgroup of 409 participants at enrolment (13-14 years old) and two years later (15-16 years old). First, we examined the association between smoking phenotypes and cortisol concentration. Second, we evaluated whether these associations differed between adolescents with and without depressive symptoms. The mean difference between smokers and non-smokers in cortisol concentrations was close to zero at both time points. For instance, the adjusted mean difference for morning cortisol concentration between current and non-current smokers was 0.000 µg/dl [95% CI -0.055, 0.056]. In addition, there were no differences in cortisol concentration at the second time-point between those who had smoked and those who did not during the two previous years. Moreover, cortisol levels were not associated with depressive symptoms. The hypothesis that dysregulation of the hypothalamic-pituitary-adrenal axis might be involved in the association between smoking behavior and depressive symptoms during adolescence was not supported by this data

Symptoms of mental health problems among Italian adolescents in 2017–2018 school year: a multicenter cross-sectional study

Background Identifying individual and contextual factors that influence adolescent well-being is a research priority. This study aimed to assess the prevalence of symptoms of mental health problems and some related factors in Italian adolescents in 2017–2018. Methods The present study was a cross-sectional survey among 3002 students aged 15–16 years who resided in two Italian provinces, in North and South Italy. Symptoms of mental health problems were assessed using the SDQ and CES-DC, and students’ risk-taking behaviors and school climate perception were assessed. All information was collected anonymously. Logistic regression models were used to assess the associations of tobacco and alcohol use, screen time, bullying, and school climate with symptoms of mental health problems. Results One student out of five reported symptoms of mental health problems, with a more than double proportion among girls than boys (28.7% vs 10.4% with depressive symptoms, respectively). Thirty percent and 40% of students smoked tobacco or drank alcoholic beverages at least once in the past month, and more than 40% reported being victims or authors of bullying in the past 6 months. Smoking behavior, alcohol consumption, screen time, bullying, and negative school climate had 1.2- to 3.3-fold increased odds of symptoms of mental health problems without substantial differences between sexes and geographical areas. Conclusions Tobacco and alcohol use, screen time, bullying, and school climate were independently associated with symptoms of mental health problems in a large sample of 15–16-year-old Italian adolescents without substantial gender and geographical differences

Integrating Multiple Research Methods to Unravel the Complexity of Human-Water Systems

Abstract: Predicting floods and droughts is essential to inform the development of policy in water management, climate change adaptation and disaster risk reduction. Yet, hydrological predictions are highly uncertain, while the frequency, severity and spatial distribution of extreme events are further complicated by the increasing impact of human activities on the water cycle. In this commentary, we argue that four main aspects characterizing the complexity of human‐water systems should be explicitly addressed: feedbacks, scales, tradeoffs and inequalities. We propose the integration of multiple research methods as a way to cope with complexity and develop policy‐relevant science

The risk of late or advanced presentation of HIV infected patients is still high, associated factors evolve but impact on overall mortality is vanishing over calendar years: Results from the Italian MASTER Cohort

BACKGROUND: We aimed at evaluating frequency and factors associated with late presentation and advanced HIV disease and excess risk of death due to these conditions from 1985 to 2013 among naïve HIV infected patients enrolled in the Italian MASTER Cohort. METHODS: All antiretroviral naive adults with available CD4+ T cell count after diagnosis of HIV infection were included. Multivariable logistic regression analysis investigated factors associated either with late presentation or advanced HIV disease. Probabilities of survival were estimated both at year-1 and at year-5 according to the Kaplan-Meier method. Flexible parametric models were used to evaluate changes in risk of death overtime according to late presentation and advanced HIV disease. The analyses were stratified for calendar periods. RESULTS: 19,391 patients were included (54 % were late presenters and 37.6 % were advanced presenters). At multivariable analysis, the following factors were positively associated with late presentation: male gender (OR = 1.29), older age (≥55 years vs. <25 years; OR = 7.45), migration (OR = 1.54), and heterosexual risk factor for HIV acquisition (OR = 1.52) or IDU (OR = 1.27) compared to homosexual risk. Survival rates at year-5 increased steadily and reached 92.1 % for late presenters vs. 97.4 % for non-late presenters enrolled in the period 2004-2009. Using flexible parametric models we found a sustained reduction of hazard ratios over time for any cause deaths between late and non-late presenters over time. Similar results were found for advanced HIV disease. CONCLUSION: Screening polices need to be urgently implemented, particularly in most-at-risk categories for late presentation, such as migrants, older patients and those with heterosexual intercourse or IDU as risk factors for HIV acquisition. Although in recent years the impact of late presentation on survival decreased, about 10 % of patients diagnosed in more recent years remains at increased risk of death over a long-term follow-up

Smell and taste alterations in Covid-19: a cross-sectional analysis of different cohorts

Olfactory (OD) and gustatory (GD) dysfunction have been proven to be a typical symptom of SARS-CoV-2 infection. However, their prevalence in different patient populations still needs to be clarified