Associations between smoking, sex steroid hormones, trouble sleeping, and depression among U.S. adults: a cross-sectional study from NHANES (2013–2016)
Open accessAbstract
Background: Dose-response and nonlinear relationships of cigarette exposure with sleep disturbances and depression are warranted, and the potential mechanism of sex hormones in such associations remains unclear. Methods: Cigarette exposure, trouble sleeping, and depression were assessed by standard questionnaires, and the levels of cotinine and sex steroid hormones were determined among 9900 adults from the National Health and Nutrition Examination Survey (NHANES). Multiple linear regression, logistic regression, and mediation models were conducted to evaluate the associations between smoking, sex steroid hormones, trouble sleeping, and depression. Results: With never smokers as a reference, current smokers had a higher prevalence of trouble sleeping (OR = 1.931, 95% CI: 1.680, 2.219) and depression (OR = 2.525, 95% CI: 1.936, 3.293) as well as testosterone level (β = 0.083, 95% CI: 0.028, 0.140). Pack-years of smoking and cigarettes per day were positively associated with the prevalence of trouble sleeping and depression as well as testosterone level (Ptrend <0.05). The restricted cubic spline model showed linear relationships of cotinine with trouble sleeping, depression, and testosterone. The positive associations of cigarettes per day with trouble sleeping and depression were greater in females than that in males (Pmodification <0.05). However, the potential role of sex hormones was not observed in the association of cotinine with trouble sleeping or depression (Pmediation >0.05). Conclusion: Smoking may induce sex hormone disturbance and increase the risk of sleep problems and depression symptoms, and ceasing smoking may reduce the risk of such complications.
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Written from the paper’s full text.
TL;DR
In a cross-sectional NHANES 2013–2016 sample of 9,900 U.S. adults, current smoking was associated with higher prevalence of trouble sleeping and depression and with higher testosterone levels. Sex steroid hormones did not mediate the associations between cotinine and trouble sleeping or depression.
Key findings
- With never smokers as reference, current smokers had higher odds of trouble sleeping (OR = 1.931, 95% CI: 1.680, 2.219) and depression (OR = 2.525, 95% CI: 1.936, 3.293), and higher testosterone (β = 0.083, 95% CI: 0.028, 0.140). Former smokers also had higher trouble sleeping (OR = 1.578, 95% CI: 1.368, 1.821) and depression (OR = 1.334, 95% CI: 1.003, 1.773).
- Pack-years and cigarettes per day were positively associated with trouble sleeping and depression (Ptrend < 0.05). Each 1 cigarette/day increase among current smokers was associated with higher testosterone (+0.5%, 95% CI: 0.2%, 0.7%) and SHBG (+0.3%, 95% CI: 0.1%, 0.6%).
- Associations of cigarettes per day with trouble sleeping and depression were greater in females than males (Pmodification < 0.05). Restricted cubic spline models showed linear relationships of cotinine with trouble sleeping, depression, and testosterone.
- Mediation analysis did not identify testosterone, estrogens, or SHBG as mediators between cotinine and trouble sleeping or depression (Pmediation > 0.05; proportion mediated 0.10%–0.40% where calculable).
Methods
- Cross-sectional analysis of 9,900 adults aged ≥18 from NHANES 2013–2016, the only cycles in which sex steroid hormones were quantified. Smoking exposure was assessed by questionnaire and serum cotinine; testosterone, estrogens, and SHBG were measured in serum; trouble sleeping was self-reported; depression was defined as PHQ-9 score ≥10.
- Multiple linear regression, logistic regression, restricted cubic spline models, gender-stratified analyses, and mediation models were used. Models adjusted for age, gender, BMI, race, educational qualification, physical activity, alcohol consumption, ratio of family income to poverty, regular periods, and survey cycle; missing values were imputed.
- Analyses were survey-weighted and performed in R.
Limitations
- The paper states that the cross-sectional design limits inference on temporality and causality; other covariates such as dietary assessment, genes, and environmental pollutants were not considered; and cotinine and sex steroid hormones are relatively unstable over long periods, so repeated-measures trajectory models are warranted.
- Evident from the text: trouble sleeping and depression were questionnaire-based rather than clinically diagnosed; smoking exposure and hormone levels were measured at a single time point; mediation analysis cannot establish causal mediation; residual confounding remains possible despite adjustment.
Model-written summary. Check it against the paper before relying on it.
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Registry
Cites
Statistics
Claims the paper makes
8 of 11 cited sources checked · 4 supported · 0 flagged · accuracy not yet measured
- Premisecitation
NHANES is a representative cross-sectional survey.
“The NHANES is a representative cross-sectional survey, which has been described elsewhere [20, 21].”
Quote in the paperSubstantial claim2 of 2 sources checked- cites [20] Zhang Y, Mustieles V, Sun Y, Oulhote Y, Wang Y-X, Messerlian C. Association between serum per- and polyfluoroalkyl substances concentrations and common cold among children and adolescents in the United States. Environ Int. 2022;164:107239. source
- cites [21] Chen C, Ye Y, Zhang Y, Pan X-F, Pan A. Weight change across adulthood in relation to all cause and cause specific mortality: prospective cohort study. BMJ. 2019;367:l5584. source
- Premisecitation
Disruption of sex steroid hormones has been found to be associated with multiple adverse health effects, including sleep problems and depression.
“Disruption of sex steroid hormones has been found to be associated with multiple adverse health effects, including sleep problems and depression [14, 15].”
Quote in the paperSubstantial claim2 of 2 sources checked- cites [14] Morssinkhof MWL, van Wylick DW, Priester-Vink S, van der Werf YD, den Heijer M, van den Heuvel OA, Broekman BFP. Associations between sex hormones, sleep problems and depression: a systematic review. Neurosci Biobehav Rev. 2020;118:669–80. source
- cites [15] Slavich GM, Sacher J. Stress, sex hormones, inflammation, and major depressive disorder: extending Social Signal Transduction Theory of Depression to account for sex differences in mood disorders. Psychopharmacology. 2019;236(10):3063–79. source
The Introduction (page unavailable) links sex-hormone fluctuations and hormonal transitions with depressed mood and risk for depression. It does not link disruption of sex steroid hormones to sleep problems; searches for sleep and sleep disturbances found no supporting passage. (LLM, conf=0.86)
Experimental — accuracy not yet measured
- Findingown data
The difference in testosterone level between current and former smokers was insignificant.
“with never smokers as a reference, the level of TST increased by 8.3% (95% CI: 2.8%, 14.0%) in current smokers, whereas the difference with former smokers was insignificant.”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The adjusted covariates are sufficient to control confounding for the associations.
- Findingown data
The number of cigarettes per day was positively associated with TST levels.
“the number of cigarettes per day was positively associated with the TST and SHBG levels”
Quote in the paperSubstantial claim - Findingown data
The RCS models yielded a linear relationship between serum cotinine concentrations and SHBG levels (P for total < 0.05 and P for nonlinear > 0.05).
“the RCS models also yielded a linear relationship between serum cotinine concentrations and TST and SHBG levels (figure S3, P for total < 0.05 and P for nonlinear > 0.05).”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The adjusted covariates are sufficient to control confounding for the associations.
- Findingown data
SHBG has a U-shaped relationship with depression prevalence among males.
“U-shaped relationships of TST and SHBG levels with depression prevalence were shown among males in subgroup analyses (figure S5, P for total and P for nonlinear < 0.05).”
Quote in the paperSubstantial claim - Findingown data
There was no significant difference in sex steroid hormone levels between former and never smokers.
“there was no significant difference in sex steroid hormone levels between former and never smokers.”
Quote in the paperSubstantial claim - Findingown data
Current smokers had a greater prevalence of depression compared to never smokers and former smokers.
“In the present study, we found that current smokers had higher levels of TST and a greater prevalence of trouble sleeping and depression compared to never smokers and former smokers.”
Quote in the paperSubstantial claim - Findingown data
Higher smoking intensity was associated with increased risk of depression.
“our own research demonstrated that both current and former smoking were associated with an increased risk of trouble sleeping and depression, with the risk becoming more pronounced with higher smoking intensity.”
Quote in the paperSubstantial claim - Findingown data
Current smokers had higher levels of TST compared to never smokers and former smokers.
“In the present study, we found that current smokers had higher levels of TST and a greater prevalence of trouble sleeping and depression compared to never smokers and former smokers.”
Quote in the paperSubstantial claim - Findingown data
With never smokers as reference, the prevalence of trouble sleeping increased by 57.8% (95% CI: 1.368, 1.821) in former smokers.
“the prevalence of trouble sleeping increased by 57.8% (95% CI: 1.368, 1.821) and 93.1% (95% CI: 1.680, 2.219), and the prevalence of depression increased by 33.4% (95% CI: 1.003, 1.773) and 152.5% (95% CI: 1.936, 3.293) in former and current smokers, respectively.”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The adjusted covariates are sufficient to control confounding for the associations.
- Rests on an assumption: The single questionnaire item validly measures trouble sleeping.
- Findingown data
No mediating effect of TST, EST, or SHBG was observed in the association between cotinine concentrations and trouble sleeping.
“Indeed, the mediating effect of TST, EST, or SHBG was not observed in the association between cotinine concentrations and trouble sleeping or depression (Pmediating >0.05).”
Quote in the paperSubstantial claim- Rests on an assumption: Serum cotinine concentration is a valid biomarker of cigarette exposure.
- Rests on an assumption: The assumptions required for mediation analysis (such as no unmeasured confounding of the mediator-outcome relationship) hold.
- Findingown data
Pack-years of smoking were positively associated with the prevalence of depression (Ptrend <0.05).
“the prevalence of trouble sleeping and depression were significantly increased with the elevated quartiles of pack-years of smoking and cigarettes per day (P and Ptrend <0.05)”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The adjusted covariates are sufficient to control confounding for the associations.
- Rests on an assumption: The single questionnaire item validly measures trouble sleeping.
- Findingown data
The restricted cubic spline model showed a linear relationship of cotinine with testosterone.
“The restricted cubic spline model showed linear relationships of cotinine with trouble sleeping, depression, and testosterone.”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The adjusted covariates are sufficient to control confounding for the associations.
- Findingown data
The prevalence of trouble sleeping and depression in current smokers significantly increased when former smokers were used as a reference (P < 0.05).
“the prevalence of trouble sleeping and depression in current smokers significantly increased when former smokers as a reference (P < 0.05).”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The adjusted covariates are sufficient to control confounding for the associations.
- Rests on an assumption: The single questionnaire item validly measures trouble sleeping.
- Findingown data
The association of current cigarette consumption with depression was stronger in females than in males.
“the associations of current cigarette consumption with trouble sleeping and depression were stronger in females than that in males.”
Quote in the paperSubstantial claim - Findingown data
The positive association of cigarettes per day with depression was greater in females than in males (Pmodification <0.05).
“The positive associations of cigarettes per day with trouble sleeping and depression were greater in females than that in males (Pmodification <0.05).”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The adjusted covariates are sufficient to control confounding for the associations.
- Rests on an assumption: The single questionnaire item validly measures trouble sleeping.
- Findingown data
Serum cotinine level was linearly associated with the prevalence of depression.
“Serum cotinine level was linearly associated with TST level and the prevalence of trouble sleeping and depression.”
Quote in the paperSubstantial claim- Rests on an assumption: Serum cotinine concentration is a valid biomarker of cigarette exposure.
- Findingown data
Cigarettes per day were positively associated with testosterone level (Ptrend <0.05).
“the estimated changes of TST and SHBG were significantly increased with the elevated quartiles of cigarettes per day (Ptrend <0.05)”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The adjusted covariates are sufficient to control confounding for the associations.
- Findingown data
Serum cotinine level was linearly associated with TST level.
“Serum cotinine level was linearly associated with TST level and the prevalence of trouble sleeping and depression.”
Quote in the paperSubstantial claim- Rests on an assumption: Serum cotinine concentration is a valid biomarker of cigarette exposure.
- Findingown data
Each 1 cigarette per day increase in current smokers was associated with a 0.3% increase in SHBG level (95% CI: 0.1%, 0.6%).
“Each 1 cigarette per day increase in current smokers was associated with increased levels of TST and SHBG for 0.5% (0.2%, 0.7%) and 0.3% (0.1%, 0.6%), respectively.”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The adjusted covariates are sufficient to control confounding for the associations.
- Findingown data
TST has a linear negative relationship with trouble sleeping prevalence in total participants.
“The RCS models showed a linear negative relationship between TST and trouble sleeping prevalence (P for total < 0.05 and P for nonlinear > 0.05)”
Quote in the paperSubstantial claim - Findingown data
The association between cotinine and depression prevalence appeared to be J-shaped in females (P for total and P for nonlinear < 0.05).
“the association between cotinine and depression prevalence appeared to be J-shaped in females (P for total and P for nonlinear < 0.05).”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The adjusted covariates are sufficient to control confounding for the associations.
- Rests on an assumption: The single questionnaire item validly measures trouble sleeping.
- Findingown data
The association between smoking intensity and trouble sleeping was greater in females than in males.
“Notably, we found that the association between smoking intensity and trouble sleeping as well as depression was greater in females than in males.”
Quote in the paperSubstantial claim - Findingown data
Higher smoking intensity was associated with increased risk of trouble sleeping.
“our own research demonstrated that both current and former smoking were associated with an increased risk of trouble sleeping and depression, with the risk becoming more pronounced with higher smoking intensity.”
Quote in the paperSubstantial claim - Findingown data
Current cigarette exposure was positively associated with TST levels.
“Current rather than former or total cigarette exposure was positively associated with the levels of TST and SHBG”
Quote in the paperNot a substantial claim - Findingown data
When former smokers were used as a reference, the level of TST significantly increased in current smokers (P < 0.05).
“When former smokers as a reference, the level of TST significantly increased, but EST significantly decreased in current smokers (P < 0.05).”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The adjusted covariates are sufficient to control confounding for the associations.
- Findingown data
TST has a U-shaped relationship with trouble sleeping in males.
“In addition, trouble sleeping was observed to present a U-shaped relationship with TST in males and with EST in females (figure S4, P for total and P for nonlinear < 0.05).”
Quote in the paperNot a substantial claim - Findingown data
EST has a U-shaped relationship with trouble sleeping prevalence in total participants.
“and a U-shaped relationship between EST and trouble sleeping prevalence (P for total and P for nonlinear < 0.05).”
Quote in the paperSubstantial claim - Findingown data
When former smokers were used as a reference, the level of EST significantly decreased in current smokers (P < 0.05).
“When former smokers as a reference, the level of TST significantly increased, but EST significantly decreased in current smokers (P < 0.05).”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The adjusted covariates are sufficient to control confounding for the associations.
- Findingown data
The association of current cigarette consumption with trouble sleeping was stronger in females than in males.
“the associations of current cigarette consumption with trouble sleeping and depression were stronger in females than that in males.”
Quote in the paperSubstantial claim - Findingown data
The potential role of sex hormones was not observed in the association of cotinine with trouble sleeping (Pmediation >0.05).
“the potential role of sex hormones was not observed in the association of cotinine with trouble sleeping or depression (Pmediation >0.05)”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The adjusted covariates are sufficient to control confounding for the associations.
- Rests on an assumption: The single questionnaire item validly measures trouble sleeping.
- Findingown data
With never smokers as reference, the prevalence of depression increased by 33.4% (95% CI: 1.003, 1.773) in former smokers.
“the prevalence of trouble sleeping increased by 57.8% (95% CI: 1.368, 1.821) and 93.1% (95% CI: 1.680, 2.219), and the prevalence of depression increased by 33.4% (95% CI: 1.003, 1.773) and 152.5% (95% CI: 1.936, 3.293) in former and current smokers, respectively.”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The adjusted covariates are sufficient to control confounding for the associations.
- Rests on an assumption: The single questionnaire item validly measures trouble sleeping.
- Findingown data
The restricted cubic spline model showed a linear relationship of cotinine with trouble sleeping.
“The restricted cubic spline model showed linear relationships of cotinine with trouble sleeping, depression, and testosterone.”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The adjusted covariates are sufficient to control confounding for the associations.
- Rests on an assumption: The single questionnaire item validly measures trouble sleeping.
- Findingown data
Pack-years of smoking were positively associated with the prevalence of trouble sleeping (Ptrend <0.05).
“the prevalence of trouble sleeping and depression were significantly increased with the elevated quartiles of pack-years of smoking and cigarettes per day (P and Ptrend <0.05)”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The adjusted covariates are sufficient to control confounding for the associations.
- Rests on an assumption: The single questionnaire item validly measures trouble sleeping.
- Findingown data
Females had higher prevalence of trouble sleeping and depression than males (P < 0.05).
“Females seemed to have higher levels of BMI, EST, and SHBG, as well as prevalence of trouble sleeping and depression, but lower levels of cotinine and TST than males (P < 0.05).”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The single questionnaire item validly measures trouble sleeping.
- Findingown data
The positive association of cigarettes per day with trouble sleeping was greater in females than in males (Pmodification <0.05).
“The positive associations of cigarettes per day with trouble sleeping and depression were greater in females than that in males (Pmodification <0.05).”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The adjusted covariates are sufficient to control confounding for the associations.
- Rests on an assumption: The single questionnaire item validly measures trouble sleeping.
- Findingown data
No association was observed between the levels of sex steroid hormones and pack-years of smoking (P and Ptrend >0.05).
“similar association was not observed between the levels of sex steroid hormones and pack-years of smoking (P and Ptrend >0.05).”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The adjusted covariates are sufficient to control confounding for the associations.
- Findingown data
Cigarettes per day were positively associated with the prevalence of trouble sleeping (Ptrend <0.05).
“the prevalence of trouble sleeping and depression were significantly increased with the elevated quartiles of pack-years of smoking and cigarettes per day (P and Ptrend <0.05)”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The adjusted covariates are sufficient to control confounding for the associations.
- Rests on an assumption: The single questionnaire item validly measures trouble sleeping.
- Findingown data
The associations of current smoking status and amounts with the SHBG level were significant in males rather than females.
“the associations of current smoking status and amounts with the SHBG level were significant in males rather than females.”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The adjusted covariates are sufficient to control confounding for the associations.
- Findingown data
The number of cigarettes per day was positively associated with SHBG levels.
“the number of cigarettes per day was positively associated with the TST and SHBG levels”
Quote in the paperSubstantial claim - Findingown data
TST has a U-shaped relationship with depression prevalence among males.
“U-shaped relationships of TST and SHBG levels with depression prevalence were shown among males in subgroup analyses (figure S5, P for total and P for nonlinear < 0.05).”
Quote in the paperSubstantial claim - Findingown data
The estimated changes of TST and SHBG were significantly increased with the elevated quartiles of cigarettes per day (Ptrend <0.05).
“the estimated changes of TST and SHBG were significantly increased with the elevated quartiles of cigarettes per day (Ptrend <0.05).”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The adjusted covariates are sufficient to control confounding for the associations.
- Findingown data
Each 1 cigarette per day increase in current smokers was associated with a 0.5% increase in TST level (95% CI: 0.2%, 0.7%).
“Each 1 cigarette per day increase in current smokers was associated with increased levels of TST and SHBG for 0.5% (0.2%, 0.7%) and 0.3% (0.1%, 0.6%), respectively.”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The adjusted covariates are sufficient to control confounding for the associations.
- Findingown data
Sex steroid hormones were not associated with depression prevalence in total participants.
“Although the association between sex steroid hormones and depression prevalence was not observed in total participants (P for total and P for nonlinear > 0.05)”
Quote in the paperSubstantial claim - Findingown data
Both former and current smoking were positively associated with the prevalence of trouble sleeping.
“In this study, we found that cigarette exposure, both former and current smoking, was positively associated with the prevalence of trouble sleeping and depression”
Quote in the paperSubstantial claim - Findingown data
Current cigarette exposure was positively associated with SHBG levels.
“Current rather than former or total cigarette exposure was positively associated with the levels of TST and SHBG”
Quote in the paperSubstantial claim - Findingown data
Serum cotinine level was linearly associated with the prevalence of trouble sleeping.
“Serum cotinine level was linearly associated with TST level and the prevalence of trouble sleeping and depression.”
Quote in the paperSubstantial claim- Rests on an assumption: Serum cotinine concentration is a valid biomarker of cigarette exposure.
- Findingown data
Among U.S. adults in NHANES 2013-2016, current smokers had a higher testosterone level than never smokers (β = 0.083, 95% CI: 0.028, 0.140).
“current smokers had a higher prevalence of trouble sleeping (OR = 1.931, 95% CI: 1.680, 2.219) and depression (OR = 2.525, 95% CI: 1.936, 3.293) as well as testosterone level (β = 0.083, 95% CI: 0.028, 0.140)”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The adjusted covariates are sufficient to control confounding for the associations.
- Findingown data
Current smokers had a greater prevalence of trouble sleeping compared to never smokers and former smokers.
“In the present study, we found that current smokers had higher levels of TST and a greater prevalence of trouble sleeping and depression compared to never smokers and former smokers.”
Quote in the paperSubstantial claim - Findingown data
In subgroup analyses, the associations of current smoking status and amount with the TST level remained significant (P and Ptrend <0.05).
“the associations of current smoking status and amount with the TST level remained significant (P and Ptrend <0.05)”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The adjusted covariates are sufficient to control confounding for the associations.
- Findingown data
The association between smoking intensity and depression was greater in females than in males.
“Notably, we found that the association between smoking intensity and trouble sleeping as well as depression was greater in females than in males.”
Quote in the paperSubstantial claim - Findingown data
Among U.S. adults in NHANES 2013-2016, current smokers had a higher prevalence of trouble sleeping than never smokers (OR = 1.931, 95% CI: 1.680, 2.219).
“current smokers had a higher prevalence of trouble sleeping (OR = 1.931, 95% CI: 1.680, 2.219)”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The adjusted covariates are sufficient to control confounding for the associations.
- Rests on an assumption: The single questionnaire item validly measures trouble sleeping.
- Findingown data
The restricted cubic spline model showed a linear relationship of cotinine with depression.
“The restricted cubic spline model showed linear relationships of cotinine with trouble sleeping, depression, and testosterone.”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The adjusted covariates are sufficient to control confounding for the associations.
- Rests on an assumption: The single questionnaire item validly measures trouble sleeping.
- Findingown data
EST has a U-shaped relationship with trouble sleeping in females.
“In addition, trouble sleeping was observed to present a U-shaped relationship with TST in males and with EST in females (figure S4, P for total and P for nonlinear < 0.05).”
Quote in the paperSubstantial claim - Findingown data
The potential role of sex hormones was not observed in the association of cotinine with depression (Pmediation >0.05).
“the potential role of sex hormones was not observed in the association of cotinine with trouble sleeping or depression (Pmediation >0.05)”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The adjusted covariates are sufficient to control confounding for the associations.
- Rests on an assumption: The single questionnaire item validly measures trouble sleeping.
- Findingown data
Cigarettes per day were positively associated with the prevalence of depression (Ptrend <0.05).
“the prevalence of trouble sleeping and depression were significantly increased with the elevated quartiles of pack-years of smoking and cigarettes per day (P and Ptrend <0.05)”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The adjusted covariates are sufficient to control confounding for the associations.
- Rests on an assumption: The single questionnaire item validly measures trouble sleeping.
- Findingown data
No mediating effect of TST, EST, or SHBG was observed in the association between cotinine concentrations and depression.
“Indeed, the mediating effect of TST, EST, or SHBG was not observed in the association between cotinine concentrations and trouble sleeping or depression (Pmediating >0.05).”
Quote in the paperSubstantial claim- Rests on an assumption: Serum cotinine concentration is a valid biomarker of cigarette exposure.
- Rests on an assumption: The assumptions required for mediation analysis (such as no unmeasured confounding of the mediator-outcome relationship) hold.
- Interpretationcitation
Cigarette exposure may disrupt sex steroid hormone levels.
“indicating that cigarette exposure may disrupt sex steroid hormone levels.”
Quote in the paperSubstantial claim - Interpretationreasoning
Ceasing smoking may reduce the risk of such complications.
“ceasing smoking may reduce the risk of such complications.”
Quote in the paperNot a substantial claim- Rests on an assumption: The observed cross-sectional associations reflect a causal effect of smoking on trouble sleeping, depression, and sex hormones rather than reverse causation or confounding.
- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The adjusted covariates are sufficient to control confounding for the associations.
- Interpretationown data
Smoking may increase the risk of depression symptoms.
“Smoking may induce sex hormone disturbance and increase the risk of sleep problems and depression symptoms”
Quote in the paperSubstantial claim- Rests on an assumption: The observed cross-sectional associations reflect a causal effect of smoking on trouble sleeping, depression, and sex hormones rather than reverse causation or confounding.
- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The adjusted covariates are sufficient to control confounding for the associations.
- Rests on an assumption: The single questionnaire item validly measures trouble sleeping.
- Interpretationown data
Smoking may only have a short-term effect on sex steroid hormone disruption.
“These findings suggest that smoking may only have a short-term effect on sex steroid hormone disruption, and smoking cessation may reduce the risk of hormone-related diseases.”
Quote in the paperSubstantial claim - Study design and conductreasoning
The cross-sectional design limits inference on temporality.
“First, the cross-sectional design limits inference on the temporality, and a casual effect needs to be confirmed in prospective cohort studies.”
Quote in the paperSubstantial claim - Interpretationown data
Smoking may induce sex hormone disturbance.
“Smoking may induce sex hormone disturbance and increase the risk of sleep problems and depression symptoms”
Quote in the paperSubstantial claim- Rests on an assumption: The observed cross-sectional associations reflect a causal effect of smoking on trouble sleeping, depression, and sex hormones rather than reverse causation or confounding.
- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The adjusted covariates are sufficient to control confounding for the associations.
- Premisecitation
A cross-sectional study among 30,524 US adults from NHANES revealed that individuals who currently or previously smoked have a heightened risk of experiencing depression compared to those who have never smoked.
“a cross-sectional study conducted among a sample of 30,524 US adults from the National Health and Nutrition Examination Survey (NHANES) revealed that individuals who currently or previously smoked have a heightened risk of experiencing depression compared to those who have never smoked [11].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [11] Wu Z, Yue Q, Zhao Z, Wen J, Tang L, Zhong Z, Yang J, Yuan Y, Zhang X. A cross-sectional study of smoking and depression among US adults: NHANES (2005–2018). Front Public Health. 2023;11:1081706. source
Checked before — its earlier verdict is held back until a new check runs.
- Interpretationreasoning
Smoking cessation may reduce the risk of hormone-related diseases.
“These findings suggest that smoking may only have a short-term effect on sex steroid hormone disruption, and smoking cessation may reduce the risk of hormone-related diseases.”
Quote in the paperSubstantial claim - Interpretationown data
Smoking may increase the risk of sleep problems.
“Smoking may induce sex hormone disturbance and increase the risk of sleep problems and depression symptoms”
Quote in the paperSubstantial claim- Rests on an assumption: The observed cross-sectional associations reflect a causal effect of smoking on trouble sleeping, depression, and sex hormones rather than reverse causation or confounding.
- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The adjusted covariates are sufficient to control confounding for the associations.
- Rests on an assumption: The single questionnaire item validly measures trouble sleeping.
- Classified as probably not a substantial claim. 15
- May combine two claims. 10
Classified as probably not a substantial claim.
PremisecitationPrevious studies have shown that smokers have significantly higher levels of TST and EST than non-smokers.
“previous studies have shown that smokers have significantly higher levels of TST and EST than non-smokers [16–19]”
Quote in the paperSubstantial claim4 of 4 sources checked- cites [16] Holmboe SA, Priskorn L, Jensen TK, Skakkebaek NE, Andersson A-M, Jørgensen N. Use of e-cigarettes associated with lower sperm counts in a cross-sectional study of young men from the general population. Hum Reprod. 2020;35(7):1693–701. source
The Cigarette smoking section reports significantly higher total testosterone in cigarette smokers than non-smokers (P-trend <0.01). The Discussion describes oestradiol as only “slightly higher” in daily smokers and does not establish that this difference was significant. Thus, the claim that both TST and EST were significantly higher overstates the paper. (LLM, conf=0.88)
Experimental — accuracy not yet measured - cites [17] Kimblad A, Ollvik G, Lindh CH, Axelsson J. Decreased sperm counts in Swedish users of oral tobacco. Andrology. 2022;10(6):1181–8. source
The Results table (page not available) reports significantly higher testosterone in snuff users than non-users, but it does not compare smokers with non-smokers; the oestradiol difference between snuff groups was not significant (P = 0.19). The Discussion reports a significant positive association of urinary cotinine with both hormones, which lends partial support to the hormone association but does not establish the claimed smoker-versus-non-smoker comparison. (LLM, conf=0.83)
Experimental — accuracy not yet measured - cites [18] Ihenacho U, Sriprasert I, Mack WJ, Hamilton AS, Unger JB, Press MF, Wu AH. A systematic review and meta-analysis of smoking and circulating sex hormone levels among premenopausal women. Nicotine Tob Res. 2022;24(11):1705–13. source
The Association between smoking and hormone levels section (p. 13) reports significantly higher testosterone only in the subgroup with varied sample-collection timing; the overall testosterone difference was not significant. The same section (p. 12) reports no significant overall difference in estradiol between smokers and nonsmokers, so the claim that both hormones are significantly higher is not supported for the premenopausal women studied. (LLM, conf=0.90)
Experimental — accuracy not yet measured - cites [19] Shiels MS, Rohrmann S, Menke A, Selvin E, Crespo CJ, Rifai N, Dobs A, Feinleib M, Guallar E, Platz EA. Association of cigarette smoking, alcohol consumption, and physical activity with sex steroid hormone levels in US men. Cancer Causes Control. 2009;20(6):877–86. source
May combine two claims.
Findingown dataSmoking status was positively associated with the prevalence of trouble sleeping and depression.
“smoking status was positively associated with the prevalence of trouble sleeping and depression.”
Quote in the paperSubstantial claim- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The adjusted covariates are sufficient to control confounding for the associations.
- Rests on an assumption: The single questionnaire item validly measures trouble sleeping.
May combine two claims.
Findingown dataFemales had lower levels of cotinine and TST than males (P < 0.05).
“Females seemed to have higher levels of BMI, EST, and SHBG, as well as prevalence of trouble sleeping and depression, but lower levels of cotinine and TST than males (P < 0.05).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown dataAmong sex steroid hormones, there were very weak positive correlations between TST and EST and between EST and SHBG, and a very weak negative correlation between TST and SHBG.
“Among sex steroid hormones, very weak positive correlations were presented between TST and EST, and EST and SHBG, whereas a very weak negative correlation was presented between TST and SHBG.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown data4728 (47.76%) of the 9900 participants were male.
“with 4728 (47.76%) male.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataThe proportions of never, former, and current smokers were 59.89%, 18.79%, and 21.32%, respectively.
“The proportions for never smokers, former smokers, and current smokers were 59.89%, 18.79%, and 21.32%, respectively.”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
May combine two claims.
Findingown dataBoth former and current smoking were positively associated with the prevalence of depression.
“In this study, we found that cigarette exposure, both former and current smoking, was positively associated with the prevalence of trouble sleeping and depression”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataThe mean age of all subjects was 42.68 years (SD 15.11).
“The mean age of all subjects was 42.68 (standard deviation (SD) 15.11) years”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataFemales had higher levels of BMI, EST, and SHBG than males (P < 0.05).
“Females seemed to have higher levels of BMI, EST, and SHBG, as well as prevalence of trouble sleeping and depression, but lower levels of cotinine and TST than males (P < 0.05).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataTrouble sleeping and depression rates were 25.49% and 8.17%, respectively.
“Trouble sleeping and depression rates were 25.49% and 8.17%, respectively.”
Quote in the paperNot a substantial claim- Rests on an assumption: Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
- Rests on an assumption: The single questionnaire item validly measures trouble sleeping.
Classified as probably not a substantial claim.
Study design and conductown dataSurvey-weighted multiple linear and logistic regression analyses were performed.
“survey-weighted multiple linear and logistic regression analyses were performed with the “survey” package by R software.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenSerum total TST and EST were measured using an ID-LC-MS/MS method that demonstrates high accuracy and precision.
“The concentrations of serum total TST and EST were measured using isotope dilution liquid chromatography tandem mass spectrometry (ID-LC-MS/MS) method which was created for high sample throughput and demonstrates high accuracy and precision.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationA longitudinal study based on 7960 US adolescents showed a positive association between smoking status and the development of sleep problems.
“A longitudinal study based on 7960 US adolescents showed a positive association between smoking status and the development of sleep problems [10].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [10] Patten CA, Choi WS, Gillin JC, Pierce JP. Depressive symptoms and cigarette smoking predict development and persistence of sleep problems in US adolescents. Pediatrics. 2000;106(2):E23. source
Classified as probably not a substantial claim.
Study design and conductnone givenCovariates were adjusted for age, gender, BMI, race, educational qualification, physical activity, alcohol consumption, ratio of family income to poverty, regular periods, and batch (survey cycle) in all models.
“Covariates were adjusted for age, gender, BMI, race, educational qualification, physical activity, alcohol consumption, ratio of family income to poverty, regular periods, and batch (survey cycle) in all models.”
Quote in the paperSubstantial claim- Rests on an assumption: The adjusted covariates are sufficient to control confounding for the associations.
Classified as probably not a substantial claim. May combine two claims.
PremisecitationCotinine is a major product of nicotine primary metabolism and is a widely used biomarker for the assessment of cigarette exposure, including active and passive smoking.
“Cotinine, a major product of nicotine primary metabolism, is a widely used biomarker for the assessment of cigarette exposure, including active and passive smoking [12].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [12] Silva AI, Camelo A, Madureira J, Reis AT, Machado AP, Teixeira JP, Costa C. Urinary cotinine assessment of maternal smoking and environmental tobacco smoke exposure status and its associations with perinatal outcomes: a cross-sectional birth study. Environ Res. 2022;203:111827. source
May combine two claims.
Interpretationown dataNever smoking or smoking cessation may reduce the risk of depression symptoms.
“These findings indicate that never smoking or smoking cessation may prevent diseases related to sex hormone disorders and reduce the risk of sleep problems and depression symptoms.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
Study design and conductnone givenCotinine and sex steroid hormones in biological samples are relatively unstable over long periods of time.
“Third, cotinine and sex steroid hormones in biological samples are relatively unstable over long periods of time, and a trajectory model with repeated measurement is warranted.”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationown dataNever smoking or smoking cessation may reduce the risk of sleep problems.
“These findings indicate that never smoking or smoking cessation may prevent diseases related to sex hormone disorders and reduce the risk of sleep problems and depression symptoms.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Study design and conductnone givenMissing values for BMI, educational qualification, ratio of family income to poverty, trouble sleeping, and cotinine were imputed using multiple imputation.
“Missing values for BMI, educational qualification, ratio of family income to poverty, trouble sleeping, and cotinine were imputed with the use of the multiple imputation approach.”
Quote in the paperSubstantial claim- Rests on an assumption: Missing data for the imputed variables are missing at random.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenOther covariates (dietary assessment, gene, environmental pollutants, etc.) that may affect sex steroid hormones, trouble sleeping, and depression were not considered.
“Second, other covariates (dietary assessment, gene, environmental pollutants, etc.) that may affect sex steroid hormones, trouble sleeping, and depression were not considered.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenReported results for all assays meet the Division of Laboratory Sciences quality control and quality assurance performance criteria for accuracy and precision.
“Reported results for all assays meet the Division of Laboratory Sciences quality control and quality assurance performance criteria for accuracy and precision.”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationown dataNever smoking or smoking cessation may prevent diseases related to sex hormone disorders.
“These findings indicate that never smoking or smoking cessation may prevent diseases related to sex hormone disorders and reduce the risk of sleep problems and depression symptoms.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenAll quality control procedures recommended by the manufacturers were followed for serum cotinine measurement.
“All quality control procedures recommended by the manufacturers were followed.”
Quote in the paperNot a substantial claim
The paper relies on this without support.
The observed cross-sectional associations reflect a causal effect of smoking on trouble sleeping, depression, and sex hormones rather than reverse causation or confounding.
“Smoking may induce sex hormone disturbance and increase the risk of sleep problems and depression symptoms”
The paper relies on this without support.
Self-reported questionnaire assessments of smoking, trouble sleeping, and covariates accurately classify participants.
“Cigarette exposure, including age started smoking, whether smoking now, time since quitting smoking, cigarettes per day during the past 30 days, and cigarettes per day when smoking cessation, were collected using standard questionnaires.”
The paper relies on this without support.
Missing data for the imputed variables are missing at random.
“Missing values for BMI, educational qualification, ratio of family income to poverty, trouble sleeping, and cotinine were imputed with the use of the multiple imputation approach.”
The paper relies on this without support.
The adjusted covariates are sufficient to control confounding for the associations.
“Covariates were adjusted for age, gender, BMI, race, educational qualification, physical activity, alcohol consumption, ratio of family income to poverty, regular periods, and batch (survey cycle) in all models.”
The paper relies on this without support.
The single questionnaire item validly measures trouble sleeping.
“Trouble sleeping was defined by a questionnaire item “Have you ever told a doctor or other health professional that you have trouble sleeping”.”
The paper relies on this without support.
Serum cotinine concentration is a valid biomarker of cigarette exposure.
“The mediating effects of sex steroid hormones in the associations between serum cotinine and the prevalence of trouble sleeping and depression are presented in Table 5.”
The paper relies on this without support.
The assumptions required for mediation analysis (such as no unmeasured confounding of the mediator-outcome relationship) hold.
“The mediating effects of sex steroid hormones in the associations between serum cotinine and the prevalence of trouble sleeping and depression are presented in Table 5.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Abstract claims a testosterone trend for pack-years that Table 4 does not show
MajorThe abstract says pack-years were positively associated with testosterone with Ptrend <0.05, but Table 4 reports a testosterone Ptrend of 0.080 for pack-years.
“Pack-years of smoking and cigarettes per day were positively associated with the prevalence of trouble sleeping and depression as well as testosterone level (Ptrend <0.05).”
“| Ptrend | 0.080 | 0.995 | 0.117 |”
Female current-smoker percentage does not match the count
MinorTable 1 lists 922 current smokers among 5,172 females. That is 17.83%, not the reported 19.18%.
Reported 19.18 · recomputed 17.826759
“Current smoker | 2111 (21.32) | 1189 (25.15) | 922 (19.18)”
Reported female testosterone values are below the stated assay limit
MinorThe stated testosterone detection limit is 0.750 ng/mL, with lower values replaced by about 0.530 ng/mL (530 ng/L). Yet Table 1 reports a female median of 206 ng/L and quartiles of 141 and 295 ng/L, all below that replacement value.
“The LLODs for TST, EST, and SHBG are 0.750 ng/mL, 2.994 pg/mL, and 0.800 nmol/L, respectively. The values of sex steroid hormones below LLOD were replaced with LLOD/√2.”
“| TST, ng/L | 570.50 (199.00, 3920.00) | 4000.00 (3020.00, 5240.00) | 206.00 (141.00, 295.00) | < 0.001 |”
Cites
Vos, T., Lim, S. S., Abbafati, C., Abbas, K. M., Abbasi, M., Abbasifard, M., Abbasi-Kangevari, M., Abbastabar, H., Abd-Allah, F., Abdelalim, A., et al. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30925-9 · Cited by 19,358 · see citing works
Salk, R. H., Hyde, J. S., & Abramson, L. Y. (2017) · Psychological Bulletin · doi:10.1037/bul0000102 · Cited by 2,622 · cited 2× · see citing works
“Epidemiological studies showed that women experience more sleep problems and depressive symptoms around times when sex hormones change, such as puberty and menopause [32].”
BackgroundCross-national epidemiology of DSM-IV major depressive episode
Bromet, E., Andrade, L. H., Hwang, I., Sampson, N. A., Alonso, J., de Girolamo, G., de Graaf, R., Demyttenaere, K., Hu, C., Iwata, N., et al. (2011) · BMC Medicine · doi:10.1186/1741-7015-9-90 · Cited by 2,221 · see citing works
Liu, Q., He, H., Yang, J., Feng, X., Zhao, F., & Lyu, J. (2020) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2019.08.002 · Cited by 1,452 · see citing works
Sex Hormones in Acquired Immunity and Autoimmune Disease
Moulton, V. R. (2018) · Frontiers in Immunology · doi:10.3389/fimmu.2018.02279 · Cited by 641 · see citing works
Slavich, G. M., & Sacher, J. (2019) · Psychopharmacology · doi:10.1007/s00213-019-05326-9 · Cited by 383 · see citing works
Chen, C., Ye, Y., Zhang, Y., Pan, X.-F., & Pan, A. (2019) · BMJ · doi:10.1136/bmj.l5584 · Cited by 277 · see citing works
Trouble sleeping and anxiety/depression in childhood.
Johnson, E. O., Chilcoat, H., & Breslau, N. (2000) · Psychiatry Research · doi:10.1016/s0165-1781(00)00145-1 · Cited by 239 · see citing works
Associations between sex hormones, sleep problems and depression: A systematic review
Morssinkhof, M. W. L., van Wylick, D. W., Priester-Vink, S., van der Werf, Y. D., den Heijer, M., van den Heuvel, O. A., & Broekman, B. F. P. (2020) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2020.08.006 · Cited by 210 · see citing works
The association between sleep and depressive symptoms in US adults: data from the NHANES (2007–2014)
Li, C., Shaomei, S., & Wannian, L. (2022) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796022000452 · Cited by 178 · see citing works
Patten, C. A., Choi, W. S., Gillin, J. C., & Pierce, J. P. (2000) · Pediatrics · doi:10.1542/peds.106.2.e23 · Cited by 171 · see citing works
Shiels, M. S., Rohrmann, S., Menke, A., Selvin, E., Crespo, C. J., Rifai, N., Dobs, A., Feinleib, M., Guallar, E., & Platz, E. A. (2009) · Cancer Causes & Control · doi:10.1007/s10552-009-9318-y · Cited by 166 · see citing works
Sleep quality in cigarette smokers: Associations with smoking-related outcomes and exercise
Purani, H., Friedrichsen, S. C., & Allen, A. M. (2018) · Addictive Behaviors · doi:10.1016/j.addbeh.2018.10.023 · Cited by 132 · see citing works
Associations between smoking cessation and anxiety and depression among U.S. adults
Regan, A. K., Dube, S. R., Strine, T. W., Kroenke, K., Caraballo, R. S., & Mokdad, A. H. (2009) · Addictive Behaviors · doi:10.1016/j.addbeh.2009.01.005 · Cited by 127 · see citing works
A cross-sectional study of smoking and depression among US adults: NHANES (2005–2018)
Wu, Z., Yue, Q., Zhao, Z., Wen, J., Tang, L., Zhong, Z., Yang, J., Yuan, Y., & Zhang, X. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1081706 · Cited by 109 · see citing works
Nuñez, A., Rhee, J. U., Haynes, P. L., Chakravorty, S., Patterson, F., Killgore, W. D. S., Gallagher, R., Hale, L. E., Branas, C. C., Carrazco, N., et al. (2020) · Sleep Health · doi:10.1016/j.sleh.2020.10.006 · Cited by 102 · see citing works
Cigarette Smoking and Endogenous Sex Hormones in Postmenopausal Women
Brand, J. S., Chan, M.-F., Dowsett, M., Folkerd, E. J., Wareham, N. J., Luben, R., van der Schouw, Y. T., & Khaw, K. (2011) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-1165 · Cited by 101 · see citing works
Zhao, J., Leung, J. Y. Y., Lin, S. L., & Mary Schooling, C. (2016) · Preventive Medicine · doi:10.1016/j.ypmed.2015.12.021 · Cited by 101 · see citing works
Interaction between Reproductive Hormones and Physiological Sleep in Women
de Zambotti, M., Colrain, I. M., & Baker, F. C. (2015) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2014-3892 · Cited by 100 · see citing works
The association between smoking and depression from adolescence to adulthood
Tjora, T., Hetland, J., Aarø, L. E., Wold, B., Wiium, N., & Øverland, S. N. (2014) · Addiction · doi:10.1111/add.12522 · Cited by 77 · see citing works
Relationships Between Smoking and Sleep Problems in Black and White Adolescents
Bellatorre, A., Choi, K., Lewin, D. S., Haynie, D. L., & Simons‐Morton, B. G. (2016) · SLEEP · doi:10.1093/sleep/zsw031 · Cited by 74 · see citing works
Wang, X., Wang, B., Zhou, M., Xiao, L., Xu, T., Yang, S., Nie, X., Xie, L., Yu, L., Mu, G., et al. (2021) · Journal of Hazardous Materials · doi:10.1016/j.jhazmat.2021.126497 · Cited by 74 · see citing works
Self-citationAssociations of socioeconomic status and sleep disorder with depression among US adults
Li, W., Ruan, W., Peng, Y., Lu, Z., & Wang, D. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.08.009 · Cited by 71 · see citing works
de la Torre, J. A., Vilagut, G., Ronaldson, A., Bakolis, I., Dregan, A., Martín, V., Martínez‐Alés, G., Molina, A. J., Serrano‐Blanco, A., Valderas, J. M., et al. (2023) · The Lancet Public Health · doi:10.1016/s2468-2667(23)00220-7 · Cited by 64 · see citing works
Holmboe, S. A., Priskorn, L., Jensen, T. K., Skakkebaek, N. E., Andersson, A.-M., & Jørgensen, N. (2020) · Human Reproduction · doi:10.1093/humrep/deaa089 · Cited by 51 · see citing works
Zhang, Y., Mustieles, V., Sun, Y., Oulhote, Y., Wang, Y.-X., & Messerlian, C. (2022) · Environment International · doi:10.1016/j.envint.2022.107239 · Cited by 38 · see citing works
Dichtel, L. E., Carpenter, L. L., Nyer, M., Mischoulon, D., Kimball, A., Deckersbach, T., Dougherty, D. D., Schoenfeld, D., Fisher, L. B., Cusin, C., et al. (2020) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2020.19080844 · Cited by 34 · see citing works
Manjer, J., Johansson, R., & Lenner, P. (2005) · European Journal of Epidemiology · doi:10.1007/s10654-005-0385-4 · Cited by 31 · see citing works
Active smoking, sleep quality and cerebrospinal fluid biomarkers of neuroinflammation
Liu, Y., Li, H., Li, G., Kang, Y., Shi, J., Kong, T., Yang, X., Xu, J., Li, C., Su, K., et al. (2020) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2020.07.021 · Cited by 29 · see citing works
Impact of smoking on sleep macro– and microstructure
Truong, M. K., Berger, M., Haba‐Rubio, J., Siclari, F., Marques-Vidal, P. M., & Heinzer, R. C. (2021) · Sleep Medicine · doi:10.1016/j.sleep.2021.05.024 · Cited by 29 · see citing works
Trouble Sleeping and Depression Among US Women Aged 20 to 30 Years
Barsha, R. A. A., & Hossain, M. B. (2020) · Preventing Chronic Disease · doi:10.5888/pcd17.190262 · Cited by 28 · see citing works
Hussain, J., Ling, L., Alonzo, R., Rodrigues, R., Nicholson, K., Stranges, S., & Anderson, K. K. (2022) · Addictive Behaviors · doi:10.1016/j.addbeh.2022.107345 · Cited by 28 · see citing works
Ihenacho, U., Sriprasert, I., Mack, W. J., Hamilton, A. S., Unger, J. B., Press, M. F., & Wu, A. H. (2022) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntac066 · Cited by 19 · see citing works
Hwang, J. H., & Park, S.-W. (2022) · Epidemiology and Health · doi:10.4178/epih.e2022022 · Cited by 18 · see citing works
Sources of 24-h personal exposure to PM2.5-bound metals: results from a panel study in Wuhan, China
Wang, X., Wang, B., Xiao, L., Cui, X., Cen, X., Yang, S., Mu, G., Xu, T., Zhou, M., & Chen, W. (2021) · Environmental Science and Pollution Research · doi:10.1007/s11356-021-12386-y · Cited by 13 · see citing works
Self-citationSilva, A. I., Camelo, A., Madureira, J., Reis, A. T., Machado, A. P., Teixeira, J. P., & Costa, C. (2022) · Environmental Research · doi:10.1016/j.envres.2021.111827 · Cited by 12 · see citing works
Decreased sperm counts in Swedish users of oral tobacco
Kimblad, A., Ollvik, G., Lindh, C. H., & Axelsson, J. (2022) · Andrology · doi:10.1111/andr.13198 · Cited by 11 · see citing works
Wang, X., Wang, B., Cheng, M., Yu, L., Liu, W., Nie, X., Wang, M., Zhou, M., & Chen, W. (2023) · Environmental Science and Pollution Research · doi:10.1007/s11356-023-26702-1 · Cited by 6 · see citing works
Self-citation
Flagged first, then by citations
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Sorted by citations
Association between social determinants of health and periodontitis: a population-based study
Li, Y., Zhang, E., Wu, Y., & Song, J. (2025) · BMC Public Health · doi:10.1186/s12889-025-22416-w · Cited by 20 · see citing works
Mei, Y., Chen, Y., Wang, X., Xu, R., & Feng, X. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1458193 · Cited by 13 · see citing works
Self-citationMagnesium depletion score and depression: a positive correlation among US adults
Zhao, W., & Jin, H. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1486434 · Cited by 9 · see citing works
Dong, Y., Wen, H., Lu, C., Li, J., & Zheng, Q. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-07182-8 · Cited by 9 · see citing works
Pérez-Díaz, C., Echeverría, R., Pérez-Carrascosa, F. M., Salcedo‐Bellido, I., Requena, P., Barrios‐Rodríguez, R., Ramos, J. J., Olea, N., Fernández, M. F., Martín‐Olmedo, P., et al. (2025) · iScience · doi:10.1016/j.isci.2025.112876 · Cited by 4 · see citing works
Yan, Q., Liu, G., Wang, R., Li, D., & Wang, D. (2025) · Journal of Health Population and Nutrition · doi:10.1186/s41043-025-00890-7 · Cited by 3 · see citing works
Yang, F., Liu, L., Zhang, Y. Y., Cheng, D., Yu, R., & Lin, J. (2026) · Annals of General Psychiatry · doi:10.1186/s12991-026-00656-3 · Cited by 3 · see citing works
Yang, H., Liu, Y., Huang, Z., & Deng, G. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1434116 · Cited by 3 · see citing works
Guan, H., & Chen, F. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.120243
Zhou, F., Wei, D., Guo, Y., Ma, N., & Wang, S. (2026) · BMC Psychiatry · doi:10.1186/s12888-026-07817-4
Xu, Y., Cao, M., Zhao, Y., Yang, H. J., Fu, H., Zhan, H., Wang, S., Xuechun, L., Cao, H., Ruan, L., et al. (2026) · Ecotoxicology and Environmental Safety · doi:10.1016/j.ecoenv.2026.120054
Self-citationPrevalence and associated factors of insomnia among adults in Anhui Province, China
Yan, J., Liu, Y., Xu, X. J., & Wang, H. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1794419
Sinkevicius, L. V., Sakalauskaitė, S., Rakauskas, K., Lõokene, M., Valickiene, R. P., & Serapinas, D. (2026) · Medicina · doi:10.3390/medicina62091618
- Authors
- Huang, J., Shi, P., Zhao, Y., Zhang, H., Gao, T., & Wang, X.
- Affiliations
- Tang Du Hospital (CN)
- Corresponding author
- Gao, Tian
- Wang, Xing
- Venue
- BMC Public Health
- Published
- 2024-06-07
- Volume
- 24
- Issue
- 1
- Pages
- 1541-1541
- ISSN
- 1471-2458 (ISSN-L)
- PMC
- PMC11157951
- OpenAlex
- W4399438860
- Semantic Scholar
- 9201cbaa876c124f6f2f665ede6a17faa181c6d0
- Cited by
- 13
- References
- 39
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 3
- FWCI
- 3.36
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- the General Project of Key Research and Development Plan of Shaanxi (2023YBSF424)
- the General Project of Basic Research Plan of Shaanxi (2024JC-YBMS-700)
- the “Phoenix Introduction Plan” Project of Tangdu Hospital, Air Force Military Medical University (2022YFJH007)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Keywords
- cigarette smoking, sex hormones, testosterone, sleep disorders, depression, cotinine, pack-years, sex differences, mediation, dose-response relationship, NHANES
- MeSH terms
- Adult, Aged, Cotinine, Cross-Sectional Studies, Depression, Female, Humans, Male, Middle Aged, Nutrition Surveys, Gonadal Steroid Hormones, Sleep Wake Disorders, Smoking, Testosterone, United States, Prevalence, Young Adult
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