2008, Number 4
Relación entre el consumo de tabaco, salud mental y malestares físicos en hombres trabajadores de una empresa textil mexicana
Rodríguez MAC, Martínez VNA, Juárez GF, López LEK, Carreño GS, Medina-Mora ME
Full text
Language: Spanish
References: 26
Page: 291-297
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ABSTRACT
Introduction: Tobacco use is considered a worldwide public health problem because of the amount of death and disease it causes. The WHO reports that 30% of the adult population in the world are cigarette smokers, and that nearly five million of these will die within one year. Prospective studies performed by the WHO show that if current tobacco use continues, in 2020 there will be 8.4 million deaths due to tobaccorelated diseases every year; seven out of 10 of these deaths will occur in emergent countries, like Mexico. More than 53000 tobacco users die every year in Mexico because of tobacco-related diseases, and at least 147 of these die daily. Data from the National Addictions Survey (NAS) 2002 showed that 26.4% of the people between 12 and 65 years old were active tobacco consumers; this amounted to nearly 14 million individuals. Of these, 7.1% were under 18 years old. The number of tobacco consumers in Mexico has increased from nine million in 1988 to 14 million in 2002. According to the NAS, 52% of the users smoke on a daily basis, and 61.4% of them began smoking when they were minors. To know the actual consumption levels, it is important to consider some factors: the number of cigarettes a person smokes, the different situations where a person smokes, and the social and physical consequences of smoking. Thus, it would be possible to develop a consumer classification (i. e. soft consumers, mild consumers, and hard consumers). There may be numerous causes for a person to be ill. When speaking about the harmful effects of tobacco use, the literature is clear in stating that these begin with the first cigarette smoked. However, it can take up to 30 years for a consumer to notice the damage on his health after his/her consumption began; but within the first ten years there are problems in lung function and in physical endurance. When a person starts smoking there are acute and unpleasant side effects that are rarely associated with smoked tobacco use. Consumption creates a tolerance which makes unpleasant effects to stop or fade away, giving place to pleasant sensations produced by nicotine; concentration improves and psychomotor skills, alert, and activation get better and there is a reduction in anxiety and stress. The relationship between tobacco use and mental health is evident at the level of the emotional outcomes of suffering a chronic illness, such as lung cancer.On the other hand, nicotine use has been related to a reduction in the severity of depression. Chemical alternatives for reducing consumption, based on the substance physical effects that promote addiction, have not proven to be effective so far. There is also evidence that consumers that fail in quitting smoking or people that have dependence problems with nicotine show a high prevalence of mayor depression when compared to non-dependent consumers. This association was direct with the severity of nicotine dependence. It also has been observed that smoking interferes often with psychological learning tools, mainly when consumption starts at very early ages. Emotional distress can produce low self-esteem and a lack of selfconfidence. Therefore, the chances to begin tobacco consumption increase when it is used as a crutch to cope with social pressure and acceptance. Since tobacco use is a conduct that has shown to have serious repercussions on physical health and an important relationship with mental health in human beings, and is therefore a growing public health problem, the objective of this study is to explore a possible link among smoked tobacco consumption, mental health and physical problems in male workers from a textile factory.
Method: A non-probabilistic convenience sample was used in the study. Subjects voluntarily agreed to complete the questionnaire: 279 male workers were interviewed; 54% were between 18 and 27 years old and 23% were between 28 and 37. Most of them had studied junior high school or higher (74%) and 65% were in a serious relationship (married or living with a couple).
Data about tobacco use were collected using a questionnaire with questions from the NAS 2002. To explore mental health the fiveitem Mental Health Inventory was used (MHI-5). As it is a self-answered screening test, it does not give a diagnosis, but it does allow establishing if subjects have symptoms of a probable mental health problem. Information about physical distress was collected through an 11-item somatization sub-scale from the Symptoms Check List-90 (SCL- 90). The number of physical troubles that subjects reported during the last month was considered. All instruments have good levels of reliability and validity. Finally, several socio-demographic questions were included.
The questionnaire was answered in groups inside a training room. Trained interviewers participated in the process of collecting information. Subjects’ participation was voluntary and their verbal acceptation was obtained before answering the questionnaires. Anonymity and confidentiality were guaranteed. Workers were told that no information would be given to the union or business authorities, and those who asked for their results received them personally. Neither invasive procedures nor intervention techniques were used. The union authorities received a global report so they could acknowledge the importance of smoked tobacco and mental health-related problems among their workers. Statistical analyses were performed using SPSS 11.
Results: From the total sample, 74.6% (n=208) had smoked tobacco once in their life, 49.8% (n=139) during the last year (active consumer group), and 31.2% (n=87) during the past 30 days; 59.4% of the subjects reported muscular pain and 47.4% headaches; 57% of the active consumers had smoked more than 100 cigarettes, and they had been consumers for 9.5 years. Those who had smoked less than 100 cigarettes had been consumers for 8.92 years (47%) (p›0.05). Active consumers reported having their first cigarette at age 16. No significative differences (p›:.05) were found in emotional distress among different types of consumers, and neither in the number of physical symptoms compared by type of consumer (p›.05). The relationship among physical symptoms, emotional distress, and smoked tobacco use indicators was analyzed through a path analysis. The result showed that time of consumption is the main predictor of physical symptoms in current consumers, and that physical symptoms are an important predictor of emotional distress.
Discussion: Most of the tobacco users were between 18 and 29 years old, which is similar to previous results from general population in Mexico. It was observed, however, that regardless of the number of cigarettes smoked, the frequency of use, or other indicators of tobacco use, the time of consumption was the most important predictor of physical symptoms. This may be the result of the impact that long use has over health; thus it is confirmed that after 10 years of smoking subtle physical symptoms appear, and after 20 or 30 years mayor physical problems arise. This result becomes more important when considering the age of the first cigarette smoked, because subjects with 26 years of use have subtle symptoms while those with 36 would have more severe related symptoms. Although no direct association was found between consumption and emotional distress, an indirect one can be suggested because of the influence that consumption has over physical wellbeing. Thus it can be expected that as long as tobacco use continues and physical problems increase, there would be more emotional distress. Consequences of smoking can become a burden when related diseases appear because they imply money expenses in health care and family stress, which could have an impact on mental health. It would be important to consider the time of consumption as a relevant variable when studying smoking, as well as the frequency and amount of use to observe how these variables interact with emotional distress and physical problems in different populations. Accepting that any smoked tobacco use can be considered as abuse, then prevention is the topic that must be outlined in health programs because, as observed in this study, low levels of consumption do not prevent those with a long history of use to have more physical problems. On the other hand, the models presented here must be completed with other variables to know how the use and abuse of tobacco is related to other factors that influence physical and emotional well-being.
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