Sex Differences in the Associations Among Smoking, Alcohol Drinking, and Depressive Symptoms: Data from the 8th Korean National Health and Nutrition Examination Survey (2019-2021)

Purpose: This study examines the relationships among smoking, alcohol consumption, and depressive symptoms, focusing on sex differences, using data from the 8th Korean National Health and Nutrition Examination Survey, 2019- 2021. Methods: This cross-sectional study analyzed data from 17,899 adults aged 19 or older. Depressive symptoms were defined as feelings of sadness or hopelessness lasting at least two consecutive weeks. Smoking status was categorized into non-smokers, former smokers, and current smokers and was further subdivided by daily consumption. Alcohol consumption was assessed by frequency and high-risk drinking behavior. Covariates were income, education, occupation, marital status, exercise, chronic disease, and stress. Results: Among women, current smokers had double the risk of depressive symptoms. High-risk drinking (≥4 times/week) further increased the risk. Among men, high-risk drinking was associated with depressive symptoms, but no significant relationship was found with smoking. Conclusion: Smoking and high-risk drinking were strongly associated with depressive symptoms in women, while high-risk drinking was the primary risk factor in men. These findings suggest the need for sex-specific interventions targeting smoking and alcohol consumption.