Association between heaviness of cigarette smoking and serious psychological distress is stronger in women than in men: a nationally representative cross-sectional survey in Japan.

Previous studies have suggested that an association between heaviness of cigarette smoking and SPD may be significant, but gender differences in the association are unclear.

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The possible reasons for inconsistent results in previous studies may be as follows: (1) the differences in the age structure of people with SPD (e.g., SPD was prevalent in older age-groups [ 4 ] or in younger age-groups [ 3 , 6 ], a U-shaped association with a nadir for persons aged 65–69 years [ 5 ], or an inverted U-shaped relationship with a peak for persons aged 45–64 years [ 8 ]); (2) an increasing trend in the number of people with SPD [ 7 ]; (3) a falling trend in cigarette smoking prevalence in the wake of the buildup of anti-smoking measures [ 1 , 13 ]; and (4) the differences in the stages of the cigarette epidemic [ 14 ].

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