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However, gender and age differences in the association between heaviness of cigarette smoking and SPD have not been fully investigated.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We used anonymized data from a nationally representative survey in Japan (33,925 men and 37,257 women). SPD was measured using the Kessler 6-item Psychological Distress Scale and defined as\u2009\u2265\u200913 points. Multiple logistic regression analyses stratified by gender and age-groups (20\u201344\u00a0years, 45\u201364\u00a0years, and\u2009\u2265\u200965\u00a0years) were used to estimate adjusted odds ratio (aOR) and 95% confidence interval (CI) for SPD.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>After adjusting for sociodemographic confounders including education, equivalent household expenditures, and employment contract, women had a significant association between heavier smoking and more frequent SPD: compared to never-smokers, aORs (95% CIs) of ex-smokers, current light smokers who smoked 1\u201310 cigarettes per day (CPD), current moderate smokers 11\u201320 CPD, and current heavy smokers\u2009\u2265\u200921 CPD were 1.22 (0.92\u20131.63), 1.52 (1.25\u20131.84), 1.75 (1.46\u20132.09), and 2.22 (1.59\u20133.10), respectively (<jats:italic>P<\/jats:italic>-trend\u2009&lt;\u20090.001). A significant positive association among women was consistent across all age-groups. Among men, there was no association between heaviness of cigarette smoking and SPD in all age-groups, and only current heavy smokers aged 20\u201344\u00a0years had a significantly higher OR for SPD (aOR, 1.37 [95% CI, 1.02\u20131.85]) than never-smokers.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>There was a positive association between heaviness of cigarette smoking and SPD only among women, but not among men. For female smokers experiencing mental disorders, there is a need not only to improve mental health services but also to improve smoking-cessation support.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12954-021-00469-5","type":"journal-article","created":{"date-parts":[[2021,3,4]],"date-time":"2021-03-04T11:03:21Z","timestamp":1614855801000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["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"],"prefix":"10.1186","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9471-6987","authenticated-orcid":false,"given":"Kimiko","family":"Tomioka","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Midori","family":"Shima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keigo","family":"Saeki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,3,4]]},"reference":[{"key":"469_CR1","unstructured":"GBD 2015 Tobacco Collaborators. 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The data provided had personally identifiable information removed.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"KS received research grants from YKK AP Inc.; Ushio Inc.; Tokyo Electric Power Company; EnviroLife Research Institute Co., Ltd.; Sekisui Chemical Co., Ltd.; LIXIL Corp.; and KYOCERA Corp. This does not alter our adherence to Harm Reduction Journal\u2019s policies on sharing data and materials. KT and MS declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"27"}}