Anxiety Level Differences on Light Smokers and Heavy Smokers in

Tegal Sari Mandala II and III Villages

Nanda Sari Nuralita

Cut Mourisa

Department of Psychiatry, Faculty of Medicine, University of Muhammadiyah Sumatera Utara, Medan, Indonesia

Keywords: Anxiety level, Smokers.

Abstract: Smoking is one cause of death in the United States. Almost a quarter of the population smokes, and this

habit has been associated with about 430,000 deaths per year. Psychiatric disorders are 2-3 times more

common among smokers than non-smokers or ex-smokers. The prevalence of smoking in patients with

anxiety is 17% to 55%. By behavior, the stimulant effect of nicotine results in increased attention, time to

react, learning and problem-solving skills. The aim of this study is to examine the relationship between light

and heavy smoking habit and anxiety level with citizens in Tegal Sari Mandala II and III village, Medan.

This study is categorical analytic study with cross sectional method to see the relation between smoker and

anxiety level to citizen in Tegal Sari Mandala 2 and 3 village with 180 subjects in this study and will be

analyze by Chi-Square. The level of smoking habit will be asked during interviews and the anxiety level

will be examined by Hamilton Anxiety Rating Scale (HARS). In this study it was found that the greatest

possible level of anxiety/anxiety in both light smokers and heavy smokers was the same, i.e. moderate

anxiety but it can be ascertained that in heavy smokers it is less likely to experience mild anxiety (p <0.001).

1 INTRODUCTION

Smoking is one cause of death in the United States.

Almost a quarter of the population smokes, and this

habit has been associated with about 430,000 deaths

per year. Smoking is associated with asthma, chronic

bronchitis, lung cancer, coronary heart disease, and

emphysema. Although about 35% of smokers try to

quit smoking each year, less than 5% are successful.

The majority of researchers agree that one of the

major obstacles to success in quitting smoking is the

nicotine withdrawal syndrome (Morrell HE, 2006).

According to Morissette et al., 2007, the

prevalence of smoking in patients with anxiety is

17% to 55%. Hughes et al., 1986 found that 47% of

psychiatric patients treated with anxiety disorders

had a smoking habit. Himle et al., 1988 went on to

study Hughes, also observed smoking comorbidities

against more specific anxiety disorders. They

encountered simple phobias, 47%; social phobia,

27%; agoraphobia, 57%; panic disorder, 47%;

general anxiety, 29%, and obsessive compulsive

disorder, 9% who smoked. Himle also suggests that

smoking levels may differ between types of anxiety

disorders. Studies conducted by Johnson et al., 2000

show that heavy smokers (more than 20 cigarettes /

day) are associated with increased risk of anxiety

disorders, panic disorders, and agoraphobia

disorders during adulthood. The invention is also

consistent with previous findings that smoking

increases the risk of anxiety disorders.

Smoking prevalence, particularly nicotine

dependence is 2-3 times among patients with

anxiety, attention-deficit, mood, substance use, and

other psychiatric disorders. Psychiatric disorders are

2-3 times more common among smokers than non-

smokers or ex-smokers. By behavior, the stimulant

effect of nicotine results in increased attention, time

to react, learning and problem-solving skills.

Nuralita, N. and Mourisa, C.

Anxiety Level Differences on Light Smokers and Heavy Smokers in Tegal Sari Mandala II and III Villages.

DOI: 10.5220/0008791802710275

In Proceedings of the 2nd Syiah Kuala International Conference on Medicine and Health Sciences (SKIC-MHS 2018), pages 271-275

ISBN: 978-989-758-438-1

271

Tobacco users also report that smoking can reduce

depressive feelings, elevate mood and reduce tension

(Huges JR, 2009 and Sadock BJ, 2007). Nicotine has

a complex structure. The effects of nicotine on the

central nervous system are also widespread. The

central nervous system associated with nicotine will

result in changes in the neuronal receptor nicotinic

acetylcholine (nAChRs). These receptors can be

found throughout the brain area and when there is

stimulation, there are releases of neurotransmitters

such as dopamine, norepinephrine, vasopressin,

glutamate, serotonin, gamma aminobutyric acid

(GABA), and other neurotransmitters. Increased

concentrations of nAChRs receptors are found in the

mesolimbic system of dopamine and locus ceruleus

(Kamluddin A, 2011).

Nicotinic receptors in cognitive function,

are strongly associated with pleasure and reward

systems. Nicotine work on nAChRs will modulate

the amount of stress hormones, monoaminergic

transmission and neurotransmitters in the brain that

will improve memory and affect the level of anxiety

and depression in the normal brain. In addition to

nicotine, cigarette smoke contains monoamine

oxidase inhibitors (MAOI); an antidepressant, so

that the destruction of some neurotransmitters such

as dopamine, norepinephrine and serotonin will be

reduced. The release of serotonin, corticosteroids

and endorphins due to nicotine, can reduce fatigue

and improve the efficiency of the brain's cognitive

processes.

Because of these effects, nicotine has a

sedative effect that decreases anxiety (Kamluddin A,

2011). The aim of this study is to examine the

relationship between light and heavy smoking habit

with anxiety. The hypothesis of this study is there is

a relationship between light and heaving smoking

habit with anxiety in Tegal Sari Mandala II and III

Village Medan.

2 METHOD

This study is categorical analytic study with cross

sectional method to see the relationship between

smoker and anxiety level to citizen in Tegal Sari

Mandala 2 and 3 village. Population Study: residents

in Tegal Sari Mandala 2 and 3 villages.

Inclusion criteria: citizens registered in Tegal Sari

Mandala 2 and 3 , have a smoking history for 1 year,

men aged 20-40 years, Cooperative and willing to

participate in study. Exclusion criteria: have a

history of substance abuse other than nicotine, have

a history of general medical disorders, have a history

of psychiatric disorders.

The sample size is measured using the formula:

n1= n2= Z∝ 2PQ + Z𝛽 P1Q1 + P2Q2

P1 – P2

Using the formula above we get the sample of 90

people for each group. The total sample size is 180

people. This study activity is carried out in several

stages of preparation phase, implementation and

preparation of study result report. The step that has

been passed in this study is preparation and early

stage of study implementation. At the preparatory

stage, the activity is a literature study of theories that

support the study (study journal). Furthermore, the

management and permission application to conduct

study from the Medical Ethics and Study Committee

(KEPK) Faculty of Medicine, University of

Muhammadiyah Sumatera Utara.

Approval is obtained after 2 weeks submission.

The outcome of the preparatory phase is the draft

study work plan. After getting approval, the study is

continued to the stage of study implementation.

Activities undertaken by conducting study according

to draft work that has been prepared together by the

study team from the previous stage. Implementation

of the study begins with requesting permission in

advance with the Village Heads in Tegal Sari

Mandala II and III to collect the residents and ask

questions to fill out the questionnaire after first

getting information about the study and the purpose

of the study.

The residents of Tegal Sari Mandala II and III

Urban Villages meeting the inclusion criteria are

given explanation of the study and for the willing

citizens who will be the subjects of the study, are

required to complete the consent form. After

completing the consent form, the subject is

requested to sign the consent form. Then given the

form data, and given an explanation of its usefulness

SKIC-MHS 2018 - The 2nd Syiah Kuala International Conference on Medicine and Health Sciences

272

and how to fill it. After that the subject in the

interview for charging of Hamilton Anxiety Rating

Scale (HARS). After filling HARS done total sum of

HARS score, and performed data processing.

Implementation phase of the study until now

completed at the stage of data collection, while the

results of the study will be analyze by Chi-Square.

3 RESULT

Table 1: Distribution of sample demographic data

Demographic

data

Gender

Men

180

100.0

Smoking level

Mild

50.0

Severe

50.0

Age

20-29 years

22.2

30-39 years

35.0

≤40 years

42.8

Education

Elementary

10.0

Junior high

26.1

High school

33.3

University

30.6

Occupation

Employed

133

73.9

Unemployed

26.1

The table above shows that there were 180 male

samples, with light smokers as many as 90 people

(50.0%) and heavy smokers as many as 90 people

(50.0%), age range 20-29 years as many as 40

people (22.2 %), sample with age range 30-39 year

counted 63 people (35,0), and 40 ≤ year counted 77

person (42,8%). Based on the level of education, the

sample with the level of primary education found as

many as 18 people (10.0%), junior high school

education level of 47 people (26.1%), high school

education level of 60 people (33.3%), and college

level as many as 55 people (30.6%). Based on work,

the sample worked more with the number of 133

people (73.9%) and the non-working 47 people

(26.1%).

Table 2: Relationship of Smoking Behavior with

Anxiety Level with villagers on Tegal Sari Mandala

II and III.

Smokin

g habit

level

Anxiety level

Mild

anxiety

Moderate

anxiety

Severe

anxiety

value

n %

Light

60 66.7

20 22.2

10 11.7

0.001

Heavy

0 0

55 61.1

35 38.9

Total

60 33.3

75 41.7

45 25.0

The table above shows that there are 60 people

(66,7%) of light smoker with mild anxiety. There are

20 people (22,2%), heavy anxiety is 10 people

(11,1%). In the subject of heavy smokers

experiencing anxiety was found as many as 55

people (61.1%) and as many as 35 people who

experienced severe anxiety (38.9%). The p value

shows 0.001 (p<0.05) which means there is a

significant correlation between smoking behavior

and anxiety level with villagers on Tegal Sari

Mandala II and III.

4 DISCUSSION

The study of "anxiety level differences in

light smokers and heavy smokers" is an unpaired

categorical analytical study with cross sectional

methods. The purpose of this study was to determine

the difference of anxiety level in light smokers and

heavy smokers in Tegal Sari Mandala 2 and 3

villages. In this study it was found that the greatest

possible level of anxiety/anxiety in both light

smokers and heavy smokers was the same, i.e.

moderate anxiety but it can be ascertained that in

heavy smokers it is less likely to experience mild

anxiety (p <0.001).

This study is in accordance with a study conducted

Byeon in 2015 in South Korea that smoking has a

significant relationship with anxiety. Smokers have

an anxiety tendency of 1.5 times (OR = 1.49, 95%

CI [1,14-1,96]) greater than non-smokers (p <0.05)

and adolescents who smoke more than 5 cigarettes

Anxiety Level Differences on Light Smokers and Heavy Smokers in Tegal Sari Mandala II and III Villages

273

day 1.5 times (OR = 1.49, 95% CI [1.07-2.08]) are

more likely to have anxiety (p <0.05).

This study, however, does not match the

study by Khademalhosseini in 2015 in Iran against

1020 high school adolescents where there is no

significant relationship between smokers and

anxiety. In addition, the findings of Lee et al in 2017

in the United States with interesting findings suggest

that mild smokers (less than 1-5 cigarettes a day) but

very depressed/depressed have a 5.8 times greater

risk of having anxiety disorders Thorough compared

to individuals who do not smoke and have mild

symptoms of depression. Also, multiple stroke but

highly depressed smokers have a 3.8 times greater

risk for having an overall anxiety disorder,

compared to people who smoked less than half a

pack a day and had low symptoms of depression.

Symptoms of depression seem to have a stronger

relationship with a complete anxiety disorder than

smoking.

Recent conclusions in terms of cigarette linkage

with anxiety can be seen from a literature study by

Fluharty et al in 2017 in the UK where from 148

studies categorized as: onset of smoking, smoking

status, heavy smoking, tobacco dependence and

smoking trajectory. The results for each category

vary substantially, with positive associative evidence

in both directions (smoking with later mental health

effects and mental health leads to later smoking

behavior). Overall, nearly half of the studies

reported that baseline anxiety was associated with

several types of smoking behavior, while more than

one-third found evidence that smoking exposure was

associated with anxiety that would subsequently

emerge. However, there are several studies that

directly support the two-way model of smoking and

anxiety can occur mutually. While this incidence

could be explained by the fact that the impact given

to smokers has the effect of being given

psychostimulants. Acute nicotine exposure, whether

obtained by smoking or intravenous infusion of

nicotine, has an effect on elevating the amount of

cortisol in the human body and animals. Long-term

smoking can cause persistent dysregulation of

hormonal regulation. Hypertensive patients also

experience increased sympathetic tone, where can

increase the intensity of anxiety symptoms in

patients.

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