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While cigarette smoking is a well-established risk factor, what about smokeless tobacco

Selection Criteria Studies were included in the review if they met the following criteria: (1) human participants, (2) smoking as the exposure variable and depression and/or anxiety as the outcome variable, or vice versa (depression and/or anxiety as the exposure variable and smoking as the outcome variable), (3) longitudinal study design, and (4) reported primary data not previously reported elsewhere

What self-care steps might help

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(2017) Life course changes in smoking by gender and education: A cohort comparison across France and the United States

This would not negate the level 5 visit