The Association Between Adolescent Mental Health Symptoms and Characteristics of Cigarette and E-Cigarette Use

Introduction: While there is a bi-directional relationship between internalizing mental health (IMH) symptoms (i.e., symptoms of depression, symptoms of anxiety) and nicotine use, it is unclear how IMH relates to patterns of use. The purpose of this study is to quantitatively examine the relationship between IMH symptoms and indicators of nicotine dependence, quit intentions, and quit attempts among adolescents who use cigarettes and/or e-cigarettes. Methods: Data come from the 2020–2023 waves of the International Tobacco Control (ITC) Adolescents Tobacco and Vaping Survey. The analytic sample for this study includes those reporting past 30-day use of cigarettes and/or e-cigarettes (n = 18,800). We measured indicators of nicotine dependence (i.e., frequency of use, time to first use, and perceived addiction), quit intention, and quit attempt history separately for cigarettes and e-cigarettes. Respondents reported current IMH symptoms (any vs. none). We examined associations between IMH symptoms and all outcomes using regression models, adjusting for dual use, and examining moderation by dual use. Results: IMH symptoms were positively associated with e-cigarette nicotine dependence indicators and intention to quit e-cigarettes. IMH symptoms were positively associated with cigarette nicotine dependence indicators and intention to quit for those reporting dual use of e-cigarettes and cigarettes, but not exclusive cigarette use. IMH symptoms were positively associated with ever having a quit attempt for both products. Conclusions: Findings indicate that IMH symptoms were comorbid with greater dependence on nicotine products, particularly e-cigarettes. Smoking and e-cigarette cessation interventions should consider mental health, though research is needed to understand the directionality of the relationship between IMH symptoms and e-cigarette use.