Restricted accessResearch articleFirst published online 2024-5
Past-Year Mental Illness Diagnosis and E-cigarette Use Status Among a College-Aged Sample: Findings From the National College Health Assessment (2017-2019)
To examine associations between past-year mental illness (MI) diagnoses and e-cigarette use status.
Design
Data were obtained from the National College Health Assessment, a nationally recognized cross-sectional survey of university students.
Setting
Participants were recruited from 2-year and 4-year public and private universities across the United States from 2017-2019.
Subjects
The analytic sample included 277 291 university students.
Measures
Self-reported past-year MI diagnosis, binarily coded, served as the primary predictor. The outcome was e-cigarette use status (never, noncurrent, and current user).
Analysis
Multinomial logistic regression models were used to estimate relative risk ratios (RRR) of e-cigarette use, as predicted by past-year MI diagnoses, age, race/ethnicity, sex and gender, sexual identity, geographic region, and other combustible tobacco, alcohol, and marijuana use.
Results
Compared to those who had never received any MI diagnosis in the past year, those who did had a 16% higher relative risk (RRR = 1.16, 95% CI: 1.11, 1.20) of being a noncurrent e-cigarette user and a 33% higher relative risk (RRR = 1.33, 95% CI: 1.28, 1.38) of being a current e-cigarette user. Schizophrenia, substance use or addiction, bipolar disorder, and attention deficit and hyperactivity disorder (ADHD) diagnoses demonstrated the strongest associations with noncurrent and current e-cigarette use.
Conclusion
Results suggest the need to screen young adults for e-cigarette use and mental health indicators to facilitate early detection and timely intervention for at-risk university students.
Key substance use and mental health indicators in the United States: results from the 2021 national survey on drug use and health. Published online 2021.
2.
AdamsSHSchaubJPNagataJMParkMJBrindisCDIrwinCE. Young adult anxiety or depressive symptoms and mental health service utilization during the COVID-19 pandemic. J Adolesc Health. 2022;70:985-988.
3.
DeHayTMorrisCMayMGDevineKWaxmonskyJ. Tobacco use in youth with mental illnesses. J Behav Med. 2012;35(2):139-148. doi:10.1007/s10865-011-9336-6.
4.
BeckerTDArnoldMKRoVMartinLRiceTR. Systematic review of electronic cigarette use (vaping) and mental health comorbidity among adolescents and young adults. Nicotine Tob Res. 2021;23(3):415-425. doi:10.1093/ntr/ntaa171.
5.
CavalloDAKrishnan-SarinS. Nicotine use disorders in adolescents. Pediatr Clin North Am. 2019;66(6):1053-1062. doi:10.1016/j.pcl.2019.08.002.
6.
GoriounovaNAMansvelderHD. Short- and long-term consequences of nicotine exposure during adolescence for prefrontal cortex neuronal network function. Cold Spring Harb Perspect Med. 2012;2(12):a012120. doi:10.1101/cshperspect.a012120.
7.
LeventhalAMZvolenskyMJ. Anxiety, depression, and cigarette smoking: a transdiagnostic vulnerability framework to understanding emotion-smoking comorbidity. Psychol Bull. 2015;141(1):176-212. doi:10.1037/bul0000003.
CumminsSEZhuSHTedeschiGJGamstACMyersMG. Use of e-cigarettes by individuals with mental health conditions. Tob Control. 2014;23(Suppl 3):iii48-53. doi:10.1136/tobaccocontrol-2013-051511.
10.
GentzkeAS. Tobacco product use and associated factors among middle and high school students — national youth tobacco survey, United States, 2021. MMWR Surveill Summ. 2022:71:1. doi:10.15585/mmwr.ss7105a1.
11.
BandieraFCLoukasALiXWilkinsonAVPerryCL. Depressive symptoms predict current e-cigarette use among college students in Texas. Nicotine Tob Res. 2017;19(9):1102-1106. doi:10.1093/ntr/ntx014.
12.
HefnerKRSollazzoAMullaneySCokerKLSofuogluM. E-cigarettes, alcohol use, and mental health: use and perceptions of e-cigarettes among college students, by alcohol use and mental health status. Addict Behav. 2019;91:12-20. doi:10.1016/j.addbeh.2018.10.040.
13.
ObisesanOHMirboloukMOseiAD, et al.Association between e-cigarette use and depression in the behavioral risk factor surveillance system, 2016-2017. JAMA Netw Open. 2019;2(12):e1916800. doi:10.1001/jamanetworkopen.2019.16800.
14.
JavedSUsmaniSSarfrazZ, et al.A scoping review of vaping, e-cigarettes and mental health impact: depression and suicidality. J Community Hosp Intern Med Perspect. 2022;12(3):33-39. doi:10.55729/2000-9666.1053.
15.
IñiguezSDWarrenBLPariseEM, et al.Nicotine exposure during adolescence induces a depression-like state in adulthood. Neuropsychopharmacology. 2009;34(6):1609-1624. doi:10.1038/npp.2008.220.
16.
MasakiKTaketaRMNakamaMKKawamotoCTPokhrelP. Relationships between depressive symptoms, anxiety, impulsivity and cigarette and e-cigarette use among young adults. Hawaii J Health Soc Welf. 2022;81(3):51-57.
17.
MoustafaAFTestaSRodriguezDPianinSAudrain-McGovernJ. Adolescent depression symptoms and e-cigarette progression. Drug Alcohol Depend. 2021;228:109072. doi:10.1016/j.drugalcdep.2021.109072.
18.
GrantJELustKFridbergDJKingACChamberlainSR. E-cigarette use (vaping) is associated with illicit drug use, mental health problems, and impulsivity in university students. Ann Clin Psychiatry. 2019;31(1):27-35.
19.
KingJLReboussinBASpanglerJCornacchione RossJSutfinEL. Tobacco product use and mental health status among young adults. Addict Behav. 2018;77:67-72. doi:10.1016/j.addbeh.2017.09.012.
20.
LeventhalAMStrongDRSussmanS, et al.Psychiatric comorbidity in adolescent electronic and conventional cigarette use. J Psychiatr Res. 2016;73:71-78. doi:10.1016/j.jpsychires.2015.11.008.
21.
ObisesanOHMirboloukMOseiAD, et al.Association between e-cigarette use and depression in the behavioral risk factor surveillance system, 2016-2017. JAMA Netw Open. 2019;2(12):e1916800. doi:10.1001/jamanetworkopen.2019.16800.
22.
Audrain-McGovernJRodriguezDTestaSAlexanderEPianinS. Adolescent e-cigarette onset and escalation: associations with internalizing and externalizing symptoms. J Adolesc Health. 2021;68(4):801-807. doi:10.1016/j.jadohealth.2020.09.033.
23.
LechnerWVJanssenTKahlerCWAudrain-McGovernJLeventhalAM. Bi-directional associations of electronic and combustible cigarette use onset patterns with depressive symptoms in adolescents. Prev Med. 2017;96:73-78. doi:10.1016/j.ypmed.2016.12.034.
24.
XuGSnetselaarLGStrathearnLRyckmanKNothwehrFTornerJ. Association of attention-deficit/hyperactivity disorder with e-cigarette use. Am J Prev Med. 2021;60(4):488-496. doi:10.1016/j.amepre.2020.11.010.
25.
KianersiSZhangYRosenbergMMacyJT. Association between e-cigarette use and sleep deprivation in U.S. young adults: results from the 2017 and 2018 behavioral risk factor surveillance system. Addict Behav. 2021;112:106646. doi:10.1016/j.addbeh.2020.106646.
26.
RiehmKEYoungASFederKA, et al.Mental health problems and initiation of e-cigarette and combustible cigarette use. Pediatrics. 2019;144(1):e20182935. doi:10.1542/peds.2018-2935.
27.
LechnerWVJanssenTKahlerCWAudrain-McGovernJLeventhalAM. Bi-directional associations of electronic and combustible cigarette use onset patterns with depressive symptoms in adolescents. Prev Med. 2017;96:73-78. doi:10.1016/j.ypmed.2016.12.034.
28.
GreenVRConwayKPSilveiraML, et al.Mental health problems and onset of tobacco use among 12- to 24-year-olds in the PATH study. J Am Acad Child Adolesc Psychiatry. 2018;57(12):944-954.e4. doi:10.1016/j.jaac.2018.06.029.
29.
MarsdenDGLoukasAChenBPerryCLWilkinsonAV. Associations between frequency of cigarette and alternative tobacco product use and depressive symptoms: a longitudinal study of young adults. Addict Behav. 2019;99:106078. doi:10.1016/j.addbeh.2019.106078.
30.
BierhoffJHaardörferRWindleMBergCJ. Psychological risk factors for alcohol, cannabis, and various tobacco use among young adults: a longitudinal analysis. Subst Use Misuse. 2019;54(8):1365-1375. doi:10.1080/10826084.2019.1581220.
31.
SpindleTRHilerMMCookeMEEissenbergTKendlerKSDickDM. Electronic cigarette use and uptake of cigarette smoking: a longitudinal examination of U.S. college students. Addict Behav. 2017;67:66-72. doi:10.1016/j.addbeh.2016.12.009.
TankersleyWMartzGMekalaHMMotiwalaH. Risk factors for illicit substance vaporizer use in adolescents. Addict Disord Their Treat. 2019;18(1):22. doi:10.1097/ADT.0000000000000143.
35.
HefnerKValentineGSofuogluM. Electronic cigarettes and mental illness: reviewing the evidence for help and harm among those with psychiatric and substance use disorders. Am J Addict. 2017;26(4):306-315. doi:10.1111/ajad.12504.
36.
GilbertPAKavaCMAfifiR. High-school students rarely use e-cigarettes alone: a sociodemographic analysis of polysubstance use among adolescents in the United States. Nicotine Tob. 2021;23(3):505-510. doi:10.1093/ntr/ntaa037.
37.
GansonKTNagataJM. Associations between vaping and eating disorder diagnosis and risk among college students. Eat Behav. 2021;43:101566. doi:10.1016/j.eatbeh.2021.101566.
38.
ClendennenSLChenBSumbeAHarrellMB. Patterns in mental health symptomatology and cigarette, e-cigarette and marijuana use among Texas youth and young adults amid the COVID-19 pandemic. Nicotine Tob Res. 2023:25:266.doi:10.1093/ntr/ntac205. Published online August 26, 2022:ntac205.
39.
CambronC. E-cigarette use is associated with increased psychological distress among youth: a pooled cross-sectional analysis of state-level data from 2019 and 2021. Int J Environ Res Public Health. 2022;19(18):11726. doi:10.3390/ijerph191811726.
