Bi-directional associations of electronic and combustible cigarette use onset patterns with depressive symptoms in adolescents

Socio-ecological factors that influence youth vaping: perspectives from Western Australian school professionals, parents and young people

PURPOSE

To understand from the perspectives of school professionals, parents and young people the socio-ecological factors that may facilitate and prevent e-cigarette use among young people in Perth, Western Australia.

METHODS

Purposive sampling was used to recruit school professionals, parents and young people for one-on-one (n = 35) or joint (n = 3) interviews (in-person n = 11 or online n = 27). Data were analysed using thematic analysis and classified into four domains based on the socio-ecological model: i) individual, ii) interpersonal, iii) organizational/community and iv) societal/policy.

RESULTS

Factors that were found to support vaping among young people included sensation-seeking and risk-taking behaviour; a low-risk perception of vapes; attractive characteristics of vapes; ease of access; perception vaping is a social activity; and lack of knowledge about vaping among parents and school professionals. Vaping prevention messages originating from the familial, educational and community spheres are lacking but wanted by adults and young people.

CONCLUSIONS

The pervasiveness of the e-cigarette trade and persistent challenges related to surveillance and enforcement need to be addressed to reduce exposure and access to e-cigarettes. A mixture of "hard" and "soft" public policy tools involving key stakeholders in a range of settings is needed to prevent e-cigarette access and uptake by young people.

Depression, anxiety, stress, and current e-cigarette use: Results from the Truth Longitudinal Cohort of youth and young adults (2022-2023)

OBJECTIVE

To examine associations between depression, anxiety, and stress, as measured by the Depression, Anxiety and Stress Scale (DASS-21) scale, with current e-cigarette use.

METHODS

Data from the Truth Longitudinal Cohort - a nationally representative sample of youth and young adults - was collected between October 2022 to February 2023. The analytic sample was comprised of participants who provided information on e-cigarette use and the DASS-21 scale (N = 4198). Chi-square statistics were used to determine differences by current e-cigarette use across covariates and DASS-21 items. Logistic regression analyses were applied to the cross-sectional data to determine which scales predicted current e-cigarette use, adjusted for the effects of age, gender identity, race and ethnicity, parental educational attainment, perceived financial situation, and current use of alcohol, marijuana, and other tobacco use.

RESULTS

Those who had severe/extremely severe levels of depression, anxiety, and stress had greater odds of current e-cigarette use, relative to those who had normal levels of depression, anxiety, and stress, even after adjusting for covariates. Results also demonstrated associations between age, race/ethnicity, parental education, and current use of alcohol, marijuana, and other tobacco products with current e-cigarette use.

LIMITATIONS

Cross-sectional analyses of self-reported data limit the ability to determine directionality of effects between depression, anxiety, stress, and current e-cigarette use.

DISCUSSION

More severe levels of depression, anxiety, and stress were associated with a greater likelihood of current e-cigarette use. Future research is needed to evaluate changes in e-cigarette use, in response to depression, anxiety, and stress symptomatology.

Prospective longitudinal relations among frequent social media use, nicotine vaping and experiencing internalizing mental health problems

AIMS

To compare four a priori rival mediated pathways of frequent social media use, electronic nicotine delivery systems (ENDS) use and internalizing mental health (MH) problems across five waves of nationally representative data.

DESIGN, SETTING AND PARTICIPANTS

This was a longitudinal study using data drawn from waves 2-5 (October 2014-November 2019) of the Population Assessment of Tobacco and Health Study, a nationally representative cohort study spanning approximately 5 years, conducted in the United States. The analytical sample of participants included those who were aged 12-14 years at wave 2 and who provided data in subsequent waves until wave 4.5 (n = 4627, 69.7% were White and 51.4% were male).

MEASUREMENTS

Frequent social media use (several times a day), ENDS use (past 30-day use) and internalizing MH problems (endorsed symptoms on four items in the past year) were dichotomized for analysis.

FINDINGS

The weighted proportions of the three key variables increased over time. From wave 2 to wave 5, frequent social media use grew from 56.9 to 77.2%; internalizing MH problems from 18.9 to 29.0%; and ENDS use from 1.4 to 11.4%. In weighted logistic regressions using generalized linear mixed models with random effects, there was a significant within-person association between frequent social media use at time t and greater ENDS use at t + 1 [adjusted odds ratio (aOR) = 1.87; 95% confidence interval (CI) = 1.47, 2.37] and worsened internalizing MH problems at t + 1 (aOR = 1.19; 95% CI = 1.04, 1.37). A model-based causal mediation analysis and marginal structural models were fitted to estimate the average causal mediation effect. Among all four examined mediation pathways throughout the three constructs, partial mediation was observed, and all the pathways were significant for both boys and girls. Sex differences did not emerge in the examined prospective mediated pathways.

CONCLUSIONS

Among youth in the United States, frequent social media use appears to mediate the prospective association between experiencing internalizing mental health problems and using electronic nicotine delivery systems.

Quitting intentions and behaviours among young Australian e-cigarette users

BACKGROUND AND AIMS

With the prevalence of e-cigarette use among Australian youth increasing significantly in recent years, greater attention is being paid to encouraging and supporting cessation. However, research to inform such efforts is lacking. The present study sought to (i) measure desire to quit e-cigarette use and actual quitting attempts among young Australians and (ii) explore correlates of quitting-related cognitions and behaviours.

DESIGN, SETTING AND PARTICIPANTS

This was a cross-sectional on-line survey conducted in Australia. The participants were 14-25-year-old e-cigarette users (n = 602; 53% women).

MEASUREMENTS

Desire to quit vaping and attempts to quit vaping were the primary dependent variables. The independent variables included several individual (e.g. harm perceptions, perceived appeal of vapes), social (descriptive norms) and environmental (e.g. ease of e-cigarette access) factors.

FINDINGS

A majority of respondents (61%) expressed a desire to quit vaping, and just over half (55%) had made a quit attempt. Finding vapes easy to access was associated with both a lack of desire [odds ratio (OR) = 0.71] and attempts to quit (OR = 0.77), while self-reported addiction to vaping (OR = 1.42 and OR = 3.11) and perceiving vaping to be associated with mental health risks (OR = 1.30 and OR = 1.40) were positively correlated with these variables. Perceiving that vaping is common among people of one's age (OR = 0.82) and finding vapes appealing (OR = 0.55) were associated with a lack of desire to quit, while perceiving vaping to have physical health risks was positively associated with quitting desire (OR = 1.58). School-based education on vaping was associated with reporting an attempt/s to quit (OR = 0.47).

CONCLUSIONS

This survey of young Australian e-cigarette users suggests a high level of desire to quit using e-cigarettes and attempts to quit. Increasing knowledge regarding the physical and mental health risks associated with e-cigarette use may assist with promoting quitting-related intentions. Changing social norms, reducing the accessibility of e-cigarettes and reducing the appeal of the products also constitute potential means of increasing the desire to quit.

Does the time to nicotine dependence vary by internalizing symptoms for young people who use e-cigarettes? An analysis of the Population Assessment of Tobacco and Health (PATH) study, (Waves 1-5; 2013-2019)

OBJECTIVE

To determine the relationship between past-year internalizing symptoms and the time to first report of signs of nicotine dependence among young people.

METHODS

Secondary analysis using data from the Population Assessment of Tobacco and Health (PATH) (Waves 1-5; 2013-2019). The study included 2,102 (N = 5,031,691) young people (age 12-23 years) who reported past-30-day (P30D) e-cigarette use in one or more waves. Kaplan Meier curves, stratified by past year internalizing symptoms were used to estimate the time to the first report of three nicotine dependence symptoms (i.e., use within 30 min of waking, cravings, and really needing to use) following the first P30D e-cigarette use. Cox proportional hazard models were used to estimate crude and adjusted hazard ratios (AHR), comparing any past year internalizing symptoms to no past year internalizing symptoms.

RESULTS

We found no significant differences between past year internalizing symptoms and the time to the first report of cravings (AHR = 1.30, 95 % CI = 92-1.85), really needing to use (AHR = 1.31; 95 % CI = 0.92-1.89) and use within 30 min of waking for follow-up times 0-156 weeks (AHR = 0.84; 95 % CI = 0.55-1.30) and > 156 weeks (AHR = 0.41; 95 % CI = 0.04-4.67) respectively.

CONCLUSION

Past year internalizing symptoms did not modify the time to the first report of nicotine dependence among youth with P30D e-cigarette use. Further research is needed to understand how changing internalizing symptoms and e-cigarette use frequency influence nicotine dependence over time and, how this relationship impacts cessation behavior.

A review of vaping's health effects, treatment, and policy implications: Nursing's call to action

ABSTRACT

The emergence and subsequent surge in popularity of electronic nicotine delivery systems (ENDS), especially among adolescents and young adults, have reshaped the landscape of tobacco consumption, including use patterns and beliefs as well as therapeutic approaches to the condition. The health implications of ENDS are a cause for concern among NPs, as they include severe nicotine dependence, mental health consequences, and adverse effects on respiratory and cardiac systems, among other issues. This article focuses on the health implications of vaping across the lifespan and emphasizes the need for NPs to evaluate ENDS use consistently across age groups and offer age-appropriate treatment within the clinical setting. Importantly, although vaping is prevalent among various age groups, most tobacco use, including vaping, begins and becomes established during adolescence. This back-to-school season therefore marks an ideal time for NPs to educate their pediatric patients, along with their parents or caregivers, about the widespread effects of vaping on health, and it also serves as a reminder to screen for the condition in adults, regardless of smoking history. To combat this trend on a larger scale, NPs can further advocate for community health by promoting youth prevention programs and supporting policy initiatives aimed at curbing ENDS use.

Association Between E-Cigarettes, Cognition and Mood in Adolescents

OBJECTIVE

Research has indicated potentially neutral or even positive cognitive effects of e-cigarette usage in adults, but whether these findings extend to adolescents remains uncertain. This study aimed to examine the interplay between e-cigarette use, mind wandering and self-efficacy, and mood.

METHOD

The responses of 432 adolescents aged 11-18 years from an online survey were analyzed. Among them, 88 adolescents had used e-cigarettes.

RESULTS

Adolescents who have used e-cigarettes reported poorer academic self-efficacy, t (430) = 3.26, 95% CI [1.12, 4.51], p < 0.001; greater mind-wandering tendencies t(430) = -3.38, 95% CI [-4.14, -1.10], p < 0.001; and greater severity of depression, t(430) = -3.38, p < 0.001, anxiety t(430) = -2.67, p = 0.01, and stress t(430) = -3.32, p < .001. Increased frequency of e-cigarette use was also associated with attitudes toward e-cigarette use, r (86) = 0.31, p = 0.003 and lower academic self-efficacy, r (86) = -0.27, p = .010. However, there was no significant correlation between frequency of use and mind-wandering. Further network analysis suggested negative relationships between frequency of e-cigarette use, academic self-efficacy and mind-wandering.

CONCLUSION

Our findings suggest a potential adverse impact of e-cigarette use on mind-wandering and academic confidence among adolescents. However, the direct or indirect relationship between e-cigarette use and these effects could not be definitively determined due to the cross-sectional survey design employed in our study. Nonetheless, our findings underscore the importance of considering developmental differences and the unique vulnerabilities of adolescents when assessing the impact of e-cigarette use.

Psychological predictors of vaping uptake among non-smokers: A longitudinal investigation of New Zealand adults

INTRODUCTION

Demographic and health factors are known to predict vaping. Less is known about psychological predictors of vaping uptake, particularly among non-smoking adults using longitudinal designs. We aimed to model how psychological factors related to personality and mental health predicted the likelihood of vaping uptake over time in non-smoking adults ages 18+ using longitudinal data.

METHODS

Longitudinal regression models utilised data from the 2018-2020 waves of the New Zealand Attitudes and Values Study to assess how the Big Five personality traits, mental distress and self-control predicted who began vaping over time among non-users (non-vapers and non-smokers), controlling for gender, age, ethnicity and economic deprivation.

RESULTS

Analyses included 36,309 adults overall (ages 18 to 99; M = 51.0). The number of non-users who transitioned into current vaping was small (transitioned from 2018 to 2019, n = 147; 0.48%; 2019 to 2020, n = 189, 0.63%). Fully adjusted models showed that adults with higher mental distress (adjusted odds ratio [aOR] 1.43; 95% confidence interval [CI] 1.09-1.88), lower self-control (aOR 0.79; 95% CI 0.69-0.89) and higher extraversion (aOR 1.09; 95% CI 1.06-1.13) were more likely to begin vaping at the next time point compared to adults who remained non-users. Higher neuroticism and lower conscientiousness also predicted vaping uptake in initial models, but inclusion of mental distress and self-control superseded these traits.

DISCUSSION AND CONCLUSIONS

Psychological factors related to mental distress, impulse control and sociability predicted who was more likely to begin vaping as non-smoking adults. Harm prevention interventions could target these factors to reduce vaping uptake in non-smokers.

E-cigarettes in college: Associations between mental health and e-cigarette use with other substances

INTRODUCTION

College students are a priority population for substance use prevention, and other studies have reported associations between mental health and e-cigarette use. This study described the association of mental health to e-cigarette and other substance use (ECIG+ use) among US college students.

METHODS

We used Fall 2018 and Spring 2019 National College Health Assessment data among undergraduate students aged 18-24 years (n=55654) at 138 institutions. We characterized substance use patterns and used multinomial regression to model adjusted odds of past 30-day ECIG use type [no substance use (reference); sole e-cigarette use; e-cigarette use and other substance use (ECIG+ use); no e-cigarette use but other substance use] by mental health characteristics, past 12-month diagnosis/treatment and psychological distress, individual characteristics, and college characteristics.

RESULTS

Alcohol was the most prevalent substance (58%) used, followed by cannabis (23%) and e-cigarettes (15%). Nearly all (95%) students who used e-cigarettes reported using another substance. Adjusted odds of ECIG+ use (vs no substance use) were higher among students with past 12-month mental health diagnosis/treatment (AOR=1.5; 95% CI: 1.4-1.6) and higher psychological distress (AOR=1.1; 95% CI: 1.1-1.2). Other characteristics significantly associated with ECIG+ use included gender identity, sexual orientation, race and ethnicity, self-rated health, year in school, cumulative grade average, fraternity/sorority membership, and current residence.

CONCLUSIONS

Most students who used e-cigarettes also reported other substance use, and this pattern of use was associated with poorer mental health outcomes than no substance use. Clarifying the relationship between mental health and ECIG+ use may enhance health interventions for college students.

Co-design of digital public health substance use resources: A collaboration between young people and experts

ISSUE ADDRESSED

Substance use and mental illness remain critical issues for young Australians, however, engagement with evidence-based health resources is challenging among this age group. This study aimed to develop engaging, useful digital health resources, underpinned by neuroscience principles, to build awareness of the harms of electronic cigarettes (e-cigarettes) and concurrent alcohol and antidepressant use.

METHODS

A mixed-methods approach was adopted to co-design two evidence-based videos resources. The resources were co-designed with the Matilda Centre's Youth Advisory Board Centre's Youth Advisory Board through a series focus groups and individual feedback reviews. Young people residing in New South Wales were then invited to complete a survey to evaluate the usefulness, relatability and impact on perceived harms associated with each substance pre- and post-viewing resources.

RESULTS

A total of 100 participants completed the survey (mean age = 21.5 years, SD = 2.77, 42% Female, 2% Non-binary). The animated videos were well received, with the large majority (91% and 87% respectively) of participants rating them 'excellent' or 'very good'. After viewing the videos, there was a significant increase in the perception of harm associated with e-cigarette use, monthly (t(99) = 2.76, p = .003), weekly (t(99) = 4.82, p < .001) and daily (t(99) = 4.92, p < .001), and consuming alcohol whilst taking antidepressants both weekly (t(100) = 2.93, p = .004) and daily (t(100) = 3.13, p = .002).

CONCLUSIONS

This study describes a successful co-design process demonstrating how meaningful involvement of young people, alongside traditional research methods, can produce substance use prevention resources that are useful, engaging and increase knowledge of harms among young people. SO WHAT?: To achieve meaningful public health impact researchers, experts and digital creators can work together to co-create substance use educational materials that are engaging, well-liked, while imparting important health knowledge.

Relationship between electronic cigarette use, dual smoking habits, and psychological distress among youth in Northern Thailand: A cross-sectional study

INTRODUCTION

Amidst the escalating trend of electronic cigarette (e-cigarette) use and dual smoking habits among youth, understanding their potential impact on psychological well-being is imperative. Limited research has explored this relationship, particularly among youth in settings where e-cigarettes are banned. This study investigates the relationship between current e-cigarette and traditional cigarette use patterns and the presence of depression and anxiety symptoms among youth in Thailand.

METHODS

Using a cross-sectional survey encompassing 3424 individuals aged 15-24 years in Northern Thailand from December 2021 to September 2022, we accessed cigarette and e-cigarette usage over the past 30 days alongside depression and anxiety symptoms over the past two weeks. Multivariable logistic regression was employed to analyze the association of these variables, adjusting for sociodemographic factors.

RESULTS

Among the surveyed youths, 10.8% reported cigarette use, 6.2% utilized e-cigarettes, and 3.3% were dual users within the past 30 days. Regarding mental health, 33.96% exhibited moderate-severe to severe depression, while 52.54% experienced anxiety at similar levels. After adjusting for covariates, both current e-cigarette users and dual users exhibited heightened depression symptoms (AOR=1.80; 95% CI: 1.30-2.51, and AOR=2.30; 95% CI: 1.49-3.55, respectively) and only e-cigarette use had increased odds of increased anxiety levels (AOR=1.70; 95% CI: 1.24-2.32) compared to non-users. Notably, current cigarette smokers demonstrated no association with depression but had decreased odds of higher levels of anxiety compared to non-users (AOR=0.73; 95% CI: 0.55-0.96).

CONCLUSIONS

A substantial number of Thai youths are using e-cigarettes and experiencing psychological distress. E-cigarette use is associated with heightened levels of depression and anxiety, whereas cigarette smoking is not associated with depression but is likely to be associated with an increased reporting of anxiety. These contradictory findings highlight the need for comprehensive investigations, especially when e-cigarettes are prohibited.

Identifying promising themes and messages for youth vaping prevention: A national study

Use of e-cigarettes and vapes among adolescents continues to be a major public health concern. Health communication efforts can discourage e-cigarette use among adolescents by influencing beliefs and behavior. However, to do so, studies need to identify the most promising themes and messages based on the latest evidence about the harms of e-cigarettes and vaping. Participants were a nationally representative sample of 1,603 US adolescents aged 13-17 years, recruited in the summer of 2022. Adolescents were randomly assigned to view 7 vaping prevention statements (one from each theme: nicotine addiction, chemical harms, health symptoms, mental health, organ effects, cosmetic effects, and monetary cost) and 1 control statement (vape litter theme) from a pool of 46 statements that were developed through a systematic process. Participants rated each statement on perceived message effectiveness (PME), awareness, and believability. Results of linear mixed models indicated that all vaping prevention themes out-performed control messages on PME, with chemical harms and organ effects having the largest effects, followed by nicotine addiction and then other themes. For most message themes, PME effects were stronger for youth susceptible to vaping compared to non-susceptible youth and users. Both awareness and believability predicted higher levels of PME. In secondary analyses, we found that statements specifying the target ("you") and longer statements were also rated higher on PME. Results suggests that the most potent vaping prevention messages for adolescents are those that focus on vape chemicals and the potential of vaping to damage organs and increase disease risk.

Past-Year Mental Illness Diagnosis and E-cigarette Use Status Among a College-Aged Sample: Findings From the National College Health Assessment (2017-2019)

PURPOSE

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.

E-cigarette use or dual use of E-cigarette and combustible cigarette and mental health and cognitive impairment: Findings from the National Health Interview Survey, 2020-2021

BACKGROUND

Studies on the association between e-cigarette use and mental health are mostly among adolescents and young adults, leaving limited evidence of this association among general US adults. Besides, few studies have examined how e-cigarette use or dual use of e-cigarette and combustible cigarette is related to cognitive function.

METHODS

Cross-sectional data of 56,734 adults from the 2020-2021 National Health Interview Survey were analyzed. Weighted multivariable logistic regression models were applied to examine the independent association between e-cigarette use or dual use and anxiety symptoms, depression symptoms, serious psychological distress (SPD), and cognitive impairment.

RESULTS

Compared with never e-cigarette users, current e-cigarette users had 2.10-fold (95 % CI: 1.84, 2.39), 2.53-fold (95 % CI: 2.13, 3.00), 2.02-fold (95 % CI: 1.47, 2.76), and 2.00-fold (95 % CI: 1.47, 2.72) higher odds of reporting anxiety symptoms, depression symptoms, SPD, and cognitive impairment, respectively. Former e-cigarette use was also associated with all three mental conditions and cognitive impairment (AOR ranged from 1.38 to 2.53, all P < 0.01). Dual users were more likely to report all three mental conditions and cognitive impairment than those who never used combustible cigarette and e-cigarette (AOR ranged from 1.89 to 2.83, all P < 0.01). Dual users also had a greater likelihood of having anxiety or depression symptoms than exclusive combustible cigarette users (AOR ranged from 1.46 to 1.47, all P < 0.01).

CONCLUSIONS

E-cigarette use or dual use is associated with poor mental health and cognitive impairment among US adults. Regulations on e-cigarette use are needed to prevent mental illness and improve cognitive function.

Association of ever use of e-cigarettes with health and lifestyle variables among young adults: a Canadian health measure survey study

Research suggests that vaping raises oxidative stress levels and has been implicated in poor mental health. The objective of this study is to assess cross-sectional associations between quality of life (QOL) indicators and e-cigarette (EC) use in young Canadian adults. We used data from the 2016-2017 Canadian Health Measures Survey. We compared physical activity (daily steps), physiological measurements (high-density lipoprotein for cholesterol level), self-perceived life stress, mental health, and QOL between ever-use EC users and non-users. Multivariable binary or ordinal logistic regressions were used to calculate odds ratios (OR) with 95% confidence intervals (CI). Analyses included 905 participants (15-30 years) with 115 (12.7%) reporting EC use and 790 non-users. After adjusting for confounders, compared to non-users, EC users had significantly higher odds of being physically active (OR = 2.19, 95%CI: 1.14-4.20) but also with self-reported extreme life stress (OR = 2.68, 95%CI: 1.45-4.92). Albeit statistically non-significant, EC users also had higher odds of poorer QOL (OR = 1.12, 95%CI: 0.64-1.95). No statistically significant interactions between EC use, cigarette smoking, cannabis consumption and health outcomes were observed.

CONCLUSION

Our study found that EC use was independently and significantly associated with increased odds of life stress and an indication of poorer QOL. Ongoing surveillance on young EC users is important to measure the long-term impact of vaping on their physical, mental health and quality of life to target for interventions.

WHAT IS KNOWN

• E-cigarette use has been associated with high-risk behaviours and adverse mental health outcomes, such as depression and anxiety.

WHAT IS NEW

• E-cigarette users had significantly higher odds of being physically active and higher amounts of life stress.

The Associations of Physical Activity and Health-Risk Behaviors toward Depressive Symptoms among College Students: Gender and Obesity Disparities

Engaging in health-risk behaviors (HRBs) may be correlated with depressive symptoms among college students, but these relationships require more research. The purpose of this study was to examine the associations of physical activity levels (i.e., light [LPA] and moderate-vigorous [MVPA]) and HRBs (i.e., sedentary behavior [screen-based and non-screen-based behavior] and cigarette and e-cigarette tobacco use) with depressive symptoms in a sample of college students. Physical activity levels and HRBs were assessed through validated questionnaires. In total, 366 students participated (Mage = 22.59 ± 3.54; 60.1% female; 52.9% normal weight). E-cigarette use in males (β = 0.23, p < 0.05) and screen-based sedentary behavior in females (β = 0.14, p < 0.05) showed significant predictive utility toward depressive symptoms. In the overweight/obese group, screen-based sedentary behaviors (β = 0.19, p < 0.05) and e-cigarette use (β = 0.23, p < 0.01) showed significant predictive utility toward depressive symptoms. Females reported higher levels of depressive symptoms (Mfemale = 18.23 vs. Mmale = 14.81; η2 = 0.03) and less MVPA (Mmale = 52.83 vs. Mfemale = 41.09; η2 = 0.06) than males. Enhancing mental health by improving physical activity and eliminating HRBs should be tailored toward at-risk demographics.

Effects of a Social Media Intervention on Vaping Intentions: Randomized Dose-Response Experiment

BACKGROUND

e-Cigarette use, especially by young adults, is at unacceptably high levels and represents a public health risk factor. Digital media are increasingly being used to deliver antivaping campaigns, but little is known about their effectiveness or the dose-response effects of content delivery.

OBJECTIVE

The objectives of this study were to evaluate (1) the effectiveness of a 60-day antivaping social media intervention in changing vaping use intentions and beliefs related to the stimulus content and (2) the dose-response effects of varying levels of exposure to the intervention on vaping outcomes, including anti-industry beliefs, vaping intentions, and other attitudes and beliefs related to vaping.

METHODS

Participants were adults aged 18 to 24 years in the United States. They were recruited into the study through Facebook (Meta Platforms) and Instagram (Meta Platforms), completed a baseline survey, and then randomized to 1 of the 5 conditions: 0 (control), 4, 8, 16, and 32 exposures over a 15-day period between each survey wave. Follow-up data were collected 30 and 60 days after randomization. We conducted stratified analyses of the full sample and in subsamples defined by the baseline vaping status (never, former, and current). Stimulus was delivered through Facebook and Instagram in four 15-second social media videos focused on anti-industry beliefs about vaping. The main outcome measures reported in this study were self-reported exposure to social media intervention content, attitudes and beliefs about vaping, and vaping intentions. We estimated a series of multivariate linear regressions in Stata 17 (StataCorp). To capture the dose-response effect, we assigned each study arm a numerical value corresponding to the number of advertisements (exposures) delivered to participants in each arm and used this number as our focal independent variable. In each model, the predictor was the treatment arm to which each participant was assigned.

RESULTS

The baseline sample consisted of 1491 participants, and the final analysis sample consisted of 57.28% (854/1491) of the participants retained at the 60-day follow-up. We compared the retained participants with those lost to follow-up and found no statistically significant differences across demographic variables. We found a significant effect of the social media treatment on vaping intentions (β=-0.138, 95% CI -0.266 to -0.010; P=.04) and anti-industry beliefs (β=-0.122, 95% CI 0.008-0.237; P=.04) targeted by the intervention content among current vapers but not among the full sample or other strata. We found no significant effects of self-reported exposure to the stimulus.

CONCLUSIONS

Social media interventions are a promising approach to preventing vaping among young adults. More research is needed on how to optimize the dosage of such interventions and the extent to which long-term exposure may affect vaping use over time.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04867668; https://clinicaltrials.gov/study/NCT04867668.

Perceptions of Australia's e-cigarette regulations and recommendations for future reforms: a qualitative study of adolescents and adults

OBJECTIVE

To assess public perceptions of the effectiveness of e-cigarette regulations in minimising use among adolescents and those who have never smoked. Specifically, we explored (1) perceived effectiveness of current regulations relating to e-cigarettes and (2) ideas for further regulations that could reduce use.

DESIGN AND PARTICIPANTS

Focus groups (n=16) were conducted with Australian adolescents (14-17 years), young adults (18-24 years) and adults (25-39 years). Groups were stratified by age, gender and e-cigarette use status. Data were analysed using reflexive thematic analysis.

SETTING

Focus groups were conducted in-person in two major Australian cities.

RESULTS

Groups lacked a comprehensive understanding of e-cigarette regulations in Australia. When informed of these regulations, half of the groups considered the prescription model for nicotine e-cigarette products to be effective when enforced appropriately. Almost all groups considered access to non-nicotine products problematic. All groups suggested a range of demand reduction regulations, including plain packaging, health warnings, flavour restrictions and increased vape-free areas. Most groups (predominantly those who had never vaped) also recommended supply reduction regulations such as banning all e-cigarettes. The need for supply reduction measures to include addiction and mental health supports was discussed.

CONCLUSIONS

The regulations recommended by participants largely align with those that are to be introduced in Australia, indicating that these reforms are likely to be accepted by the public. Ensuring these reforms are complemented by formal supports for young people experiencing nicotine dependence and related mental health concerns is critical.

Vaping among young people-Our best defence is self-defence

Use of electronic cigarettes (e-cigarettes or 'vapes') has risen rapidly among young Australians in recent years. To combat this, on 2 May 2023, the Albanese Government announced a suite of reforms to reduce the desirability and accessibility of e-cigarettes to young people-including a ban on disposable e-cigarettes, restricting flavours, colours and nicotine content and requiring pharmaceutical-like packaging. While many have welcomed this announcement, the efficacy of such reforms in reducing the availability of e-cigarettes to young people remain to be seen, particularly given the current prescription-only model has done little to curb youth vaping. We argue that, in an uncertain landscape where e-cigarettes will likely remain accessible and desirable to young people, it is critical that we also upskill, empower and arm our young people with the skills, resilience, resources and knowledge to make informed and positive health decisions so that: (i) fewer young people opt to take up vaping (primary prevention); and (ii) among those who already do vape, more seek help earlier on to reduce or cease their use before dependency develops (secondary prevention). Schools are an ideal setting for the delivery of these programs, where they can be delivered en masse, integrated into existing alcohol and other drug programs and aligned with school curricula. Skills-based school prevention programs have demonstrated significant and sustained reductions in drug-related harms up to 7 years post-intervention. For as long as vapes remain widely available, desirable and purposefully marketed towards young people, we believe our best defence is self-defence.

A clinical overview of adolescent e-cigarette use (vaping)

E-cigarette use (also known as "vaping") has become increasingly popular among adolescents over the past decade and grown into a significant public health concern in North America, the United Kingdom, and other countries. Concerns about this new trend have generated numerous new research studies. This aim of this study was to summarize recent scientific findings, with a focus on their relevance to clinicians working with adolescents. The first half covers epidemiology, risk factors for e-cigarette use, characteristics of e-cigarette use, youth perceptions of e-cigarettes, physical health risks of e-cigarettes, evidence for "gateway effects" of e-cigarette exposure on subsequent substance use, and the relationship between e-cigarette use and mental health. The review concludes with a clinical focus on assessment of youth who vape, psychoeducation for youth and families, clinical management of vaping, and regulatory considerations.

Co-Use of Tobacco Products and Cannabis Is Associated with Absenteeism and Lower Grades in California High School Students

OBJECTIVE

To examine the association between co-use of commercial tobacco product (hereafter referred to as tobacco) and cannabis with educational outcomes among high school students.

STUDY DESIGN

We analyzed high school student data from the 2021-2022 California Healthy Kids Survey (n = 287 653). Current (past-month) or ever tobacco and cannabis use was categorized as co-use, only tobacco or cannabis, or neither. Two self-reported educational outcomes were examined: absenteeism and grades. Adjusted logistic and linear regression models were used to examine the association between tobacco/cannabis use and absenteeism or grades, respectively. Estimates were adjusted for individual, peer, and school covariates, and clustering within schools.

RESULTS

Current co-use of tobacco and cannabis was more than double the use of only tobacco (3.7% vs 1.7%) and similar to only cannabis (3.7%). Almost 18% of students reported absenteeism. Compared with students who used neither substance, students with current co-use had greater odds of absenteeism (aOR 1.41, 95% CI 1.33-1.49) and lower grades (β = -0.87, 95% CI -0.92 to -0.82). Compared with students using tobacco alone, students with co-use also had a significant elevated odds of absenteeism (aOR 1.19, 95% CI 1.10-1.29) and lower grades (β = -0.39, 95% CI -0.46 to -0.32). Similar results were found for students who ever used tobacco and cannabis.

CONCLUSIONS

California youth who co-use tobacco and cannabis were most likely to have absenteeism and lower grades. Comprehensive efforts to prevent or reduce youth substance use may improve educational outcomes.

Understanding the longitudinal associations between e-cigarette use and general mental health, social dysfunction and anhedonia, depression and anxiety, and loss of confidence in a sample from the UK: A linear mixed effect examination

OBJECTIVE

Our objective was to the longitudinal associations between e-cigarette use and general mental health, social dysfunction & anhedonia, depression & anxiety, and loss of confidence in a sample from the UK.

METHODS

We analyzed data of 19,706 participants from Wave 9 (collected from 2017 to 2018) and Wave 10 (collected from 2018 to 2019) of the Understanding Society: the UK Household Longitudinal Study using a confirmatory factor analysis, linear mixed effect model, and one-sample t-tests.

RESULTS

We found that there is a significant time by e-cigarette use status interaction on mental health issues (b = 0.32, p < 0.001, 95 % C.I. [0.15, 0.49]), social dysfunction & anhedonia (b = 0.36, p < 0.001, 95 % C.I. [0.18, 0.54]), and loss of confidence (b = 0.24, p < 0.01, 95 % C.I. [0.06, 0.41]). Indeed, participants who became e-cigarette smokers at Wave 10 had worse mental health (t(107) = 2.64, p < 0.01, 95 % C.I. [0.07, 0.48], Cohen's d = 0.28), social dysfunction & anhedonia (t(107) = 3.16, p < 0.01, 95 % C.I. [0.12, 0.52], Cohen's d = 0.32), and loss of confidence (t(107) = 2.08, p < 0.05, 95 % C.I. [0.01, 0.37], Cohen's d = 0.19) comparing to one year ago.

LIMITATION

Limitations of this study included its self-report measures, unclassified e-cigarette type, limited generalizability to other populations, and lack of experimental manipulations.

CONCLUSION

We revealed longitudinal associations between e-cigarette initiation and adverse general and dimensions of mental health except for depression and anxiety, which have significant implications for public health, specifically in terms of e-cigarette product regulation and advertising.

Unhealthy behaviors associated with mental health disorders: a systematic comparative review of diet quality, sedentary behavior, and cannabis and tobacco use

Background

There are well-established literatures documenting the associations between mental disorders and unhealthy behaviors such as poor diet quality, sedentary behavior, and cannabis and tobacco use. Few studies have attempted to understand the respective findings in light of each other, however.

Objective

The purpose of this review was to assemble comparable data for each behavior-disorder association and assess the associations in terms of their overall strength. The review aimed to include a representative, but not exhaustive, range of studies that would allow for explorative comparisons.

Methods

Eligible studies were identified via Pubmed searches and citation searching, restricted to publications no older than 2015 written in English. To obtain comparable data, only studies that reported findings as odds ratios were included, and risk of bias related to study samples, behavioral measurement disparities, and control variables was assessed via sensitivity analyses. Findings for each disorder were compared on the basis of different measures of central tendency.

Results

From 3,682 records, 294 studies were included. The review found evidence of associations between each of the four unhealthy behaviors and psychosis, depression, anxiety, bipolar disorder, attention-deficit/hyperactivity disorder (ADHD), and post-traumatic stress disorder (PTSD), while personality disorder was only investigated in relation to cannabis and tobacco use. In overall comparison, the associations were generally of similar strength, and only the association between cannabis use and personality disorder was exceptional in terms of being significantly stronger than its counterparts across disorders and across behaviors. Analyses of bias risk identified some influence from behavioral measurement disparities and lack of adequate statistical control, but findings were generally robust across a range of sensitivity analyses.

Conclusion

This explorative and comparative review found that poor diet quality, sedentary behavior, and cannabis and tobacco use are about equally strongly associated with a range of different mental disorders. Given the general nature of these associations, we should probably understand them to reflect a general and shared etiology. However, the findings in this review should be regarded as tentative until confirmed by more comprehensive investigations.

E-Cigarette Dependence and Depressive Symptoms Among Youth

INTRODUCTION

Although the relationship between smoking and depression has been well-established, little is known about the association between use of e-cigarette and depression, particularly among youth and young adults. This study proposes that e-cigarette dependence, rather than simply use, serves as a potential stressor and may interact with pre-existing vulnerabilities to contribute to depression in youth, consistent with the diathesis-stress theory. This study examines the longitudinal association of vaping dependence and vaping frequency on depression symptoms among youth and young adults who have never smoked cigarettes.

METHODS

People who used e-cigarettes in the past month who reported never smoking a cigarette (N=1,226) aged between 16 and 25 years were followed longitudinally every 3 months for up to 1 year beginning in 2020. The Penn State E-Cigarette Dependence Index at time t was used to predict depression symptoms assessed using the Center for Epidemiologic Studies Depression Scale at time t+1.

RESULTS

A total of 32.1% reported vaping in the past month with the Penn State E-Cigarette Dependence Index score (M=8.5) and a Center for Epidemiologic Studies Depression Scale score (M=15.8). Higher vaping dependence scores were significantly associated with increased depression symptoms scores at follow-up among youth and adults (β=0.08; 95% CI=0.01, 0.15), controlling for baseline depression symptom scores and covariates. Although vaping dependence was highly associated with vaping frequency level, no significant association between the frequency of vaping and depression was found (β= -0.33; 95% CI= 1.21, 0.54).

CONCLUSIONS

These results are consistent with the diathesis-stress model of the relationship between substance use and depression. Vaping dependence but not vaping frequency was associated with increased depressive symptoms among people who never smoked cigarettes.

The interaction of e-cigarette use and mental health symptoms on risk of cigarette smoking initiation among young adults in the United States

BACKGROUND AND AIMS

It is unknown whether young adults who vape nicotine and have poor mental health have greater risk of smoking initiation than expected based on individual risks of vaping and mental health alone. This study aimed to estimate the joint association of vaping and mental health symptoms with smoking initiation among young adults, and test for additive interaction between vaping and mental health in smoking initiation risk.

DESIGN

Using five waves of the Population Assessment of Tobacco and Health (wave 1, 2013-2014; wave 2, 2014-2015; wave 3, 2015-2016; wave 4, 2016-2018; wave 5, 2018-2019), we estimated risk differences (RD) for the association of time-varying and time-lagged vaping and internalizing (e.g., anxiety, depressive) and externalizing (e.g., inattention/hyperactivity) mental health symptoms with cigarette smoking initiation at follow-up, over four 1-year intervals. We calculated interaction contrasts (IC) to estimate the excess risk of smoking initiation attributable to the interaction of vaping and mental health symptoms.

SETTING

United States.

PARTICIPANTS

A total of 6908 cigarette-naïve individuals aged 18-24 years.

MEASUREMENTS

Exposures included current (past-30 day) vaping and internalizing and externalizing mental health symptoms (high vs moderate/low symptoms). The outcome was smoking initiation (ever cigarette use) after 1 year.

FINDINGS

The per-interval risk of smoking initiation was 7.6% (1039 cases/13 712 person-intervals). Compared with noncurrent vaping and moderate/low mental health symptoms, adjusted RDs for current vaping and high mental health symptoms were 17.2% (95% confidence interval [CI]: 7.2% to 27.3%) for internalizing and 18.7% (95%CI: 8.1% to 29.2%) for externalizing symptoms. The excess risk attributed to interaction of current vaping and high externalizing symptoms was IC = 11.3% (95%CI: 1.3% to 21.2%; P = 0.018), with inconclusive findings for internalizing symptoms (IC = 7.7% [95%CI: -2.2% to 17.7%; P = 0.097]).

CONCLUSIONS

There is possible, but inconclusive, superadditivity between vaping and mental health in risk of smoking initiation among young adults in the United States.

Youth mental health and nicotine vape use: The moderating role of rural-urban/suburban school environments

OBJECTIVE

To understand and compare the association between nicotine vape use and mental health among youth in rural and urban/suburban areas.

METHODS

This cross-sectional study included 146,489 high school students from the 2019-2020 California Student Tobacco Survey. Descriptive statistics were estimated with frequencies and percentages. Separate bivariate associations between each covariate/predictor variable and mental health were examined using linear regression. Multivariate linear regression models were used to examine the association between nicotine vape use and mental health for youth attending school in rural versus suburban/urban communities.

RESULTS

Findings showed that vaping nicotine was associated with poorer overall mental health (b = -0.307, SE = 0.019, p < 0.001), and that this association differed based on rural versus urban/suburban school environments (b = -0.135, SE = 0.046, p = 0.004). Specifically, the relationship between vaping and poor mental health was stronger for youth attending school in rural areas (b = -0.443, SE = 0.042, p < 0.001) than in urban/suburban localities (b = -0.307, SE = 0.019, p < 0.001).

CONCLUSIONS

Although differences in mental health were not shown based on rural versus urban/suburban school environments alone, findings showed that the relationship between nicotine vape use and mental health was stronger for youth attending high school in rural areas. Additional research is needed to understand the underlying social and environmental mechanisms that exacerbate this relationship. Future interventions might consider how to support and improve the mental health of rural nicotine vapers to better achieve health equity across different school environments.

Factors associated with susceptibility to e-cigarette use among Australian adolescents

BACKGROUND

Preventing uptake of e-cigarette use among adolescents is critical to minimizing vaping-related harms. To inform the development of effective prevention programs and policies, this study explored potential determinants of susceptibility to e-cigarette use among young Australians.

METHODS

A cross-sectional online survey was administered to 12- to 17-year-old Australians who had never smoked nor vaped (N = 973; 53 % women). The survey assessed susceptibility to e-cigarette use (curiosity about use, willingness to use, and intentions to use) and a comprehensive range of potential correlates that included individual, social, and environmental factors. Regression analyses were conducted to identify factors significantly correlated with each of the dependent variables.

RESULTS

Susceptibility to e-cigarette use was observed in 45 % of respondents. Individual factors associated with susceptibility included respondents' (i) overall opinion of e-cigarettes, (ii) attitudes toward e-cigarettes, (iii) affect regulation expectancies, and (iv) quitting perceptions. Significant social factors included both descriptive and injunctive norms, specifically: perceiving that use is ok for people of one's age, approval from important others to use, and having at least one family member or close friend who vapes.

CONCLUSION

Susceptibility to vaping was observed in a substantial proportion of adolescents who have never smoked. Shifting attitudes and social norms around e-cigarette use appears critical to reducing susceptibility. Recommended prevention efforts include the development of communications addressing misperceptions about the benefits of vaping on affect regulation and stricter regulations on e-cigarette advertising to reduce young Australians' exposure to claims that may result in favourable attitudes to e-cigarette use.

Association between e-cigarette use and depression in US cancer survivors: a cross-sectional study

PURPOSE

Though prior studies have observed significant association between e-cigarette use and mental health outcomes including depression in the general population, the relationship between e-cigarette use and clinical depression in the cancer survivor subpopulation is unknown. The purpose of this study was to examine the cross-sectional association between e-cigarette use and self-reported clinical depression among cancer survivors.

METHODS

Pooled data from the 2017 and 2018 Behavioral Risk Factor Surveillance Survey were used. Multivariable logistic regression was used to analyze the independent association between e-cigarette use and self-reported clinical depression in a sample of 7,498 cancer survivors.

RESULTS

Among cancer survivors in this study, 22.1% reported a history of clinical diagnosis of depression. The overall prevalence rates for current and former e-cigarette use were 2.6% and 10.5%, respectively. Analysis showed 51.3% of current users, 40% of former users, and 19.1% of those who had never used e-cigarettes self-reported a history of clinical depression. In the multivariable analysis, the odds of self-reported clinical depression were significantly higher for survivors who were current users (OR = 2.85; 95% CI: 1.38-5.90) and former users (OR = 1.63; 95% CI: 1.05-2.55) compared to never e-cigarette users.

CONCLUSION

Findings from this study suggest a statistically significant association between e-cigarette use and depression in cancer survivors. Future studies should focus on examining the longitudinal association between e-cigarette use and depression in cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

Study findings reemphasized the need for interventions to support cancer survivors with evidence-based treatments for depression as well as the need for clinicians to screen for psychological distress and/or e-cigarette use and make appropriate recommendations.

Beyond the label: current evidence and future directions for the interrelationship between electronic cigarettes and mental health

Electronic cigarette use has dramatically increased over the last decade. With this recent technological development and wide range of constituents in various products, putative adverse effects on the brain and body have been largely unexplored. Here, we review current evidence linking electronic nicotine cigarette use with potential health consequences and provide evidence supporting an association between drug use and depression in humans. We also examine the biological effects of individual constituents in electronic cigarette aerosols, which include labeled ingredients, such as propylene glycol, vegetable glycerin, nicotine, and flavorants, as well as unlabeled ingredients found in the aerosols, such as carbonyls and heavy metals. Lastly, we examine the effects of electronic cigarette use on endogenous metabolism via changes in cytochrome P450 enzymes, which can thereby impact therapeutic outcomes. While the current evidence offers insight into the potential effects of electronic cigarette use on biological processes, further studies are necessary to determine the long-term clinical relevance of aerosol inhalation.

Reducing e-cigarette use among youth and young adults: evidence of the truth campaign's impact

BACKGROUND

Mass media campaigns have been shown to be effective in reducing cigarette use. However, evidence is limited for whether campaigns can shift e-cigarette use among youth and young adults (YYA). To assess the impact of the truth anti-e-cigarette campaign, which focused on the effects of vaping on mental health, this study examines the relationship between campaign awareness and e-cigarette behaviour among YYA.

METHODS

Data from weekly cross-sectional surveys of YYA aged 15-24 years from September 2021 to October 2022 were used for multilevel models assessing how weekly campaign awareness is related to intentions to use e-cigarettes and current e-cigarette use (past 30 days). Weekly campaign awareness was calculated by averaging individual-level awareness for each week. Control variables included individual-level campaign awareness, sociodemographics, perceived financial situation, parental smoking, sensation seeking, and mental health.

RESULTS

Weekly campaign awareness ranged from 50% to 78%, with most weeks (77%) being within 65% and 75% of weekly campaign awareness. At weekly awareness levels between 65% and 75%, there was a significant association with lower intentions to use e-cigarettes. A dose-response relationship was observed for current use: compared with weeks with lower (<65%) awareness, weeks with awareness of 65-70% had 14% lower odds of current use, weeks with 70-75% awareness had 16% lower odds and weeks with >75% weekly awareness had 18% lower odds (p=0.018, p=0.009 and p=0.007, respectively).

CONCLUSIONS

Findings from this analysis of weekly campaign awareness demonstrate that exposure to the truth anti-e-cigarette campaign is associated with significantly lower odds of intentions to use and current use of e-cigarette among YYA.

Underlying patterns of the co-occurrence of tobacco use and mental health among youth

We aimed to examine how bidirectional relationships between mental health problems and tobacco use are formed over time by types of tobacco use in recent samples of U.S. youth. Data were drawn from Waves 1-4 of the Population Assessment of Tobacco and Health Study (N = 10,082) and analyzed using cross-lagged panel models. A high level of internalizing problems at Wave 1 predicted conventional cigarette smoking (adjusted odds ratio [AOR] = 1.19, 95% CI = 1.06-1.34) and e-cigarette use (AOR = 1.25, 95% CI = 1.09-1.43) at Wave 2, but not vice versa. Both cigarette smoking and e-cigarette use at Wave 2 tended to persist into Wave 3, which, in turn, increased the risk of subsequent internalizing problems in late adolescence or young adulthood (Wave 4). The bidirectional relationship between tobacco use and internalizing problems seems to begin as a procession from internalizing problems to tobacco use, and then from persistent tobacco use to exacerbated internalizing problems over time.

Psychosocial stressors and current e-cigarette use in the youth risk behavior survey

BACKGROUND

This study explores the association between psychosocial stressors and current e-cigarette use among adolescents in the United States.

METHODS

We used data from 12,767 participants in the 2019 National Youth Risk Behavioral Survey to examine the association between psychosocial stressors (bullying, sexual assault, safety-related absence from school, depressive symptoms, suicidal ideation, physical altercation, and weapon threats) and past-30-day e-cigarette use using multivariable-adjusted logistic regression models. We examined the association for each stressor and then as a burden score (0-7). To compare the strength of the association between stressors and current e-cigarette use to current combustible cigarette use, we additionally examined the association between each stressor and current combustible cigarette use.

RESULTS

Approximately 32.7% reported current e-cigarette use. The weighted prevalence of current e-cigarette use was higher among individuals who experienced stressors than those who did not. For example, bullying (43.9% vs. 29.0%). Similar prevalence patterns were seen among other stressors. Individuals who experienced stressors had significantly higher adjusted odds of current e-cigarette use than those who did not (OR [Odds Ratio] range: 1.47-1.75). Similarly, individuals with higher burden scores had a higher prevalence (zero [20.5%], one [32.8%], two [41.4%], three [49.6%], four to seven [60.9%]) and higher odds of current e-cigarette use (OR range: 1.43-2.73) than those with a score of zero. The strength of the association between the stressors and e-cigarette use was similar to that between the stressors and combustible cigarette use.

CONCLUSION

The study demonstrates a significant association between psychosocial stressors and adolescent e-cigarette use, highlighting the potential importance of interventions, such as targeted school-based programs that address stressors and promote stress management, as possible means of reducing adolescent e-cigarette use. Future research directions include exploring underlying mechanisms linking stressors to e-cigarette use and evaluating the effectiveness of interventions addressing stressors in reducing adolescent e-cigarette use.

The impact of the COVID-19 pandemic on a sample of US young adults who smoke cigarettes: A qualitative analysis

INTRODUCTION

The ongoing COVID-19 pandemic has been associated with increased negative mood in youth, and a few reports of changes in tobacco use. We sought to increase the depth of knowledge on the effects of the pandemic on early young adult mood states, access to tobacco products and tobacco use behaviors, and knowledge of risks associated with tobacco use and COVID-19 by learning more about the lived experience of the pandemic among young adults early in their smoking trajectories.

METHODS

Semi-structured qualitative interviews were conducted with 25 young adults ages 18-20 (M = 19) who smoked cigarettes daily or nearly every day and had used electronic cigarettes (ECs) on ≥ 2 occasions in their lifetime.

RESULTS

Our results uncovered several themes: 1) The majority of teens experienced mental health disturbances as a result of the pandemic, which manifested as depression, anxiety, and/or acute loneliness due to social isolation; 2) tobacco purchasing behaviors sometimes changed, with both greater and less access reported among participants; 3) changes in tobacco use were also reported, with some reporting increases in use, others reporting decreases, and a few reporting quitting; and 4) while some youth reported that tobacco use could increase their risk related to COVID-19, the majority reported confusion and uncertainty about how tobacco use impacted their risk.

CONCLUSIONS

The themes identified specific factors that may account for the heterogeneity of impacts of the pandemic on tobacco use, and highlight the value of qualitative work for centering the lived experience of youth for understanding larger trends in substance use.

Depressive symptoms and vaping: The mediating effect of outcome expectancies among young adults

OBJECTIVE

The purpose of the present study was to determine if positive affect reinforcement and social enhancement outcome expectancies mediate the longitudinal association between depressive symptoms and frequency of electronic nicotine delivery systems (ENDS) use one year later among young adults.

METHOD

Participants were 1567 young adults participating in the first three waves of the Marketing and Promotions Across Colleges in Texas project. At Wave 1 participants were 18-25 years old (M = 20.27; SD = 1.86), 61.46% female; 36.25% non-Hispanic white, 33.95% Hispanic/Latino, 14.10% Asian, 7.72% African American/Black, 7.98% two or more races/ethnicities or another race/ethnicity. The independent variable, depressive symptoms, was assessed with the CES-D-10 at Wave 1. The mediating variables, positive affect reinforcement and social enhancement ENDS outcome expectancies were assessed using items adapted from the Youth Tobacco Survey at Wave 2 six months later. The outcome variable was frequency of past 30-day ENDS use at Wave 3, one year after Wave 1. A mediation model was used to test the study hypothesis.

RESULTS

Positive affect reinforcement ENDS outcome expectancies (b = 0.013, SE = 0.006, Bootstrap 95%CI: [0.003, 0.025]), but not social enhancement expectancies (b = -0.004, SE = 0.003, Bootstrap 95%CI: [-0.010, 0.0003]), mediated the positive association between elevated depressive symptoms and frequency of ENDS use one year later.

CONCLUSION

Results indicate young adults experiencing elevated depressive symptoms may use ENDS at a greater frequency than their peers because they believe ENDS use will alleviate stress, increase relaxation and/or concentration.

Nicotine Vaping and Co-occurring Substance Use Among Adolescents in the United States from 2017-2019

Background: The use of electronic cigarettes (or "vaping") among adolescents remains a public health concern given exposure to harmful substances, plus potential association with cannabis and alcohol. Understanding vaping as it intersects with combustible cigarette use and other substance use can inform nicotine prevention efforts. Methods: Data were drawn from 51,872 US adolescents (grades 8, 10, 12, years: 2017-2019) from Monitoring the Future. Multinomial logistic regression analyses assessed links of past 30-day nicotine use (none, smoking-only, vaping-only, and any smoking plus vaping) with both past 30-day cannabis use and past two-week binge drinking. Results: Nicotine use patterns were strongly associated with greater likelihood of cannabis use and binge drinking, particularly for the highest levels of each. For instance, those who smoked and vaped nicotine had 36.53 [95% CI:16.16, 82.60] times higher odds of having 10+ past 2-week binge drinking instances compared to non-users of nicotine. Discussion: Given the strong associations between nicotine use and both cannabis use and binge drinking, there is a need for sustained interventions, advertising and promotion restrictions, and national public education efforts to reduce adolescent nicotine vaping, efforts that acknowledge co-occurring use.

Cigarette and e-cigarette use as a function of psychological distress following COVID-19 related university campus closures

Background: Individuals experienced increased social isolation resulting from the COVID-19 pandemic. Studies have found social isolation and loneliness to be strongly associated with anxiety and depression, which have been associated with increased smoking and vaping rates among young adults, including college students.Objectives: To examine relationships between psychological distress and nicotine use within the context of the COVID-19 pandemic.Methods: A cross-sectional online survey (n = 4634; 77.9% female) was used to collect nicotine use and psychological measures from students enrolled at a large Midwestern university. Timeline follow-back data were collected from students reporting current cigarette or electronic cigarette (e-cigarette) use in the week before and immediately following the closure of campus due to the pandemic. Generalized estimating equations were used to examine the interaction between nicotine use and psychological symptoms across the 2-week period.Results: Both cigarette (Rate ratio (RR) = 1.115, 95% CI = 1.061, 1.171, p < .0001) and e-cigarette (β = 0.258, 95% CI = 0.166, 0.351, p < .0001) use increased significantly following campus closure. Students experiencing higher levels of depression reported greater increases in e-cigarette use frequency over time as compared to students reporting fewer symptoms of depression (β = 0.018, 95% CI = 0.006, 0.030, p = .004).Conclusions: Increases in nicotine use were found immediately following the implementation of public health safety measures that closed most university campuses. Additional and/or increased stressors have potentially impacted young adults who are college students as a result of campus closures resulting from the pandemic, which may have contributed to further increases in nicotine use.

Nicotine on the developing brain

Developmental periods such as gestation and adolescence have enhanced plasticity leaving the brain vulnerable to harmful effects from nicotine use. Proper brain maturation and circuit organization is critical for normal physiological and behavioral outcomes. Although cigarette smoking has declined in popularity, noncombustible nicotine products are readily used. The misperceived safety of these alternatives lead to widespread use among vulnerable populations such as pregnant women and adolescents. Nicotine exposure during these sensitive developmental windows is detrimental to cardiorespiratory function, learning and memory, executive function, and reward related circuitry. In this review, we will discuss clinical and preclinical evidence of the adverse alterations in the brain and behavior following nicotine exposure. Time-dependent nicotine-induced changes in reward related brain regions and drug reward behaviors will be discussed and highlight unique sensitivities within a developmental period. We will also review long lasting effects of developmental exposure persisting into adulthood, along with permanent epigenetic changes in the genome which can be passed to future generations. Taken together, it is critical to evaluate the consequences of nicotine exposure during these vulnerable developmental windows due to its direct impact on cognition, potential trajectories for other substance use, and implicated mechanisms for the neurobiology of substance use disorders.

Symptoms of Depression and Anxiety and Subsequent Use of Nicotine and THC in Electronic Cigarettes

BACKGROUND

This study examines whether symptoms of depression, anxiety, or comorbid depression and anxiety are associated with future use of nicotine or THC in e-cigarettes.

METHODS

Data were from an online survey of youth and young adults in urban areas of Texas with complete data (n = 2,307) in spring 2019 (baseline) and spring 2020 (12-month follow-up). Multivariable logistic regression models examined associations between self-reported symptoms of depression, anxiety, or comorbid depression and anxiety at baseline and past 30-day e-cigarette use with nicotine or THC at 12-month follow-up. Analyses adjusted for baseline demographics and baseline past 30-day e-cigarette, combustible tobacco, marijuana, and alcohol use and stratified by race/ethnicity, gender, grade level, and SES.

RESULTS

Participants were 16-23 years old, 58.1% female and 37.9% Hispanic. At baseline, 14.7% reported symptoms of comorbid depression and anxiety, 7.9% depression, and 4.7% anxiety. Prevalence of past 30-day e-cigarette use at 12-month follow-up was 10.4% with nicotine and 10.3% with THC. Symptoms of depression and comorbid depression and anxiety at baseline were significantly associated with both nicotine and THC use in e-cigarettes 12 months later. Symptoms of anxiety were associated with nicotine use in e-cigarettes 12 months later.

CONCLUSIONS

Symptoms of anxiety and depression may be important indicators of future nicotine and THC vaping among young people. Clinicians should be aware of groups most at risk who may benefit from substance use counseling and intervention.

Perceived Health and Capacity to Cope With Stress in Recent Ex-smokers: Impact of Vaping Versus Quitting All Nicotine

INTRODUCTION

Little is known about the continued use of nicotine following smoking cessation on perceived well-being in comparison to complete cessation of nicotine use.

AIMS AND METHODS

To explore aspects of perceived well-being and coping among recent ex-smokers as a function of vaping status. Ever-daily smokers in the International Tobacco Control 4 country smoking and vaping surveys in 2016 (w1 N = 883) and 2018 (w2 N = 1088). Cross-sectional associations and longitudinal samples for those who quit between waves and those who quit at w1 and maintained abstinence to w2. Main outcome measures were: Past 30 days of depression symptoms, perceived stress, stress management since quitting, and change in perceived day-to-day health.

RESULTS

In the cross-sectional analyses vapers were more likely to report both improved stress management (aOR = 1.71, 95% CI 1.23-2.36) and perceived day-to-day health (aOR = 1.65, 95% CI 1.26-2.16) than nicotine abstainers. In the longitudinal analyses, smokers who switched to vaping between waves (n = 372) were more likely to report depression symptoms at w2 (aOR = 2.00, 95% CI 1.09-3.65) but reported improved perceived health (aOR = 1.92, 95% CI 1.16-3.20). For the past daily smokers who remained quit between waves (n = 382), vapers were more likely to report improved stress management relative to abstainers (RRR = 5.05. 95% CI 1.19-21.40). There were no other significant differences between vapers and nicotine abstainers.

CONCLUSIONS

There is little evidence to support the view that perceptions of well-being deteriorate in vapers compared to complete nicotine abstainers in the immediate years after smoking cessation.

IMPLICATIONS

This study could find no conclusive evidence that the continued use of nicotine via e-cigarettes was detrimental to health compared to completely stopping nicotine intake altogether. Our results would suggest that continuing to use nicotine may even result in some benefits in the short term such as improved stress management, however further longitudinal studies are required to examine if these effects are restricted to the early post-quitting phase and whether other positive or negative effects on psychosocial health emerge in the future.

"They're sleek, stylish and sexy:" selling e-cigarettes online

OBJECTIVE

We examined the product range, marketing strategies, access and marketing claims made by Australian and New Zealand (NZ) online e-cigarette retailers.

METHODS

Twenty Australian (n=10) and NZ (n=10) e-cigarette retail websites were identified via Google using a combination of keywords nominated by an expert panel and identified via a literature review: 'e-cigarette', 'e-cigs', 'vape', and 'vaping', combined with 'Australia', 'AU', 'New Zealand' and 'NZ' and then examined.

RESULTS

Products were extensive (disposable, pod-based, reusable, replacement parts), 95% (n=19) offered 'Starter Kits,' flavoured e-liquid (n=1,032), most containing nicotine (70%, n=14). Most retailers (85%, n=17) offered price discounts and free delivery. There were unsubstantiated health claims (80%, n=16), cessation claims (65%, n=13) and cost-benefit claims (50%, n=10) promoting e-cigarette use. Most (n=14) website age verification features simply required the purchaser to indicate they were aged 18 years.

CONCLUSIONS

Although e-cigarette regulations are different in Australia and NZ, the online product range, marketing strategies, access and marketing claims were similar and sold e-liquid containing nicotine. The health and cessation e-cigarette marketing claims were outlandish and unsubstantiated.

IMPLICATIONS FOR PUBLIC HEALTH

Most purchasing of e-cigarettes occurs online. Regulations and enforcement to limit access and stop unsubstantiated marketing claims must be a public health priority.

E-Cigarette and Cannabis Use Patterns, Depression, and Suicide Behaviors Among US Youth: Analysis of 2019 Youth Risk Behavior Survey Data

PURPOSE

To examine the associations of current electronic cigarette and cannabis use patterns with depression symptoms and suicidal ideation and behavior overall and stratified by sex among U.S. high school students.

DESIGN

Quantitative, cross-sectional study.

SETTING

The 2019 National Youth Risk Behavior Survey.

SUBJECTS

12,401 high school students in 9th-12th grade.

MEASURES

Dependent variables were depression symptoms, suicidal ideation, suicide plan, suicide attempt, and suicide attempt-related injury. Independent variables were past 30 day e-cigarette and cannabis use patterns. Covariates included demographics, grade level, and other tobacco product use.

ANALYSIS

Multivariable logistic regression models.

RESULTS

Approximately 15.7% of students were exclusive e-cigarette users, 4.5% were exclusive cannabis users, and 16.4% were concurrent e-cigarette and cannabis users. Exclusive e-cigarette and cannabis users, and concurrent users were at increased odds (P < .05) of having depression symptoms, seriously considered attempting suicide, planning suicide, suicide attempt, and having suicide attempt-related injury compared to non-users. Female users, especially concurrent users, had higher odds of reporting depression symptoms (P < .01) and all suicidal ideation and behavior outcomes (P < .01) than female non-users, but results varied for male students.

CONCLUSION

E-cigarette and cannabis use patterns significantly predicted depression symptomatology and suicidal ideation and behavior, with female students having higher odds. Results suggest the need for tailored interventions to address mental health and suicidality among U.S. adolescents, and especially female students.

Depression and Suicidal Behavior in Adolescents

Depression commonly onsets in adolescence, affecting approximately 1 in 4 female adolescents and 1 in 10 males in the United States. Adolescent depression is a significant risk factor for suicide, the cause of over a third of all American adolescent deaths. Adolescent depression is introduced alongside its developmental and gendered considerations with a focus on important risk factors of adolescent depression, including nonsuicidal self-injury, adverse childhood experiences, and substance abuse. Protective factors and contemporary special topics of the COVID-19 pandemic and social media use are reviewed. Therapeutic options and clinical barriers are highlighted before a summary of findings and conclusion.

The association of amygdala-insula functional connectivity and adolescent e-cigarette use via sleep problems and depressive symptoms

BACKGROUND

Adolescent electronic cigarette (e-cigarette) use remains high. Elucidating contributing factors may enhance prevention strategies. Neurobiologically, amygdala-insula resting-state functional connectivity (rsFC) has been linked with aspects of sleep, affect, and substance use (SU). As such, we hypothesized that amygdala's rsFC with the insula would be associated with e-cigarette use via sleep problems and/or depression levels.

METHODS

An adolescent sample (N = 146) completed a rs-fMRI scan at time 1 and self-reports at time 2 (∼15 months later). Given consistent associations between mental health outcomes and the rsFC of the laterobasal amygdala (lbAMY) with the anterior insula, we utilized a seed region (lbAMY) to region of interest (ROI) analysis approach to characterize brain-behavior relationships. Two serial mediation models tested the interrelations between amygdala's rsFC with distinct anterior insula subregions (i.e., ventral insula [vI], dorsal insula [dI]), sleep problems, depression levels, and days of e-cigarette use.

RESULTS

An indirect effect was observed when considering the lbAMY's rsFC with the vI. Greater rsFC predicted more sleep problems, more sleep problems were linked with greater depressive symptoms, and greater depressive symptoms were associated with more e-cigarette use (indirect effect = 0.08, CI [0.01,0.21]). Indicative of a neurobiological dissociation, a similar indirect effect linking these variables was not observed when considering the lbAMY's rsFC with the dI (indirect effect = 0.03, CI [-0.001,0.10]).

CONCLUSIONS

These outcomes highlight functional interactions between the amygdala and insula as a neurobiological contributor to sleep problems, depressive symptoms, and ultimately SU thereby suggesting potential intervention points to reduce teen e-cigarette use.

Bidirectional associations between depressive symptoms and cigarette, e-cigarette, cannabis, and alcohol use: Cross-lagged panel analyses among young adults before and during COVID-19

BACKGROUND

The literature regarding bidirectional relationships of depressive symptoms to cigarette and alcohol use is mixed, and limited regarding e-cigarette and cannabis use. Moreover, COVID-19 has significantly impacted mental health and substance use, especially among young adults. Thus, this is a critical period for focused research on these relationships among young adults.

METHODS

We analyzed longitudinal data (assessments in Fall 2018, 2019, and 2020) from 3,006 young adults (Mage = 24.56 [SD = 4.72], 54.8% female, 31.6% sexual minority, 71.6% White, 5.3% Black, 12.2% Asian, 11.4% Hispanic) from 6 US metropolitan statistical areas. Cross-lagged panel models were conducted to examine bidirectional associations between depressive symptoms and past 30-day use of cigarettes, e-cigarettes, cannabis, and alcohol (respectively), controlling for sociodemographics.

RESULTS

During the study period, depressive symptoms decreased before the pandemic but increased during, cigarette and e-cigarette use decreased in both periods, alcohol use showed no change before but increases during the pandemic, and cannabis use increased in both periods. Additionally, each outcome demonstrated greater stability before versus during COVID-19. Finally, greater antecedent depressive symptoms correlated with more days of subsequent cigarette (β = 0.03, SE = 0.01, p =.011) and e-cigarette use (β = 0.03, SE = 0.01, p =.021), but fewer days of alcohol use (β = -0.02, SE = 0.01, p =.035). W2 cannabis use and alcohol use, respectively, were related to W3 depressive symptoms (cannabis: β = 0.09, SE = 0.02, p <.001; alcohol: β = 0.06, SE = 0.02, p =.002). No other cross-lagged associations were significant.

CONCLUSIONS

Intervention efforts targeting depression and substance use should explicitly address the potential for onset and escalation of substance use and depressive symptoms, respectively, especially during societal stressors.

Effects of e-cigarette use on mental health among youths: quasi-experimental evidence from Canada

BACKGROUND AND AIMS

Existing research on mental health comorbidities of youth e-cigarette use is subject to confounding bias and reverse causality. This study aimed to measure the effects of e-cigarette use on youth mental health, using e-cigarette minimum legal age (MLA) law in Canada as a natural experiment.

DESIGN

We used difference-in-differences (DD), difference-in-differences-in-differences (DDD) and two-sample instrumental variables (TSIV) methods.

SETTING

Data were from nationally representative Canadian Community Health Surveys 2008-2019 and Canadian Student Tobacco Alcohol and Drugs Surveys 2008-2019.

PARTICIPANTS

The study sample comprised of respondents aged 15 to 18 (in DD analysis; n = 33 858) and aged 15 to 24 (in DDD analysis; n = 78 689).

MEASUREMENTS

Primary outcomes were self-reported mood disorders and anxiety disorders. Secondary outcomes were cannabis use, illicit drug use, cigarette use and strength of peer relationships at schools.

FINDINGS

After the e-cigarette MLA laws, risks of mood disorders declined by 1.9 percentage points (95% CI, 0.0-3.8; P = 0.05) in the DD analysis and by 2.6 percentage points (95% CI, 0.2-5.0; P = 0.03) in the DDD analysis. For anxiety disorders, while the DD estimate was negative but imprecisely estimated, the MLA law reduced risks of anxiety disorder by 3.6 percentage points (95% CI, 0.9-6.2; P = 0.01) in the DDD analysis. Youths in provinces with MLA laws were also less likely to report cannabis use and illicit drug use and more likely to feel being part of schools. TSIV analysis indicates that youth e-cigarette use increased the likelihood of mood and anxiety disorders by 44% and 37%, respectively.

CONCLUSION AND RELEVANCE

In Canada, the e-cigarette minimum legal age law appears to have reduced risks of mood and anxiety disorders, lowered substance use and improved peer relationships at schools. Combined with previous evidence of lower e-cigarette use following the minimum legal age law, our findings indicate that youth e-cigarette use increases risks of mood and anxiety disorders.

E-Cigarette Use Is Associated with Increased Psychological Distress among Youth: A Pooled Cross-Sectional Analysis of State-Level Data from 2019 and 2021

A crisis of worsening youth mental health in recent years across the United States has created alarm among health professionals. As a result, health professionals have sought to improve methods of identifying youth in need of treatment services. Cigarette, cannabis, and alcohol use each consistently serve as behavioral markers of risk for youth mental health problems. Despite the recent growth of electronic cigarette (e-cigarette) use among youth, few studies have examined whether e-cigarettes follow the same associational pattern with mental health problems in the context of other substance use. Additionally, the COVID-19 pandemic may have altered the associations between youth substance use and mental health problems due to both reduced overall use and increased mental health problems after the onset of the pandemic. The current study examined associations between youth substance use and psychological distress before and after the onset of the COVID-19 pandemic using two state-representative samples of youth in grades 8, 10, and 12 from 2019 (N = 58,689) and 2021 (N = 46,823) from Utah. Pooled cross-sectional linear and negative binomial regression models clustered by grade, stratified by school district, and weighted to represent population characteristics estimated associations between recent e-cigarette, combustible cigarette, cannabis, and heavy alcohol use and two measures of psychological distress-depressive symptoms and mental health treatment needs. After controlling for sociodemographic factors and recent uses of other substances, results indicated that psychological distress increased from 2019 to 2021 and that recent e-cigarette, combustible cigarette, cannabis, and heavy alcohol use were each significantly associated with increased levels on both measures of psychological distress. Compared to other substances, e-cigarette use showed the strongest standardized associations. The association of e-cigarette use with depressive symptoms strengthened significantly from 2019 to 2021. Given the youth mental health crisis paired with the widespread adoption of e-cigarettes, health professionals should consider recent e-cigarette use an increasingly important behavioral marker for risks of mental health problems among youth. Results suggest that future research studies examining the temporal ordering of substance use and mental health among youth should include e-cigarettes.

Back to Basics: Lifestyle Interventions for Adolescent Depression

LEARNING OBJECTIVES

After completing this activity, practitioners will be better able to:• Discuss and better understand the recently adopted screening standards for adolescents with depression and the potential advantages of using "lifestyle medicine"• Set up a process for providing effective interventions for the increased number of patients with adolescent depression• Design or update their toolbox of treatment options for adolescents with depression based on the new literature and increased demand.

ABSTRACT

Recently adopted quality standards recommend that pediatricians screen adolescents for depression and that they document follow-up plans for those who screen positive. As a result of these new recommendations, pediatricians and other pediatric providers, as well as psychiatrists and other mental health professionals, may face an increasing number of referrals and a growing need for effective interventions for adolescent depression. Given the widely acknowledged scarcity of traditional mental health resources, the current study reviewed the rapidly expanding array of evidence-based, but nontraditional, interventions applicable to outpatient pediatric and mental health care settings. Many of these interventions come from a lifestyle medicine framework. Lifestyle medicine interventions are congruent with the cultures of pediatrics and outpatient psychiatry, and offer additional evidence-based tools for providers managing adolescent depression. These interventions can be implemented individually or within group or community settings, and may be used in conjunction with more common interventions such as psychotherapy or psychotropic medications.