A recent study, led by Emily Hackworth, a 2024 graduate of the Arnold School’s Ph.D. in Health Promotion, Education, and Behavior, has uncovered a concerning connection between internalizing mental health symptoms—such as anxiety, depression, and loneliness—and increased nicotine use, particularly e-cigarettes, among youth aged 16 to 19. Published in Nicotine and Tobacco Research, the study also highlights the potential impact of the COVID-19 pandemic and its aftermath in exacerbating this issue.
Internalizing mental health symptoms are widespread among adolescents but are often undiagnosed and untreated until adulthood. This delay in treatment leaves affected individuals at greater risk for severe outcomes, including suicide and substance abuse—both of which contribute to a life expectancy that is, on average, 25 years shorter than their peers.
“Eighty-seven percent of smokers report their first use of tobacco products occurring before the age of 18, with many continuing their use into adulthood,” said Hackworth, now a postdoctoral associate at the University of Minnesota’s Masonic Cancer Center. “Adolescents are particularly vulnerable to the relationship between cigarette smoking and mental health due to the significant physiological, emotional, and psychosocial changes they experience during this developmental phase.”
While previous studies have demonstrated a bi-directional relationship between mental health and cigarette smoking, this project sought to determine whether nicotine use is limited to certain types of products, such as combustible cigarettes or non-combustible alternatives like e-cigarettes. Utilizing data from the International Tobacco Control Adolescents Tobacco and Vaping Survey, researchers analyzed the self-reported behaviors and mental health symptoms of over 80,000 16–19-year-olds across Canada, England, and the United States from 2020 to 2023. Their findings revealed a strong association between internalizing mental health symptoms and the use of both combustible and non-combustible nicotine products, with e-cigarette use emerging as the primary driver.
“While we need further research to fully understand the connection, the link between non-combustible nicotine products, especially e-cigarettes, and poor mental health in adolescents is particularly concerning,” Hackworth noted. “Efforts to reduce youth e-cigarette use should emphasize the relationship between vaping and mental health. Additionally, campaigns promoting e-cigarettes as a safer alternative to smoking need to acknowledge the potential mental health risks associated with their use.”
This study sheds light on the urgent need for targeted interventions to address the growing mental health crisis among adolescents, while also tackling the rising trend of nicotine use, particularly in the form of e-cigarettes.
Related topic:
Teen Mental Wellbeing Improves, But Depressive Symptoms Worsen for Some
Food Insecurity Increases Risk of Heart Disease, Study Finds
Poor Sleep Linked to Increased Belief in Conspiracy Theories
