Teen Tobacco Use Linked to Higher Risk of Anxiety, Depression

Credit: Adobe Stock/aleksandr_yu

Adolescence is a critical time for brain and emotional development, and mental health issues like depression and anxiety are increasingly common during these years. Now, new research adds another concern for teens, parents, and health professionals: tobacco use, including e-cigarettes, may significantly increase the risk of poor mental health in teens.

“Tobacco use and mental health challenges are known to have a complex, bidirectional relationship,” wrote a team of investigators led by Noor Abdulhay, a Ph.D. candidate in epidemiology associated with the School of Public Health at West Virginia University.

A study analyzing data from more than 60,000 U.S. middle and high school students across the 2021 to 2023 National Youth Tobacco Survey found a clear link between tobacco use and symptoms of depression, anxiety and psychological distress. Investigators looked at various patterns of tobacco use, such as e-cigarette-only use, combustible tobacco-only use (like cigarettes) and dual use (using both e-cigarettes and other tobacco), and compared mental health outcomes across groups.

To measure mental health, researchers used a widely accepted screening tool called the Patient Health Questionnaire (PHQ-4), which helps detect probable cases of depression and anxiety. Scores of 3 or higher on either subscale were considered potential signs of mental health issues. The team also looked at overall psychological distress, rated from normal to severe based on total scores.

“Understanding the relationship between adolescent tobacco use and mental health in adolescents is particularly important as adolescence is a critical developmental period during which many health-related risk-taking behaviors begin,” Abdulhay wrote.

Key Findings

• 25% of teens surveyed had signs of depression, and nearly 30% showed signs of anxiety.
• Teens who were dual users (vaping and smoking) had the highest risk of poor mental health:
  • 1.9 times more likely to have depression
  • 1.6 times more likely to have anxiety
  • 1.75 times more likely to have psychological distress
• Even using e-cigarettes alone was significantly associated with increased odds of depression and anxiety.
• Similarly, those who only used traditional combustible tobacco also had worse mental health outcomes than non-users.

The team of investigators accounted for other factors like age, gender, existing health conditions and other lifestyle variables, strengthening the reliability of their findings.

The findings further confirm what many doctors have observed anecdotally: tobacco use, including vaping, isn’t just a physical health risk — it may seriously affect teens’ mental health, too.

Dual use, or combining vaping with other forms of tobacco, appears to pose the greatest risk.

According to investigators, the study offers timely insights into the link between tobacco use and mental health among U.S. adolescents. Its strengths include providing up-to-date data from a large, national sample of children. Additionally, self-reported mental health symptoms increased the accuracy compared with parent-reported data. Unlike many previous studies focused only on cigarette smoking, this research compared mental health impacts across exclusive e-cigarette use, exclusive CTP use and dual use.

However, they noted some limitations including the cross-sectional study design, the potential for recall bias among participants, and not including key health and behavioral factors such as diet, exercise, sleep or socioeconomic status, which may have affected results. Lastly, the data did not allow for examining how the frequency or intensity of tobacco use affects mental health — an important area for future research.

“While causality cannot be determined, the results from this study showed that all forms of tobacco use were significantly associated with mental health issues,” investigators concluded. “There is a need to continue promoting mental health support and implementing tailored interventions to combat all forms of tobacco use among adolescents.”