Mental Health Problems and Onset of Tobacco Use Among 12- to 24-Year-Olds in the PATH Study

Abstract

Objective: To examine whether mental health problems predict incident use of 12 different tobacco products in a nationally representative sample of youth and young adults. Method: This study analyzed Wave (W) 1 and W2 data from 10,533 12-to 24-year-old W1 never tobacco users in the Population Assessment of Tobacco and Health (PATH) Study. Self-reported lifetime internalizing and externalizing symptoms were assessed at W1. Past 12-month use of cigarettes, electronic nicotine delivery systems (ENDS), traditional cigars, cigarillos, filtered cigars, pipe, hookah, snus pouches, other smokeless tobacco, bidis and kreteks (youth only), and dissolvable tobacco was assessed at W2. Results: In multivariable regression analyses, high-severity W1 internalizing (adjusted odds ratio [AOR] ¼ 1.5, 95% CI ¼ 1.3À1.8) and externalizing (AOR ¼ 1.3, 95% CI ¼ 1.1À1.5) problems predicted W2 onset of any tobacco use compared to no/low/moderate severity. High-severity W1 internalizing problems predicted W2 use onset across most tobacco products. High-severity W1 externalizing problems predicted onset of any tobacco (AOR ¼ 1.6, 95% CI ¼ 1.3À1.8), cigarettes (AOR ¼ 1.4, 95% CI ¼ 1.0À2.0), ENDS (AOR ¼ 1.8, 95% CI ¼ 1.5À2.1), and cigarillos (AOR ¼ 1.5, 95% CI ¼ 1.0À2.1) among youth only. Conclusion: Internalizing and externalizing problems predicted onset of any tobacco use. However, findings differed for internalizing and externalizing problems across tobacco products, and by age, gender, and race/ethnicity. In addition to screening for tobacco product use, health care providers should screen for a range of mental health problems as a predictor of tobacco use. Interventions addressing mental health problems may prevent youth from initiating tobacco use.

Mental Health Problems and Initiation of E-cigarette and Combustible Cigarette Use

“…In 2 longitudinal studies of college students and adolescents, elevated depressive symptoms were associated with increased risk of initiation of e-cigarette, combustible cigarette, and dual-product use 16,17 ; however, in neither of these studies did the authors adjust for externalizing problems. Interestingly, Green et al 13 found that internalizing problems were a predictor of initiation of combustible cigarette use even after controlling for externalizing problems, whereas we did not observe this association. This may reflect the more restricted age range or smaller sample size in our study.…”

“…Our results extend the findings of a recent article in which the authors examined a similar research question among 12- to 24-year-olds in the PATH sample. 13 First, Green et al 13 examined associations between mental health problems and initiation of electronic nicotine delivery system use, which included e-cigarettes, e-cigars, e-pipes, and e-hookahs, whereas we examined initiation of use of e-cigarettes only. On the basis of the current study, we can be more confident that mental health problems are associated with initiation of e-cigarette use specifically.…”

“…On the basis of the current study, we can be more confident that mental health problems are associated with initiation of e-cigarette use specifically. Second, we used past-year internalizing and externalizing problems as our exposure, whereas Green et al 13 used lifetime measures; by using past-year exposures, it is suggested that mental health problems are a proximal rather than distal risk factor for nicotine- and/or tobacco-product use. Third, we tested for interactive effects of internalizing and externalizing problems on risk of initiation.…”

“…6,12 Because e-cigarette use has recently emerged as a public health concern, increased attention has been focused on associations between adolescent mental health and e-cigarette use and other nicotine- and/or tobacco- product use. 13 Cross-sectional evidence generally suggests that adolescent e-cigarette users display elevated levels of internalizing and externalizing problems compared with nonusers but lower levels of internalizing and externalizing problems compared with combustible cigarette users or dual users. 14,15 Two longitudinal studies have revealed that elevated depressive symptoms predict e-cigarette use generally 16 and initiation of e-cigarette use 17 in young people, but the role of externalizing problems was not examined in either study.…”

Impact of snus use in teenage boys on tobacco use in young adulthood; a cohort from the HUNT Study Norway

“…An 18-item version of the Eysenck Personality Questionnaire, scored according to the established guide, was used to measure three dimensions of personality introversion-extraversion, neuroticism and psychoticism, and included as covariates in the multivariable regression model [23]. Tobacco use is known to be associated with all three dimensions of personality traits [24, 25]. Psychosocial and behavioral factors were considered as confounding regarding tobacco transistions from adolecence to adulthoood.…”