The Influence of COVID-19 Pandemic on the Frequent Use of E-Cigarettes and Its Association with Substance Use and Mental Health Symptoms

Abstract

Background: Although several studies examined the association between e-cigarettes, substance use, and mental health conditions, there is limited research on whether COVID-19-related stress and health outcomes, mental health symptoms, and substance use differ by the frequency of e-cigarette use during the COVID-19 pandemic. We assessed the association of past 30-day frequent use of e-cigarettes with alcohol, cannabis, anxiety/depression, and COVID-19 impact. Methods: We conducted a national online cross-sectional survey among a random sample of US adults aged 18 years or older (N = 5065) between 13 May 2021, and 9 January 2022. A multinomial logistic regression analysis was performed to assess the study aims. Results: Of the participants, 7.17% reported once to several times per month (OSTPM), 6.95% reported once to several times per week (OSTPW), and 6.57% reported every day to several times per day (ESTPD) use of e-cigarettes in the past month. Alcohol and cannabis use ESTPD and once to several times per week/month (OSTPW/M) were associated with a higher likelihood of e-cigarette use ESTPD and OSTPW/M, respectively. Anxiety/depression was associated with e-cigarette use ESTPD and OSTPW. Individuals who considered social distancing to be stressful were more likely to use e-cigarettes ESTPD and OSTPW/M compared to those that considered social distancing as not stressful. Conclusion: Individuals who engaged in the frequent use of alcohol or cannabis, had depression/anxiety, and considered social distancing to be stressful were more likely to engage in frequent e-cigarette use. Improving efforts geared toward reducing the use of substances may help decrease the health risks associated with e-cigarette use.

Immigration status-related exclusive e-cigarette use and cannabis use and their dual use disparities associated with mental health disorder symptoms

“…Specifically, the prevalence of dual use was higher in both immigrant and U.S.-born individuals who identified as non-binary/transgender, sexual minority, Black/African American, young adult, had less than high school education, experienced severe anxiety/depression symptoms, had higher loneliness scores, and used alcohol. These findings are consistent with the observations of other researchers, who found that individuals with lower and underserved socioeconomic and sociodemographic characteristics (e.g., young adults, people with less than high school education, sexual and gender minority persons, Black/African American individuals) and mental health disorder symptoms (e.g., anxiety/depression, stress) were more likely to engage in substance use, including e-cigarette and cannabis use, particularly their combinations ( Adzrago et al, 2022 ; Clendennen et al, 2021 , 2023 ; Conway et al, 2017 ; Duan et al, 2022 ; Kondracki et al, 2022 ; Lewis et al, 2022 ; Spears et al, 2019 , 2020 ; Thrul et al, 2020 ). However, none of the aforementioned studies examined subgroup differences in dual use of e-cigarettes and cannabis within immigrant and U.S.-born populations to identify immigration status-related disparities in dual use behavior for tailored substance use interventions aimed at reducing substance use and its health consequences, especially the increased risks of dual use of substances.…”

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

“…Often closely associated with depression, electronic cigarette use is also positively correlated with both self-reported anxiety symptoms and generalized anxiety disorder (GAD) in humans (17,(52)(53)(54)(55)(56). While the directionality of this association is unclear, like depression, the relationship between anxiety and electronic cigarette use may also be bidirectional.…”

E-Cigarette Use Among US Adults in the 2021 Behavioral Risk Factor Surveillance System Survey

“…This health crisis, marked by an intensified focus on personal health and safety, may have contributed to changes in attitudes and behaviors relating to e-cigarette use . Psychological stress and isolation that may have arisen from lockdown measures also may have prompted some individuals to increasingly depend on e-cigarettes and other tobacco products as a coping mechanism . In addition, the COVID-19 pandemic disrupted the conduct of surveys, especially those that relied on in-person data collection.…”

“… 13 Psychological stress and isolation that may have arisen from lockdown measures also may have prompted some individuals to increasingly depend on e-cigarettes and other tobacco products as a coping mechanism. 14 , 15 In addition, the COVID-19 pandemic disrupted the conduct of surveys, especially those that relied on in-person data collection. As a result, surveys such as the NHIS transitioned from in-person to online interviews.…”