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

Journal Article (Journal Article)

BACKGROUND AND OBJECTIVES: During adolescence, mental health problems may increase the risk of initiating combustible cigarette use. However, it is unknown if this association extends to electronic cigarettes (e-cigarettes). We examined whether internalizing and externalizing problems were associated with initiation of e-cigarette, combustible cigarette, and dual-product use among adolescents. METHODS: Participants were drawn from the Population Assessment of Tobacco and Health Study, a nationally representative longitudinal study of US adolescents followed from 2013 to 2015. The study sample included 7702 adolescents aged 12 to 17 years who at baseline reported no lifetime use of tobacco products. We examined the respective associations between baseline internalizing and externalizing problems and initiating use of e-cigarettes, combustible cigarettes, or both at 1-year follow-up. RESULTS: Compared with adolescents with low externalizing problems, adolescents with high externalizing problems were significantly more likely to initiate use of e-cigarettes (adjusted relative risk ratio [aRRR] = 2.78; 95% confidence interval [CI]: 1.76-4.40), combustible cigarettes (aRRR = 5.59; 95% CI: 2.63-11.90), and both products (aRRR = 2.23; 95% CI: 1.15-4.31). Adolescents with high internalizing problems were at increased risk of initiating use of e-cigarettes (aRRR = 1.61; 95% CI: 1.12-2.33) but not combustible cigarettes or both products. CONCLUSIONS: Mental health problems are associated with increased risk for initiating e-cigarette, combustible cigarette, and dual-product use in adolescence. This association is more consistent for externalizing problems than internalizing problems. Addressing mental health problems could be a promising target for preventing initiation of nicotine- and/or tobacco-product use by adolescents.

Full Text

Duke Authors

Cited Authors

  • Riehm, KE; Young, AS; Feder, KA; Krawczyk, N; Tormohlen, KN; Pacek, LR; Mojtabai, R; Crum, RM

Published Date

  • July 2019

Published In

Volume / Issue

  • 144 / 1

PubMed ID

  • 31160343

Pubmed Central ID

  • PMC6615573

Electronic International Standard Serial Number (EISSN)

  • 1098-4275

Digital Object Identifier (DOI)

  • 10.1542/peds.2018-2935


  • eng

Conference Location

  • United States