Adolescents who use e-cigarettes, conventional tobacco products (CTPs), or both are significantly more likely to experience symptoms of depression and anxiety than non-users, according to a new study published in PLOS Mental Health.
The research, led by Noor Abdulhay of West Virginia University and colleagues, analyzed data from over 60,000 U.S. middle and high school students surveyed between 2021 and 2023, shedding light on the critical link between teen tobacco use and mental health.
Tobacco use and mental health challenges share a complex, bidirectional relationship, with each potentially influencing the other. This interplay is especially consequential during adolescence—a pivotal developmental stage when risk-taking behaviors often emerge.
Compounding concerns, U.S. teens have seen rising rates of anxiety, depression, and suicide in recent years, alongside shifting patterns of tobacco use, making this research particularly timely.
The study drew on data from the 2021–2023 National Youth Tobacco Survey, which included responses from 60,072 students who completed all questionnaires. Of these, 21.37% reported using tobacco products: 9.94% used only e-cigarettes, 3.61% used only CTPs (such as cigarettes, cigars, hookah, and pipes), and 7.80% used both.
Overall, 25.21% of respondents reported depression symptoms, and 29.55% reported anxiety symptoms. When compared to non-users, tobacco users—whether of e-cigarettes, CTPs, or both—showed a heightened risk of these mental health issues.
Notably, teens who used both e-cigarettes and CTPs (dual users) faced the highest odds: they were 1.90 times more likely to report depression, 1.58 times more likely to report anxiety, and 1.75 times more likely to experience overall psychological distress than non-users.
Exclusive e-cigarette users and exclusive CTP users also had significantly higher risks than non-users, though their odds were lower than those of dual users. These findings held even after adjusting for potential confounding factors.
The researchers emphasize that while the study does not prove causation, it underscores a clear association between tobacco use and poor mental health in adolescents.
Given adolescence’s role in shaping long-term health behaviors, the authors stress the urgent need for tailored interventions—combining anti-tobacco efforts with mental health support—to address these overlapping risks.
The study’s results contribute to growing evidence informing policies and future research aimed at protecting teen mental health and curbing tobacco use among young people.
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