Date of Award

8-16-2024

Document Type

Open Access Dissertation

Department

Health Promotion, Education and Behavior

First Advisor

James Thrasher

Abstract

Background: There is a well-established bi-directional relationship between cigarette smoking and internalizing mental health (IMH) symptoms (e.g., symptoms of depression, symptoms of anxiety). However, it is unclear whether IMH symptoms are associated with using different types of nicotine products among adolescents, as adolescents are using a variety of nicotine products, including combustible products (cigarettes), non-combustible products (e-cigarettes), or combinations of both types of products. This dissertation examines associations between IMH symptoms and current use of various types of nicotine products across three countries from 2020-2022.

Methods: Data come from the 2020-2022 waves of the International Tobacco Control (ITC) Adolescents Tobacco and Vaping Survey, an online repeat cross-sectional survey of adolescents aged 16-19 in Canada, England, and the US (n=67946). In the full sample, current nicotine use was examined in four categories: 1) no use, 2) exclusive non-combustible product, 3) exclusive combustible product use, and 4) use of both product types. Respondents reported current symptoms of depression or anxiety, and we generated a dichotomous IMH symptoms variable (yes vs. no). Respondents also reported their age race, sex, gender identity, and socioeconomic status. We examined the association between IMH symptoms and current nicotine use using multinomial logistic regression models that adjusted for covariates. Among the respondents that reported using cigarettes and/or e-cigarettes (n=15522), we also examined the association between IMH symptoms and nicotine dependence indicators and cessation variables (quit intention, quit attempt).

Results: IMH symptoms were most strongly associated with use of both product types, followed by exclusive non-combustible use, and then exclusive combustible use. Nicotine use and IMH symptoms varied by gender identity. Among adolescents reporting current e-cigarette use, IMH symptoms were positively associated with nicotine dependence indicators. However, for those reporting cigarette use, this association varied by whether they were dual using e-cigarettes. For both products, IMH symptoms were positively associated with quit attempt and unassociated with quit intention. Conclusions: This dissertation provides an up-to-date examination of the relationship between mental health and nicotine use among adolescents. Results indicate that non-combustible product use may have a particularly strong relationship with poor mental health among adolescents. Longitudinal research is needed to better understand directionality. Results also provide an understanding of the relationship between gender identity and nicotine use.

Rights

© 2024, Emily E. Hackworth

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