Abstract
Purpose:
The use of e-cigarettes can worsen mental health symptoms in young adults. However, little is known about how young adults’ mental health may relate to their reasons for using e-cigarettes (vaping). We examined the association of mental health and vaping reasons among young adults who currently vape.
Methods:
Data were analyzed from a sample of young adults who vape (N=436, Mage =25.19) who participated in an online survey assessing mental health (stress, anxiety, and depression) and vaping reasons (vape for tension reduction or relaxation, user experience, product or substance, or utility). We conducted multiple regressions and ANCOVAs, controlling for age, gender, past 30-day e-cigarette use, and past 30-day cigarette smoking.
Results:
Experiencing higher levels of stress, anxiety, and depression were associated with vaping for tension reduction or relaxation among young adults who vape (ps < 0.001) and for those who dual use e-cigarettes and cigarettes (ps<0.01). Experiencing severe anxiety level was associated with vaping for tension reduction or relaxation than among those experiencing minimal, mild or moderate anxiety (ps < 0.05).
Conclusions:
Findings show that higher stress, anxiety, and depression are associated with greater likelihood of vaping for tension reduction or relaxation. More research should examine the association of stress, anxiety, and depression on vaping in young adults to identify and determine appropriate interventions to help with vaping cessation.
Keywords: Young adults, stress, anxiety, depression, e-cigarettes, vaping
Introduction
As of 2021, 11.0% of young adults (18 to 24-years) reported having used e-cigarettes (vaped nicotine) every day or on some days.1 Compounding this issue is the escalating prevalence of mental health problems in young adults (For instance, 33.7% of 18 to 25-year-olds reported experiencing mental health issues vs. 28.1% of 26 to 49-year-olds).2 This is concerning given the established relationship between nicotine use and mental health problems in young adults.3,4 Unfortunately, vaping causes nicotine dependence and addiction,5 in turn “trapping” those who initially vaped for relaxation for continuing or increasing vaping to relieve withdrawal symptoms.6 This cyclical relationship emphasizes the challenges of understanding the reasons in which young people vape and continue to vape.
Existing evidence suggests that experiencing mental health problems may facilitate or deter vaping in young adults. One study observed that stress significantly predicted vaping in young adults, such that those who currently vape continued vaping and those who ever vaped progressed vaping.3 Another study used a nationally representative sample of 19-year-old high school students to examine young adults’ vaping behaviors associated with stress related to the COVID-19 pandemic.7 This study found that the past-year vaping was associated with tension reduction and relaxation in this group.7 Another study involving college students (18 to 25-years) found that higher anxiety symptoms and higher depressive symptoms, respectively, were associated with current vaping.4 Fortunately, a recent study found that young adults have increasingly cited adverse mental health as a reason for quitting vaping, suggesting that increasing awareness of negative mental health effects of vaping has a potential for vaping cessation efforts.8
However, existing studies investigating the motivations of young adults’ vaping have largely focused on social and affective factors, such as peer influence, curiosity, and enjoyment. For example, a systematic review of studies (n=6) involving young adults ages 18 and 25 years found that curiosity was the most frequently cited reason for initiating vaping, although those who continued vaping reported vaping for nicotine consumption.9 However, a focus group study revealed that young adults who vaped daily found that pleasure and social factors were the main reason for liking vaping.10 Enjoyment was another major driver of initiating and continuing vaping among college students who reported ever vaping.11,12 Furthermore, a longitudinal study involving both adolescents and young adults (16 to 25-years) found that regularly interacting with friends who vape, smoke combustible cigarettes, or use substances significantly predicted vaping initiation in both adolescents and young adults who reported never vaping at baseline.13 However, these studies have not examined how vaping reasons relate to specific mental health issues such as stress, anxiety, and depression in young adults.
This study aimed to address this gap by investigating the association of vaping reasons and these specific mental health issues (stress, anxiety, and depression) among young adults who currently vape. Understanding these associations is crucial for developing targeted interventions and support strategies for individuals experiencing mental health challenges in the context of vaping. We hypothesized that mental health issues (stress, anxiety, depression) would be associated with greater likelihood of vaping for tension reduction or relaxation compared to other reasons (e.g., user experience, product or substance, or utility) among those who vape7,14 and those who both vape and smoke cigarettes.15 Additionally, we hypothesized that severity of mental health issues would be associated with greater likelihood of vaping for tension reduction or relaxation among those who vape7,14 and those who both vape and smoke cigarettes.15
Methods
Participants
In September 2023, we recruited a convenience sample of young adults (N=500) from Prolific (prolific.com), an online crowdsourcing survey platform for behavioral research. Participants were eligible if they were between 18 and 30 years old, lived in the U.S., and currently vaped. Participants were prescreened by Prolific for e-cigarette use: “I am a current (vape at least once per day). In the main survey, we validated the vaping status of participants by assessing their past-30-day e-cigarette use in the survey, which constitutes as being a current person who uses.16 To ensure data quality, all data assurance measures were utilized. Specifically, after manual review of the data, we removed responses that exceeded the maximum requested value, responding 0 to the past-30-day e-cigarette use question, and spending less than five minutes for the 20-minute study). After inspection, the final analytic sample consisted of N=436.
Procedures
This study was a part of a larger study that examined the effects health messages about vaping. Potential participants reviewed a brief description about the study on Prolific before being directed to Qualtrics. After providing consent, participants completed questions about demographics, their e-cigarette use, mental health, and reasons for vaping. After completing the study, participants were thanked and compensated $4.00 via Prolific policies. All procedures were approved by the host institution’s Institutional Review Board.
Measures
Demographics.
Participants were asked to report their age (in years), race, ethnicity, and gender.
E-cigarette use.
Participants were asked to report their past 30-day use of e-cigarettes (between 0 to 30 days).16
Cigarette use.
Participants were asked to report their past 30-day cigarette smoking (between 0 to 30 days).16
Stress.
Stress was measured by using four items from the Perceived Stress Scale (PSS-4).17 Participants were asked about their feelings and thoughts in the past month about their ability to control important things in life, confidence in their ability to handle personal problems, things going their way, difficulties piling up on a scale from 0 (Never) to 4 (Very often). The total scores ranged from 0 to 16, with higher scores indicating greater levels of stress.
Anxiety.
Anxiety was measured by using seven items from the Generalized Anxiety Disorder Scale (GAD-7).18 Participants were asked about their feelings in the past two weeks about feeling nervous, anxious or on edge, being unable to stop worrying, worrying about different things, trouble relaxing, being too restless to sit still, becoming easily annoyed or irritable, feeling afraid as if something awful might happen on a scale of 0 (Not at all) to 3 (Nearly every day). The anxiety scores were calculated by adding the scores assigned to each question item, resulting in four anxiety levels with scores ranging from 0 to 21: minimal anxiety (scores from 0–4); mild anxiety (scores from 5–9); moderate anxiety (scores from 10–14); severe anxiety (scores from 15–21).
Depression.
Depression was measured by using nine items from the Patient Health Questionnaire (PHQ-9).19 Participants were asked about their feelings and thoughts in the past two weeks about experiencing little interest or pleasure in doing things, feeling down, depressed, or hopeless; trouble falling or staying asleep or sleeping too much; feeling tired or having little energy; poor appetite or overeating; feeling bad about themselves or letting themselves or their family down; trouble concentrating on things; moving or speaking too slowly for others to notice; thinking about death or hurting themselves on a scale from 0 (Not at all) to 3 (Nearly every day). The depression scores were calculated by adding the scores assigned to each question item, resulting in five depression levels with scores ranging from 1 to 27: minimal depression (scores from 1–4); mild depression (scores from 5–9); moderate depression (scores from 10–14); moderately severe depression (scores from 15–19); severe depression (scores from 20–27).
Vaping for Tension Reduction or Relaxation.
Vaping for tension reduction or relaxation was measured by adapting three items from the modified reasons for smoking scale.20 Participants reported the extent to which they vape an e-cigarette when they feel angry about something, uncomfortable or upset about something, when they feel ‘blue’ or want to take their mind off cares and worries on a scale from 0 (Not at all true) to 5 (Very true). Items were averaged, with higher scores indicating that tension reduction or relaxation is a stronger reason for vaping (Cronbach’s alpha=0.92).
Vaping for User Experience.
Vaping for user experience was measured by using six items from reasons for using vaped nicotine scale.21 Participants reported the extent to which they vape an e-cigarette because of the level of effect they feel, how satisfied it makes them feel, how long they feel the effect after use, the control they have over how much they use, the time it takes for them to feel the effect, they like it on a scale from 0 (Not at all true) to 5 (Very true). Items were averaged, with higher scores indicating that user experience is a stronger reason for vaping (Cronbach’s alpha=0.79).
Vaping for Product or Substance.
Vaping for product or substance was measured by using five items from reasons for using vaped nicotine scale.21 Participants reported the extent to which they vape an e-cigarette because of the price, the taste, the purity of the product, the variety of product that is available to them, the amount they need to feel the effect on a scale from 0 (Not at all true) to 5 (Very true). Items were averaged, with higher scores indicating that product or substance is a stronger reason for vaping (Cronbach’s alpha=0.70).
Vaping for Utility.
Vaping for utility was measured by using four items from reasons for using vaped nicotine scale.21 Participants reported the extent to which they vape an e-cigarette because they can vape in places where they cannot smoke, it is convenient, how easy it is to do, they feel less judged by others about their use on a scale from 0 (Not at all true) to 5 (Very true). Items were averaged, with higher scores indicating that utility is a stronger reason for vaping (Cronbach’s alpha=0.69).
Statistical Analysis
SPSS v.29 (IBM, 2023) was used to conduct analyses. Descriptive statistics were performed to describe sample characteristics and check for distribution. Next, we ran multiple regressions and one-way ANCOVA tests to estimate the associations between mental health measures and outcomes. When the main effects were statistically significant, posthoc tests examined the differences of each mental health level on outcomes. All models adjusted for age (continuous), gender (collapsed to female, male, non-binary), past-30-day e-cigarette use (continuous), and past-30-day cigarette smoking (continuous). We also examined these associations using the subset of participants who reported the past-30-day cigarette smoking. We performed multiple regressions and one-way ANCOVA tests, adjusting for age, gender, and past-30-day e-cigarette use.
Results
Participant Characteristics
On average, participants were 25.19 years old (SD=3.17), self-identified as non-Hispanic White/Caucasian (62.8%) and female (49.8%; Table 1).
Table 1.
Participant Characteristics (N=436).
| N (%) or mean (SD) | |
|---|---|
| Age (years) | 25.19 (3.17) |
| Gender | |
| Female | 202 (46.3%) |
| Male | 212 (48.6%) |
| Non-binaryb | 22 (5.0%) |
| Race and ethnicity | |
| (Non-Hispanic) White/Caucasian | 274 (62.8%) |
| (Non-Hispanic) Black/African American | 47 (10.8%) |
| Othersc | 59 (13.5%) |
| Hispanic/Latino | 54 (12.4%) |
| Prefer not to answer | 2 (0.5%) |
| Cigarette smoking | |
| Currentd | 169 (44.0%) |
| Stress | 8.45 (3.67) |
| Anxiety | |
| Minimal anxiety | 81 (18.6%) |
| Mild anxiety | 133 (30.5%) |
| Moderate anxiety | 107 (24.5%) |
| Severe anxiety | 115 (26.4%) |
| Depression | |
| Minimal depression | 67 (16.5%) |
| Mild depression | 107 (26.3%) |
| Moderate depression | 98 (24.1%) |
| Moderately severe depression | 79 (19.4%) |
| Severe depression | 56 (13.8%) |
| Vaping reasons | |
| Mental health | 3.07 (1.56) |
| Experience | 3.06 (1.00) |
| Product or substance | 2.81 (1.07) |
| Utility | 3.71 (0.99) |
Young adults who self-identified as currently vaping (N=500) were recruited from Prolific, an online crowdsourcing platform.
Non-binary includes trans female/trans woman, trans male/trans man, gender queer/gender non-conforming/gender expansive.
Others include two or more race categories, Asian, Native American or Alaskan Native, or Pacific Islander.
Current cigarette smoking includes smoking at least once in the past 30 days.
Stress and Vaping Reasons
Full Sample.
We found a significant association between stress and vaping for tension reduction or relaxation (p<0.001), such that experiencing higher levels of stress was associated with endorsing vaping for tension reduction or relaxation. The associations between stress and vaping for experience, product or substance, and utility were not statistically significant (Table 2).
Table 2.
Adjusted associations of stress and vaping reasons.
| Vaping reason | B | SE | p-value | 95% CI |
|---|---|---|---|---|
| Full Sample (N=436) | ||||
| Tension reduction or relaxation | 0.12 | 0.02 | <0.001 | 0.079, 0.160 |
| Experience | −0.02 | 0.01 | 0.08 | −0.051, 0.003 |
| Product or substance | −0.02 | 0.02 | 0.32 | −0.043, 0.014 |
| Utility | 0.002 | 0.01 | 0.90 | −0.025, 0.029 |
| Sample with Dual Use (n=169) | ||||
| Tension reduction or relaxation | 0.11 | 0.03 | <0.001 | 0.044, 0.169 |
| Experience | −0.03 | 0.02 | 0.21 | −0.066, 0.015 |
| Product or substance | −0.03 | 0.02 | 0.11 | −0.074, 0.007 |
| Utility | 0.01 | 0.02 | 0.72 | −0.033, 0.047 |
Note: Unstandardized coefficients and standard error were reported. Models for the full sample controlled for age, gender, past-30-day e-cigarette use, and past-30-day cigarette smoking. Models using the subsample (dual use) controlled for age, gender, and past-30-day e-cigarette use.
Sample with Dual Use.
We found a significant association between stress and vaping for tension reduction or relaxation (p<0.001), such that experiencing higher levels of stress was associated with endorsing vaping for tension reduction or relaxation. The associations between stress and vaping for experience, product or substance, and utility were not statistically significant (Table 2).
Anxiety and Vaping Reasons
Full Sample.
We found a significant association between anxiety and vaping for tension reduction or relaxation (p<0.001). Specifically, experiencing severe anxiety level was associated with endorsing vaping for tension reduction or relaxation than experiencing minimal anxiety level (p<0.001) and mild anxiety level (p<0.001), experiencing moderate anxiety level was associated with endorsing vaping for tension reduction or relaxation than experiencing minimal anxiety level (p<0.001) and mild anxiety level (p=0.017; Table 3).
Table 3.
Adjusted association of anxiety and vaping reasons.
| Vaping Reasons | Anxiety levels | M(SE) | F(df, df) | p-value |
|---|---|---|---|---|
| Full Sample (N=436) | ||||
| Tension reduction or relaxation | F(3,373)=18.724 | <0.001 | ||
| Minimal anxiety* | 2.26 (0.17) | |||
| Mild anxiety* | 2.82 (0.13) | |||
| Moderate anxiety* | 3.43 (0.15) | |||
| Severe anxiety* | 3.79 (0.14) | |||
| Experience | ||||
| Minimal anxiety | F(3,373)=1.631 | 0.182 | ||
| Mild anxiety | ||||
| Moderate anxiety | ||||
| Severe anxiety | ||||
| Product or substance | F(3,373)=2.011 | 0.112 | ||
| Minimal anxiety | ||||
| Mild anxiety | ||||
| Moderate anxiety | ||||
| Severe anxiety | ||||
| Utility | F(3,373)=2.598 | 0.052 | ||
| Minimal anxiety | ||||
| Mild anxiety | ||||
| Moderate anxiety | ||||
| Severe anxiety | ||||
| Sample with Dual Use (n=169) | ||||
| Tension reduction or relaxation | F(3,159)=8.092 | <0.001 | ||
| Minimal anxiety | 2.21 (0.28) | |||
| Mild anxiety | 2.85 (0.22) | |||
| Moderate anxiety | 3.14 (0.23) | |||
| Severe anxiety | 3.85 (0.21) | |||
| Experience | F(3,159)=0.626 | 0.599 | ||
| Minimal anxiety | ||||
| Mild anxiety | ||||
| Moderate anxiety | ||||
| Severe anxiety | ||||
| Product or substance | F(3,159)=0.429 | 0.733 | ||
| Minimal anxiety | ||||
| Mild anxiety | ||||
| Moderate anxiety | ||||
| Severe anxiety | ||||
| Utility | F(3,159)=2.241 | 0.086 | ||
| Minimal anxiety | ||||
| Mild anxiety | ||||
| Moderate anxiety | ||||
| Severe anxiety |
Notes. Models adjusted for Bonferroni corrections. Stratified results were reported when the overall mean scores were statistically significant at 0.05 and denoted by *.
The associations between anxiety and vaping for experience, product or substance, and utility were not statistically significant (Table 3).
Sample with Dual Use.
We found a significant association between anxiety and vaping for tension reduction or relaxation (p<0.001) for those who dual use e-cigarettes and cigarette smoking. Specifically, experiencing severe anxiety level was associated with endorsing vaping for tension reduction or relaxation than experiencing minimal anxiety level (p<0.001) and experiencing mild anxiety level (p=0.007; Table 3).
Depression and Vaping Reasons
Full Sample.
We found a significant association between depression and vaping for tension reduction or relaxation (p<0.001). Specifically, experiencing severe depression level was associated with endorsing vaping for tension reduction or relaxation than experiencing minimal depression level (p<0.001) and experiencing mild depression level (p=0.007), and experiencing moderately severe depression level was associated with endorsing vaping for tension reduction or relaxation than experiencing minimal depression level (p=0.004) and mild depression level (p=0.039; Table 4).
Table 4.
Adjusted associations of depression and vaping reasons.
| Vaping Reasons | Depression levels | M(SE) | F(df, df) | p-value |
|---|---|---|---|---|
| Full Sample (N=436) | ||||
| Tension reduction or relaxation | F(4,347)=6.256 | <0.001 | ||
| Minimal depression* | 2.62 (0.20) | |||
| Mild depression* | 2.89 (0.15) | |||
| Moderate depression | 3.28 (0.16) | |||
| Moderately severe depression* | 3.55 (0.17) | |||
| Severe depression* | 3.76 (0.20) | |||
| Experience | ||||
| Minimal depression | F(4,347)=1.025 | 0.394 | ||
| Mild depression | ||||
| Moderate depression | ||||
| Moderately severe depression | ||||
| Severe depression | ||||
| Product or substance | F(4,347)=1.718 | 0.146 | ||
| Minimal depression | ||||
| Mild depression | ||||
| Moderate depression | ||||
| Moderately severe depression | ||||
| Severe depression | ||||
| Utility | F(4,347)=0.692 | 0.598 | ||
| Minimal depression | ||||
| Mild depression | ||||
| Moderate depression | ||||
| Moderately severe depression | ||||
| Sample with Dual Use (n=169) | ||||
| Tension reduction or relaxation | F(4,146)=3.662 | 0.007 | ||
| Minimal depression | 2.55 (0.35) | |||
| Mild depression* | 2.68 (0.23) | |||
| Moderate depression | 3.34 (0.24) | |||
| Moderately severe depression | 3.53 (0.25) | |||
| Severe depression* | 3.85 (0.30) | |||
| Experience | F(4,146)=3.118 | 0.017 | ||
| Minimal depression | 3.64 (0.23) | |||
| Mild depression | 2.92 (0.15) | |||
| Moderate depression | 3.04 (0.16) | |||
| Moderately severe depression | 3.55 (0.16) | |||
| Severe depression | 3.23 (0.20) | |||
| Product or substance | F(4,146)=4.053 | 0.004 | ||
| Minimal depression | 3.47 (0.23) | |||
| Mild depression* | 2.72 (0.15) | |||
| Moderate depression | 2.86 (0.15) | |||
| Moderately severe depression* | 3.42 (0.16) | |||
| Severe depression | 2.82 (0.19) | |||
| Utility | F(4,146)=1.020 | 0.399 | ||
| Minimal depression | ||||
| Mild depression | ||||
| Moderate depression | ||||
| Moderately severe depression |
Notes. Models adjusted for Bonferroni corrections. Stratified results were reported when the overall mean scores were statistically significant at 0.05 and denoted by *.
The associations between anxiety and vaping for experience, product or substance, and utility were not statistically significant (Table 4).
Sample with Dual Use.
We found a significant association between depression and vaping for tension reduction or relaxation (p=0.007) for those who dual use e-cigarettes and cigarette smoking. Specifically, experiencing severe depression level was associated with endorsing vaping for tension reduction or relaxation than experiencing mild depression level (p=0.028; Table 4).
We also found a significant association between vaping for product or substance (p=0.004), such that experiencing moderately severe depression level was associated with endorsing vaping for product or substance than those experiencing mild depression level (p=0.02; Table 4).
While the overall effects of depression on vaping for experience (p=0.017) were statistically significant, differences in the depression levels on the outcome were not statistically significant (Table 4).
The association between depression and vaping for utility was not statistically significant (Table 4).
Discussion
This study explored the association of mental health and vaping reasons among young adults who currently vape e-cigarettes. Among young adults who vape and dual use, experiencing higher levels of stress, anxiety, and depression were associated with reporting tension reduction or relaxation as a reason for vaping. Additionally, depression was associated with greater likelihood of vaping for product or substance (i.e., price, taste, and product variety) among those who dual use. Our findings suggest opportunities for future research to investigate the role of young adults’ mental health on e-cigarette vaping and dual use e-cigarettes and cigarettes to identify and determine appropriate interventions to help stop using nicotine products.
In our study, young adults experiencing higher levels of stress, anxiety, and depression were associated with reporting vaping to reduce tension or relax. Specifically, young adults who scored higher for severe anxiety and depression were associated with attributing vaping to tension reduction or relaxation more than those with lower levels of anxiety and depression. Our findings are consistent with prior findings that higher levels of anxiety and depression are associated with current vaping in young adults.4 While public health officials have begun to focus on debunking the myth about vaping on mental health benefits (e.g., Truth’s “It’s Messing with Our Heads” and “Breath of Stress Air” campaigns),22 more research is needed to alter the public misconceptions about vaping’s role on mental health. Importantly, our findings demonstrate a possible cyclical relationship between vaping and mental health. Furthermore, young adults with higher levels of stress, anxiety, and depression were associated with vaping to reduce tension or relax among those who dual use e-cigarettes and smoke cigarettes. However, as vaping exacerbates these symptoms,6 it is possible that young adults in our study continued vaping to alleviate these symptoms. Future work should design and implement messaging interventions to educate young adults about the negative mental health effects of vaping.
We also found that depression was associated with vaping for product or substance, such as for the price and taste, among young adults who dual use e-cigarettes and smoking cigarettes. Specifically, those who scored high for moderately severe depression were associated with reporting vaping for product or substance, such as the price, taste, and product variety, compared to those with mild depression, although the association was not significant among those with stress or anxiety. It is possible that young adults with greater depression levels may be using cigarettes as the primary source of tension reduction and using vape for other reasons (e.g., social, substitute for cigarettes). Overall, our findings suggest that young adults with depression may have different reasons for vaping compared to those who report stress or anxiety. Future education campaigns should tailor messaging accordingly.
Limitation and future directions.
We acknowledge limitations in our study. First, we used a convenience sample, although past tobacco-related studies have demonstrated that findings from convenience samples were comparable to those from representative samples.23 Furthermore, we did not assess whether participants have been clinically diagnosed of their mental health although we used validated measures.17–19 Future research should examine the association of mental health and vaping reasons among those who have been clinically diagnosed.
Conclusions
Findings from our study highlight the role of mental health and reasons for vaping e-cigarettes among young adults who currently vape. In our study, we found associations between experiencing higher levels of stress, anxiety, and depression and endorsing vaping for tension reduction or relaxation compared to experiencing lower levels of stress, anxiety, and depression among young adults. Additionally, experiencing higher depression levels were associated with endorsing vaping for product or substance among those who dual used. Taken together, our findings suggest a need for public health messaging to focus on educating young people about the negative mental health effects of vaping.
Funding:
This work was funded by the National Institute on Drug Abuse award R00DA046563 (EMS, PI) and additionally supported by the National Cancer Institute (NCI) and FDA Center for Tobacco Products (CTP) under award 1K99CA281094-01A1 (DNL, PI).
Footnotes
Conflicts of interest: The authors have no conflicts of interest to report.
Disclosure: Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH or Food and Drug Administration.
References
- 1.Cornelius ME. Tobacco Product Use Among Adults – United States, 2021. MMWR Morb Mortal Wkly Rep. 2023;72. doi: 10.15585/mmwr.mm7218a1 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.National Institute of Mental Health. Mental Illness. March 2023. Accessed April 8, 2024. https://www.nimh.nih.gov/health/statistics/mental-illness
- 3.Mantey DS, Clendennen SI, Sumbe A, Wilkinson AV, Harrell MB. Perceived stress and E-cigarette use during emerging adulthood: A longitudinal examination of initiation, progression, and continuation. Prev Med. 2022;160:107080. doi: 10.1016/j.ypmed.2022.107080 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Masaki K, Taketa RM, Nakama MK, Kawamoto CT, Pokhrel P. Relationships Between Depressive Symptoms, Anxiety, Impulsivity and Cigarette and E-cigarette Use Among Young Adults. Hawaii J Health Soc Welf. 2022;81(3):51–57. [PMC free article] [PubMed] [Google Scholar]
- 5.Khouja JN, Taylor AE, Munafò MR. Associations between reasons for vaping and current vaping and smoking status: Evidence from a UK based cohort. Drug Alcohol Depend. 2020;217:108362. doi: 10.1016/j.drugalcdep.2020.108362 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Truth Initiative. Nicotine use and stress. March 10, 2022. Accessed October 25, 2023. https://truthinitiative.org/research-resources/emerging-tobacco-products/nicotine-use-and-stress
- 7.Parks MJ, Fleischer NL, Patrick ME. Increased nicotine vaping due to the COVID-19 pandemic among US young adults: Associations with nicotine dependence, vaping frequency, and reasons for use. Preventive Medicine. 2022;159:107059. doi: 10.1016/j.ypmed.2022.107059 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Cha S, Amato MS, Papandonatos GD, et al. Changes over time in reasons for quitting vaping among treatment-seeking young people from 2019 to 2022. Addictive Behaviors Reports. 2024;19:100521. doi: 10.1016/j.abrep.2023.100521 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Kinouani S, Leflot C, Vanderkam P, Auriacombe M, Langlois E, Tzourio C. Motivations for using electronic cigarettes in young adults: A systematic review. Substance Abuse. 2020;41(3):315–322. doi: 10.1080/08897077.2019.1671937 [DOI] [PubMed] [Google Scholar]
- 10.Pokhrel P, Herzog TA, Muranaka N, Fagan P. Young adult e-cigarette users’ reasons for liking and not liking e-cigarettes: A qualitative study. Psychology & Health. 2015;30(12):1450–1469. doi: 10.1080/08870446.2015.1061129 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Luzius A, Dobbs PD, Jozkowski KN. College students’ reasons for using different e-cigarette products: A mixed methods analysis: Journal of American College Health. J AM COLL HEALTH. 2020;68(8):832–838. doi: 10.1080/07448481.2019.1618313 [DOI] [PubMed] [Google Scholar]
- 12.Saddleson ML, Kozlowski LT, Giovino GA, et al. Enjoyment and other reasons for electronic cigarette use: Results from college students in New York. Addictive Behaviors. 2016;54:33–39. doi: 10.1016/j.addbeh.2015.11.012 [DOI] [PubMed] [Google Scholar]
- 13.Jayakumar N, O’Connor S, Diemert L, Schwartz R. Predictors of E-Cigarette Initiation: Findings From the Youth and Young Adult Panel Study. Tob Use Insights. 2020;13:1179173X20977486. doi: 10.1177/1179173X20977486 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Truth Initiative. Colliding Crises: Youth Mental Health and Nicotine Use.; 2021. Accessed December 20, 2023. https://truthinitiative.org/research-resources/emerging-tobacco-products/colliding-crises-youth-mental-health-and-nicotine-use
- 15.Hiler M, Spindle TR, Dick D, Eissenberg T, Breland A, Soule E. Reasons for Transition From Electronic Cigarette Use to Cigarette Smoking Among Young Adult College Students. Journal of Adolescent Health. 2020;66(1):56–63. doi: 10.1016/j.jadohealth.2019.09.003 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.National Institutes of Health, U.S. Food and Drug Administration. Population Assessment of Tobacco and Health (PATH) Study: Final Adult Baseline (Wave 1) Questionnaire. National Institutes of Health.; 2013. [Google Scholar]
- 17.Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. Journal of Health and Social Behavior. 1983;24:385–396. doi: 10.1037/t02889-000 [DOI] [PubMed] [Google Scholar]
- 18.Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–1097. doi: 10.1001/archinte.166.10.1092 [DOI] [PubMed] [Google Scholar]
- 19.Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–613. doi: 10.1046/j.1525-1497.2001.016009606.x [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.De Wilde KS, Tency I, Boudrez H, Temmerman M, Maes L, Clays E. The Modified Reasons for Smoking Scale: factorial structure, validity and reliability in pregnant smokers. Journal of Evaluation in Clinical Practice. 2016;22(3):403–410. doi: 10.1111/jep.12500 [DOI] [PubMed] [Google Scholar]
- 21.Smith DM, Kozlowski L, O’Connor RJ, Hyland A, Collins RL. Reasons for individual and concurrent use of vaped nicotine and cannabis: their similarities, differences, and association with product use. J Cannabis Res. 2021;3(1):39. doi: 10.1186/s42238-021-00097-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Truth Initiative. Breath of Stress Air is calling a vape what it truly is. March 11, 2022. Accessed October 25, 2023. https://truthinitiative.org/research-resources/emerging-tobacco-products/breath-stress-air-calling-vape-what-it-truly
- 23.Jeong M, Zhang D, Morgan JC, et al. Similarities and differences in tobacco control research: Findings from convenience and probability samples. Ann Behav Med. 2018;53(5):476–485. doi: 10.1093/abm/kay059 [DOI] [PMC free article] [PubMed] [Google Scholar]