E-Cigarette Usage Associated With Depression in College Students

Depression is positively associated with the use of tobacco products, such as e-cigarettes (vapes) and cigarettes in college students.

Depression is positively associated with the use of tobacco products, such as e-cigarettes (vapes) and cigarettes in college students, according to study findings published in Psychiatry Research Communications.

This study analyzed data taken from the fall semester cohort of the 2020 Healthy Minds Study, which collected mental health information, sociodemographic covariates, and other related factors from undergraduate and graduate students. This cross-sectional, web-based survey was distributed to 36 American colleges across the country from September through December 2020. Of the 36 colleges enrolled in the 2020 Healthy Minds Study, 5 universities opted to add the substance use module to the survey, giving the present study a sample size of 2115.

Participants reported use of e-cigarettes exclusively, cigarettes exclusively, and dual use of these products. Symptoms of depression were measured using the Patient Health Questionnaire-9 (PHQ-9). Answers to Patient Health Questionnaire-9 were summed up and measured on a scale of 0 to 27, with scores greater than 5 representing probable depression.

The study measured the perceptions of the social norms of tobacco use and perceptions of risks associated with tobacco use. To measure social norms, participants were asked to estimate the percentage of tobacco usage of the students at their universities. Responses for questions about tobacco risk were measured on a scale of 1 to 4, with 1 representing “no risk” and 4 representing “great risk.”

Hierarchical logistic regression was used to analyze depression symptoms, perceived risks of tobacco use, and perceived social norms of tobacco use within the e-cigarette use, cigarette use, and dual use populations.

The mean age for participants was 23.41±7.84 years, 43.8% were women, and 85.6% were White. Participants reported past 30-day usage of exclusive e-cigarette use, exclusive cigarette use, and dual use as 22.38%, 7.89%, and 2.72%, respectively.

The study found that 33.1% of participants met criteria for probable depression with a mean of 8.00±6.33. Higher depression levels were observed in all populations using tobacco products: exclusive e-cigarette use (odds ratio [OR], 1.08; 95% CI, 1.06-1.10), exclusive cigarette use (OR, 1.09; 95% CI, 1.06-1.12), and dual use populations (OR, 1.05; 95% CI, 1.00-1.10).

Participants reported a moderate perceived risk of smoking and vaping, with an average score of 3.26±1.01 and 2.85±0.98 respectively. Higher levels of perceived social norms for both e-cigarettes (OR, 1.01; 95% CI 1.00-1.02) and cigarettes (OR, 1.02; 95% CI, 1.00-1.03) were associated with an increased use of these tobacco products.

The study participants were mostly White students, and findings may not be generalizable. While researchers emphasized confidentiality of these responses, students could have underreported tobacco usage.

Overall, researchers concluded that depression was associated with both e-cigarettes and cigarettes. They found that higher depression levels and perceived social norms for tobacco use increased the odds of e-cigarette and cigarette usage.

“This increased understanding of psychosocial and mental health-related factors could provide useful information about whether tobacco control efforts would benefit from addressing dual use among college students and attitudes and beliefs about the risks and prevalence of use of these products,” the study authors noted.

This article originally appeared on Psychiatry Advisor


Tran DD, Oh H, Zhou S, Pederson ER. Depression and perceptions of social norms and harms for electronic and combustible cigarette use: associations with tobacco use in college students. Psychiatry Res Commun. Published online June 9, 2022. doi:10.1016/j.psycom.2022.100053