Trends in Mental Health Symptoms, Nicotine Product Use, and Their Association Over Time Among Adolescents in Canada, England, and the US: Findings From the ITC Adolescents Tobacco and Vaping Survey, 2020–2023
Bibliographic record
Abstract
INTRODUCTION: There is a well-established bidirectional relationship between cigarette smoking and internalizing mental health (IMH) symptoms (eg, symptoms of depression, symptoms of anxiety). However, it is unclear whether IMH symptoms are associated with using different types or combinations of nicotine products (eg, combustible, noncombustible, exclusive product use, or multi-product use). The purpose of this study is to improve our understanding of the relationship between adolescent IMH symptoms and use of a wide variety of nicotine products by examining the association between IMH symptoms and current nicotine use from 2020 to 2023. AIMS AND METHODS: Data come from the 2020 to 2023 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 United States (n = 80,427). Current nicotine use was examined in four categories: (1) no use, (2) exclusive noncombustible product use, (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). We examined the association between IMH symptoms and current nicotine use using multinomial logistic regression models that adjusted for covariates. RESULTS: IMH symptoms were most strongly associated with use of both product types (adjusted relative risk ratio [ARRR]: 1.91, 95% confidence interval [CI] 1.80 to 2.03), followed by exclusive noncombustible use (ARRR: 1.70, 95% CI = 1.61 to 1.80), and then exclusive combustible use (ARRR: 1.29, 95% CI = 1.21 to 1.37). CONCLUSIONS: Adolescents with IMH symptoms are more likely to use nicotine products in general than adolescents without IMH symptoms. Specifically, noncombustible product use may have a particularly strong relationship with poor mental health among adolescents. Longitudinal research is needed to better understand directionality. IMPLICATIONS: This study provides an up-to-date understanding of how mental health and nicotine use are related among adolescents, particularly during the COVID-19 pandemic and its aftermath. Results indicate that youth mental health may be related to nicotine use, particularly noncombustible use, which is largely driven by e-cigarette use. Efforts to reduce youth e-cigarette use may consider emphasizing its relationship with mental health. Efforts to promote e-cigarette use as a less harmful alternative to cigarette smoking should be aware of the association between vaping and youth mental health.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".