Teens using e-cigarettes, cigarettes, cigars, hookah and pipes are significantly more likely to report symptoms of depression and anxiety than teens who don’t use tobacco products at all.


RT’s Three Key Takeaways:

  1. Tobacco Use Linked to Mental Health Issues — Adolescents who use e-cigarettes, conventional tobacco products (CTPs), or both are significantly more likely to report symptoms of depression and anxiety than non-users.
  2. Dual Use Poses Highest Risk — Teens who use both e-cigarettes and CTPs have the highest odds of experiencing mental health struggles, highlighting a particularly vulnerable group.
  3. Need for Tailored Interventions — The strong association between tobacco use and mental health challenges underscores the need for targeted prevention strategies and expanded mental health support for adolescents.


Adolescents who use either e-cigarettes or conventional tobacco products (CTP)—like cigarettes, cigars, hookah and pipes—are significantly more likely to report symptoms of depression and anxiety than teens who don’t use tobacco products at all, according to a study published in PLOS Mental Health.

Tobacco use and mental health challenges are known to have a complex, bidirectional relationship. Understanding the interplay between adolescent tobacco use and mental health is particularly important, since adolescence is a critical developmental period during which many health-related risk-taking behaviors begin. Moreover, there are increasing rates of anxiety, depression, and suicide among adolescents in the US as well as shifting patterns of tobacco use.

In the new study, researchers used data on tobacco use, depression and anxiety symptoms, among different demographics, from the 2021-2023 National Youth Tobacco Survey. Among the 60,072 middle and high school students who had completed all questionnaires in full, 21.37% had used tobacco products, with 9.94% using only e-cigarettes, 3.61% using only CTPs, and 7.80% using both.

Overall, 25.21% of respondents reported symptoms associated with depression and 29.55% reported anxiety symptoms. Compared to adolescents who had not used any tobacco products, users of e-cigarettes or CTPs displayed a potentially heightened risk of depression and anxiety, whilst those who used both CTPs and e-cigarettes had the highest odds of reporting mental health struggles

The authors conclude that “while causality cannot be determined, the results from this study showed that all forms of tobacco use were significantly associated with mental health issues. There is a need to continue promoting mental health support and implementing tailored interventions to combat all forms of tobacco use among adolescents.”