Association Between e-Cigarette Use and Depression in the Behavioral Risk Factor Surveillance System, 2016-2017

Abstract

IMPORTANCE The prevalence of the use of electronic cigarettes (e-cigarettes) in the United States has grown rapidly since their introduction to the market more than a decade ago. While several studies have demonstrated an association between combustible cigarette smoking and depression, the association between e-cigarette use and depression has not been thoroughly studied. OBJECTIVE To examine the association between e-cigarette use and depression in a nationallyrepresentative sample of the adult population in the United States. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of the Behavioral Risk FactorSurveillance System database, 2016 to 2017. The Behavioral Risk Factor Surveillance System is the largest national telephone-based survey of randomly sampled adults in the United States. A total of 892 394 participants with information on e-cigarette use and depression were included. Data analysis was conducted in May 2019.EXPOSURES Electronic cigarette use status defined by self-report as never, former, or current use. MAIN OUTCOMES AND MEASURES Self-reported history of a clinical diagnosis of depression. RESULTSOf the 892 394 participants (414 326 [29.0%] aged Ն60 years; 502 448 [51.3%] women), there were 28 736 (4.4%) current e-cigarette users, of whom 13 071 (62.1%) were aged between 18 and 39 years. Compared with never e-cigarette users, current e-cigarette users were more likely to be single, male, younger than 40 years, and current combustible cigarette smokers (single, 120 797 [24.3%] vs 10 517 [48.4%]; men, 318 970 [46.6%] vs 14 962 [60.1%]; aged 18-39 years, 129 085 [32.2%] vs 13 071 [62.1%]; current combustible cigarette use, 217 895 [7.9%] vs 8823 [51.8%]). In multivariable adjusted models, former e-cigarette users had 1.60-fold (95% CI, 1.54-1.67) higher odds of reporting a history of clinical diagnosis of depression than never users, whereas current e-cigarette users had 2.10 (95% CI, 1.98-2.23) times higher odds. Additionally, higher odds of reporting depression were observed with increased frequency of use among current e-cigarette users compared with never users (daily use: odds ratio, 2.39; 95% CI, 2.19-2.61; occasional use: odds ratio, 1.96; 95% CI, 1.82-2.10). Similar results were seen in subgroup analyses by sex, race/ethnicity, smoking status, and student status. CONCLUSIONS AND RELEVANCEThis study found a significant cross-sectional association between e-cigarette use and depression, which highlights the need for prospective studies analyzing the longitudinal risk of depression with e-cigarette use. If confirmed by other study designs, the potential mental health consequences may have regulatory implications for novel tobacco products.

Association of electronic cigarette use with self-reported difficulty concentrating, remembering, or making decisions in US youth

“…Ever use of e-cigarettes, even once or twice, together with ever smoked even one or two puffs, were used to create the composite exposure variable to examine the association of dual use, exclusive e-cigarette use, and exclusive smoking, with the cognitive problems in youth. Ever use of e-cigarette was chosen due to previous evidence on the association of ever e-cigarette use with health conditions 28 , 29 . A longitudinal analysis using the nationally representative Population Assessment of Tobacco and Health (PATH) Waves 1, 2, and 3 adult data showed significant associations of both former e-cigarette use (including even once or twice) and current e-cigarette use at Wave 1 with incident respiratory disease at Waves 2 or 3 29 .…”

“…A longitudinal analysis using the nationally representative Population Assessment of Tobacco and Health (PATH) Waves 1, 2, and 3 adult data showed significant associations of both former e-cigarette use (including even once or twice) and current e-cigarette use at Wave 1 with incident respiratory disease at Waves 2 or 3 29 . Another study using the combined 2016 and 2017 BRFSS survey data showed that former e-cigarette use (including even just one-time use) had a significant association with a history of clinical diagnosis of depression 28 . Thus, ever use of e-cigarettes, which includes both former use and current use of e-cigarettes, was used as the exposure variable to examine its association with the cognitive problems in youth.…”

Factors Associated with E-Cigarette Use in U.S. Young Adult Never Smokers of Conventional Cigarettes: A Machine Learning Approach

“…E-cigarette use has also been shown to be associated with alcohol use and alcohol use disorder in nonsmokers of cigarettes [ 74 ]. Associations with asthma [ 18 ] and depression [ 13 ] have also been reported for sole e-cigarette use. Thus, our ML approach agrees with the literature confirming some known factors associated with sole e-cigarette use.…”

“…The long-term effects of e-cigarette use remain largely unknown, but e-cigarette aerosols contain toxins that can affect health [ 5 , 6 , 7 , 8 ]. There is increasing evidence that e-cigarettes may be associated with an increased risk of oral diseases [ 9 , 10 ], prediabetes [ 11 ], depression [ 12 , 13 ], asthma, chronic obstructive pulmonary disease (COPD) and respiratory symptoms [ 14 , 15 , 16 , 17 , 18 ]. Recently, the Centers for Disease Control and Prevention (CDC) reported multiple cases of e-cigarette or vaping product use-associated lung injury (EVALI), some of which resulted in deaths [ 19 ].…”

Vitamin E Acetate as a Plausible Cause of Acute Vaping-related Illness

“…42 deaths have been confirmed in 24 states and the District of Columbia: Alabama, California (4), Connecticut, Delaware, the District of Columbia, Florida, Georgia (3), Illinois (4), Indiana (4), Kansas (2), Massachusetts (2), Michigan, Minnesota (3), Mississippi, Missouri, Montana, Nebraska, New Jersey, New York, Oregon (2), Pennsylvania, Tennessee (2), Texas, Utah, and Virginia" [21]. Vaping, may also have harmful psychological effects with a strong association between vaping, major depression and suicidal behavior as reported in a large new study [22]. The likely contributing culprit, nicotine.…”