Psychiatric comorbidity in adolescent electronic and conventional cigarette use

Abstract

The popularity of electronic (e-) cigarettes has greatly increased recently, particularly in adolescents. However, the extent of psychiatric comorbidity with adolescent e-cigarette use and dual use of conventional (combustible) and e-cigarettes is unknown. This study characterized psychiatric comorbidity in adolescent conventional and e-cigarette use. Ninth grade students attending high schools in Los Angeles, CA (M age=14) completed self-report measures of conventional/e-cigarette use, emotional disorders, substance use/problems, and transdiagnostic psychiatric phenotypes consistent with the NIMH-Research Domain Criteria Initiative. Outcomes were compared by lifetime use of: (1) neither conventional nor e-cigarettes (non-use; N=2557, 77.3%); (2) e-cigarettes only (N=412, 12.4%); (3) conventional cigarettes only (N=152, 4.6%); and (4) conventional and e-cigarettes (dual use; N=189, 5.6%). In comparison to adolescents who used conventional cigarettes only, e-cigarette only users reported lower levels of internalizing syndromes (depression, generalized anxiety, panic, social phobia, and obsessive-compulsive disorder) and transdiagnostic phenotypes (i.e., distress intolerance, anxiety sensitivity, rash action during negative affect). Depression, panic disorder, and anhedonia were higher in e-cigarette only vs. non-users. For several externalizing outcomes (mania, rash action during positive affect, alcohol drug use/abuse) and anhedonia, an ordered pattern was observed, whereby comorbidity was lowest in non-users, moderate in single product users (conventional or e-cigarette), and highest in dual users. These findings: (1) raise question of whether emotionally-healthier (‘lower-risk’) adolescents who are not interested in conventional cigarettes are being attracted to e-cigarettes; (2) indicate that research, intervention, and policy dedicated to adolescent tobacco-psychiatric comorbidity should distinguish conventional cigarette, e-cigarette, and dual use.

Perceived stress and poly-tobacco product use across adolescence: Patterns of association and gender differences

“…A previous cross-sectional study in a non-clinical general adolescent community sample demonstrated that while mental health syndromes and transdiagnostic endophenotypes, such as major depression, panic disorder, and negative urgency are higher in teens who had used e-cigarettes in comparison to those who had not used any tobacco products; these forms of emotional distress were incrementally higher in users of cigarettes vs. e-cigarettes only (Leventhal et al, 2016). Some have suggested that e-cigarettes and hookah may be drawing in new ‘lower-risk’ teens with fewer mental health or behavioral problems because these products are considered to be more socially acceptable and less harmful to health than conventional cigarettes (Barrington-Trimis et al, 2015; Leventhal et al, 2016; Wills et al, 2015). Consequently, the more socially-stigmatized and harmful product—combustible cigarettes—are suspected to be overrepresented amongst high risk youth who may overlook the negative consequences of such products.…”

E-Cigarettes and Adolescents’ Risk Status

“…4 A recent study of Iceland adolescents 5 observed a similar pattern; for example, the rate of drunkenness was 4% among nonusers, 17% among e-cigaretteonly users, and 72% among dual users. Furthermore, a recent study of California adolescents including measures of psychopathology 6 showed that nonusers were well adjusted, e-cigarette-only users were slightly less adjusted, and dual users scored high on maladjustment. A plausible explanation for these results across 4 international studies is that e-cigarettes are operating to recruit lower-risk adolescents to substance use.…”

Electronic Cigarette

“…Özellikle psikiyatrik hastalarda sigaranın zararlarını azaltmak için önerilen dual kullanımın Psikiyatrik komorbitideyi artırdığı ise Leventhal ve arkadaşları tarafından gösterilmiştir (35) .…”