Mental health problems and onset of tobacco use among 12- to 24-year-olds in the PATH study.
Open accessAbstract
Objective To examine whether mental health problems predict incident use of 12 different tobacco products in a nationally representative sample of youth and young adults.Method This study analyzed Wave (W) 1 and W2 data from 10,533 12- to 24-year-old W1 never tobacco users in the Population Assessment of Tobacco and Health (PATH) Study. Self-reported lifetime internalizing and externalizing symptoms were assessed at W1. Past 12-month use of cigarettes, electronic nicotine delivery systems (ENDS), traditional cigars, cigarillos, filtered cigars, pipe, hookah, snus pouches, other smokeless tobacco, bidis and kreteks (youth only), and dissolvable tobacco was assessed at W2.Results In multivariable regression analyses, high-severity W1 internalizing (adjusted odds ratio [AOR] = 1.5, 95% CI = 1.3-1.8) and externalizing (AOR = 1.3, 95% CI = 1.1-1.5) problems predicted W2 onset of any tobacco use compared to no/low/moderate severity. High-severity W1 internalizing problems predicted W2 use onset across most tobacco products. High-severity W1 externalizing problems predicted onset of any tobacco (AOR = 1.6, 95% CI = 1.3-1.8), cigarettes (AOR = 1.4, 95% CI = 1.0-2.0), ENDS (AOR = 1.8, 95% CI = 1.5-2.1), and cigarillos (AOR = 1.5, 95% CI = 1.0-2.1) among youth only.Conclusion Internalizing and externalizing problems predicted onset of any tobacco use. However, findings differed for internalizing and externalizing problems across tobacco products, and by age, gender, and race/ethnicity. In addition to screening for tobacco product use, health care providers should screen for a range of mental health problems as a predictor of tobacco use. Interventions addressing mental health problems may prevent youth from initiating tobacco use.
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- Authors
- Green, V. R., Conway, K. P., Silveira, M. L., Kasza, K. A., Cohn, A., Cummings, K. M., Stanton, C. A., Callahan-Lyon, P., Slavit, W., Sargent, J. D., Hilmi, N., Niaura, R. S., Reissig, C. J., Lambert, E., Zandberg, I., Brunette, M. F., Tanski, S. E., Borek, N., Hyland, A. J., & Compton, W. M.
- Affiliations
- National Institutes of Health (US)
- Roswell Park Comprehensive Cancer Center (US)
- Truth Initiative (US)
- Medical University of South Carolina (US)
- Westat (United States) (US)
- United States Food and Drug Administration (US)
- Dartmouth College (US)
- Corresponding author
- Silveira, Marushka L.
- ORCID
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2018-12
- Volume
- 57
- Issue
- 12
- Pages
- 944-954.e4
- ISSN
- 0890-8567 (ISSN-L)
- PMC
- PMC7439766
- OpenAlex
- W2895078221
- Cited by
- 86
- References
- 37
- Citations by year
- 2026: 2 · 2025: 15 · 2024: 20 · 2023: 14 · 2022: 10 · 2021: 10 · 2020: 9 · 2019: 6
- FWCI
- 4.30
- Type
- journal article
- Language
- en
- Update notices
- erratum (2025-04-01)
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Lincoln (University of Nebraska) (submittedVersion)
- Funders
- National Institute on Drug Abuse
- National Institutes of Health
- Center for Tobacco Products
- Food and Drug Administration
- Department of Health and Human Services (HHSN271201100027C)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- mental illness, internalizing problems, externalizing problems, youth and young adults, electronic cigarettes, cigarillos, cigarettes, smokeless tobacco, hookah, tobacco use screening, mental health screening, PATH Study
- MeSH terms
- Adolescent, Adult, Age Factors, Mental Disorders, Child, Female, Humans, Longitudinal Studies, Male, United States, Cohort Studies, Substance-Related Disorders, Young Adult, Self Report, Tobacco Products, Tobacco Use, Electronic Nicotine Delivery Systems
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