Social media and mental health linked to rise in e-cigarette use among US teenagers

In a recent study published in Journal of Affective Disorders, researchers from Pennsylvania investigated the role of mental health status indicators in the relationship between social media use and e-cigarette use among youth. They found that symptoms of anxiety and depression mediated the association between social media use and e-cigarettes among youth.

Study: Social media and e-cigarette use: the mediating role of mental health status. Image credit: Diego Cervo / Shutterstock


About 2.55 million students in the United States (US) use e-cigarettes, the most popular tobacco product among the nation’s youth. While e-cigarettes can be useful in helping you quit smoking, they contain nicotine and other toxic chemicals linked to lung and cardiovascular disease. Given the heavy use of social media by young people, e-cigarette brands are widely promoted through social media platforms, positioning e-cigarettes as a seemingly better alternative to smoking. As a result, previous studies have shown increased use of e-cigarettes by social media users compared to non-users.

Mental health problems have also been shown to be associated with increased experimentation and use of e-cigarettes among young people. Evidence shows that e-cigarette users are more likely to experience mental health problems such as depression and stress. Furthermore, previous studies indicate an increased impact of social media on the mental health of women than men. However, studies examining the potential influence of mental health status indicators on the association between social media use and e-cigarette use among youth are lacking. Therefore, this study aimed to test the hypothesis that indicators of mental health status may mediate increased e-cigarette use associated with social media use among youth, while examining potential gender-based differences in mediation.

About the study

Data were used from the 2022 National Youth Smoking Survey (NYTS), which assesses smoking among middle and high school students in the US. About 23,445 students were involved in the research, and the data was collected through online forms. About 49.9% of the sample were women. Students belonged to any of the following races: non-Hispanic white (55.7%), Hispanic (25.6%), non-Hispanic black (11.8%), and non-Hispanic other (8.9%). The primary outcome measured was e-cigarette use in the previous 30 days. Additionally, frequency of social media use was categorized as “never” (did not use social media), “sometimes” (less than once a week or 1-2 hours a day), “often” (3-4 hours a day), and “very often ” (>4 hours a day). The Patient Health Questionnaire-4 (PHQ-4) (an established anxiety and depression screening tool) was used to measure mental health indicators.

A potential outcomes framework was applied to study the mediation by mental health status indicators of the association between social media use and participants’ e-cigarette use. Additionally, a gender-stratified analysis was performed to understand the likely differences between the two sexes.

Results and discussion

Results suggest that individuals who use social media “very often” are more likely to use e-cigarettes compared to those who use social media “sometimes” or “never” (odds ratio (OR) = 1.41). The likelihood of using e-cigarettes was higher (OR = 1.57) and statistically significant among “very frequent” users of social networks when the results were adjusted for individual characteristics and indicators of mental health status as mediators.

Gender-stratified analysis suggested that social media use had significant effects on e-cigarette use via indicators of mental health status, and the effects were more pronounced in women (OR = 2.27) than in men (OR = 1.53). Mental state indicators showed that female students who use social media “often” or “very often” are more likely to use e-cigarettes.

The findings of this study are consistent with the existing literature and indicate that excessive use of social media may negatively affect the mental health of young people, potentially leading to their increased use of e-cigarettes. The study supports strategies and recommendations aimed at limiting the use of social media among young people.

Although this is the first study to link indicators of mental health status, social media use, and e-cigarette use among youth, it is limited by the fact that indicators, including anxiety and depression, were self-reported by participants. Future studies could be extended to out-of-school youth and could further investigate the biological mechanisms underlying the sex-based differences observed in this study.


In conclusion, this study describes the role of indicators of mental health conditions, including depression and anxiety, in the association between social media use and e-cigarette use among US school-aged youth. The study highlights the growing public health concerns associated with social media use. It is emphasized that the increasing use of social media, especially among young people, can seriously affect their physical and mental health.

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