Clinical considerations for adolescents with eating disorders who use nicotine

Adolescence is a developmental period in which individuals demonstrate increased likelihood of engaging in disordered eating and risk-taking behaviors, such as substance use. Nicotine use, in particular, (e.g., via vaping, combustible cigarettes, smokeless tobacco) is pervasive among middle and high school students. In 2022, 17.4% of middle school and high school students reported current nicotine vaping. Daily use of nicotine was reported among 27.6% of current users (Cooper et al., 2022). Research posits that eating disorders and nicotine use are highly comorbid. A recent study by Ganson and Nagata (2021) found that nearly 20% of participating adolescents with an eating disorder also used nicotine within the past 30 days. This is problematic, as nicotine use increases the mortality rate for eating disorders, which already has the second highest rate of all mental health disorders. Nicotine use may also exacerbate many of the medical complications associated with eating disorders (e.g., neuroendocrinal, dental, nutritional) and negatively impact eating disorder recovery (Ganson & Nagata, 2021).