E-Cigarette Use and Symptoms of Depression and Anxiety Among US Middle and High School Students.

Introduction: E-cigarettes are the most commonly used tobacco product among youth. Most e-cigarettes contain nicotine, which is highly addictive and can harm the developing brain. Youth e-cigarette use is associated with poor mental health.

Methods: We analyzed self-reported data from the 2024 National Youth Tobacco Survey to describe e-cigarette use and symptoms of depression and anxiety among US middle and high school students.

Results: In 2024, 42.1% of youth who currently used e-cigarettes reported moderate-to-severe symptoms of depression and anxiety compared with 21.0% of youth who never or formerly used e-cigarettes. Among youth who currently used e-cigarettes, those with moderate-to-severe symptoms of depression and anxiety (vs no-to-mild symptoms) more frequently reported symptoms of dependence - wanting to use an e-cigarette within 30 minutes of waking (28.2% vs 15.6%, P < .001) and having strong cravings (37.6% vs 22.4%, P < .001) - and "feeling anxious, stressed, or depressed" as a reason for first (41.8% vs 18.4%, P < .001) and current (51.0% vs 25.2%, P < .001) use. Most youth who used e-cigarettes attempted to quit in the past year (69.4%), but over half (58.5%) did not use any quitting resources.

Conclusion: Moderate-to-severe symptoms of depression and anxiety are common among youth who use e-cigarettes. Youth with these symptoms may need additional support to prevent or quit e-cigarette use. Integrating mental health support into comprehensive approaches to tobacco use prevention and cessation, paired with strengthening the foundations of healthy communities for youth, may reduce youth e-cigarette use.