Social media and mental health linked to rising e-cigarette use in American teens

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

Study: Social media and e-cigarette use: The mediating role of mental health conditions. Image Credit: Diego Cervo / Shutterstock


About 2.55 million school students in the United States (US) use e-cigarettes, the most popular tobacco product among the country's youth. While e-cigarettes may be useful in aiding smoking cessation, they contain nicotine and other toxic chemicals associated with lung and cardiovascular diseases. Given the youth's extensive use of social media, e-cigarette brands are widely promoted using social media platforms, positioning e-cigarettes as seemingly better alternatives to smoking. As a result, previous studies have shown an increased use of e-cigarettes by social media users as compared to non-users.

Mental health problems are also shown to be associated with increased experimentation and use of e-cigarettes in the youth. Evidence suggests that e-cigarette users are more likely to experience mental health issues such as depression and stress. Further, previous studies indicate an increased influence of social media on females' mental health than males. However, there is a lack of studies examining the potential influence of mental health condition indicators on the association between the use of social media and e-cigarettes among the youth. Therefore, this study aimed to test the hypothesis that mental health condition indicators may mediate the increased use of e-cigarettes associated with social media use among the youth while checking for potential gender-based differences in the mediation.

About the study

Data from the 2022 National Youth Tobacco Survey (NYTS) was used, which estimates tobacco use in US middle and high school students. About 23,445 students were included in the study, and information was gathered using online forms. About 49.9% of the sample were females. The 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, the frequency of social media use was categorized as "never" (did not use social media), "sometimes" (less than once per week or 1–2 hours daily), "often" (3–4 hours daily), and "very often" (>4 hours daily). To measure the mental health condition indicators, the Patient Health Questionnaire-4 (PHQ-4) (an established screening tool for anxiety and depression) was used.

The potential outcomes framework was applied to study the mediation by mental health condition indicators of the link between social media use and e-cigarette use by the participants. Additionally, a gender-stratified analysis was conducted to understand the probable differences among the two genders.

Results and discussion

The results suggest that the individuals using social media "very often" were more likely to use e-cigarettes as compared to those who used social media "sometimes" or "never" (odds ratio (OR) = 1.41). The likelihood of using e-cigarettes was higher (OR = 1.57) and statistically significant in the "very often" social media users when the results were adjusted for individual characteristics and mental health condition indicators as a mediator.

Gender-stratified analysis suggests that the use of social media had significant effects on the use of e-cigarettes via mental health condition indicators, and the effects were more pronounced in females (OR = 2.27) than in males (OR = 1.53). Female students using social media "often" or "very often" were found to be more likely to use e-cigarettes via mental health condition indicators.

The findings of this study are consistent with existing literature and indicate that excessive use of social media may negatively affect the mental health of the young population, potentially leading to increased use of e-cigarettes by them. The study supports strategies and recommendations focusing on restricting the use of social media among young people.

While this is the first study linking mental health condition indicators, social media use, and e-cigarette use among the youth, it is limited by the fact that the indicators, including anxiety and depression, were self-reported by the participants. Future studies could be extended to non-school-going youth and could further investigate the biological mechanisms underlying the gender-based differences observed in this study.


In conclusion, this study describes the role of mental health condition indicators, including depression and anxiety, in the link between the use of social media and e-cigarettes among school-going youth in the US. The study highlights the growing public health concerns associated with social media use. It emphasizes that the increasing social media use, especially among the youth, may severely impact their physical and mental health.

Journal reference:
  • Social media and e-cigarette use: The mediating role of mental health conditions. Azagba, S., Ebling, T. & Korkmaz, A., Journal of Affective Disorders (2023), DOI:,

Posted in: Child Health News | Medical Research News

Tags: Anxiety, Chemicals, Cigarette, Depression, Frequency, Mental Health, Nicotine, Public Health, Smoking, Smoking Cessation, Stress, students, Tobacco

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Written by

Dr. Sushama R. Chaphalkar

Dr. Sushama R. Chaphalkar is a senior researcher and academician based in Pune, India. She holds a PhD in Microbiology and comes with vast experience in research and education in Biotechnology. In her illustrious career spanning three decades and a half, she held prominent leadership positions in academia and industry. As the Founder-Director of a renowned Biotechnology institute, she worked extensively on high-end research projects of industrial significance, fostering a stronger bond between industry and academia. 

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