The Association Between Depression and E-Cigarette Use in US Adults, 2017-2020: An Analysis of National Survey Data Open Access

Wynne, Allison (Spring 2022)

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Objective: The prevalence of e-cigarette use in the United States is rising, yet risk factors associated with their use are not well known. This research aims to evaluate the association between depression and e-cigarette use among adults age 20 and older in the United States.

Methods: Using the National Health and Nutrition Examination Survey 2017- March 2020 Pre- Pandemic Dataset, we conducted a multiple logistic regression to evaluate the association of depression (primary exposure) and the impact of depressive symptoms (secondary exposure) with e-cigarette use (outcome). The analysis was stratified by use of combustible cigarettes, and restricted to 4,580 participants ages 20 and older with complete data for demographic information and smoking status, as well as complete depression screeners.

Results: Participants were an average of 47.6 years at the time of survey. Among US adults in 2107-2020, the prevalence of e-cigarette use was 3.5% (95% CI: 2.5-4.4), and the prevalence of depression was 12.6% (95% CI: 11.1-14.1). Among combustible cigarette non-users, the odds of using e-cigarettes was 3.2 (95%CI: 1.8-5.7) times higher among those with depression compared to those without depression, after adjusting for demographics. There was not a significant association between the impact of depressive symptoms and e-cigarette use status.

Conclusions: Among combustible cigarette non-smokers, those with depression were 3.2 times more likely to use e-cigarettes than those without depression.

Policy implications: People who suffer from depression but do not smoke conventional cigarettes may be at a higher than average risk for using e-cigarettes. This indicates that depression is a significant risk factor for e-cigarette use. The mental health of e-cigarette users should be considered in developing policies and regulations regarding the production and sale of e- cigarettes. Clinicians should employ techniques to prevent e-cigarette use among their patients who suffer from depression. 

Table of Contents

Introduction 1

Literature Review 2

Background 2

Electronic Cigarettes 3

Depression as a Public Health Concern 4

Identifying Depression in the Population: The Patient Health Questionnaire (PHQ-9) 5

Depression and E-Cigarettes 6

Methods 8

Data 8

Study Measures 8

E-cigarette use 8

Depression 8

Impact of Depression on Daily Life 9

Demographic characteristics 9

Statistical Analysis 10

Results 11

Characteristics of the Study Population, NHANES 2017-2020 (Pre-Pandemic) 11

Prevalence of Depression among E-Cigarette and Cigarette Users and Non-Users 11

Association Between Depression and E-Cigarette Use Stratified by Combustible Cigarette Use 11

Association Between Impact of Depressive Symptoms and E-Cigarette Use 12

Discussion 13

Public Health Implications 14

Tables and Figures 15

Figure 1. Sample Selection Flowchart 15

Table 1. Characteristics of the Study Population, NHANES 2017-March 2020 Pre-Pandemic 16

Figure 2. Prevalence of Depression by E-Cigarette Use and Combustible Cigarette Use 17

Table 2. Association Between Depression and E-Cigarette Use Stratified by Combustible Cigarette Use 18

Table 3. Association Between Impact of Depressive Symptoms and E-Cigarette Use Among Cigarette Non-Users 19

References 20 

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