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Smoking and e-cigarettes increase depression and anxiety in teens
Last reviewed: 27.07.2025
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Teens who use e-cigarettes or traditional tobacco products (CTP) — such as cigarettes, cigars, hookah, and pipes — are significantly more likely to report symptoms of depression and anxiety than those who do not use tobacco products at all, according to a study published in the journal PLOS Mental Health by Noor Abdulhay of West Virginia University and colleagues.
It is known that tobacco use and mental health problems have a complex, two-way relationship. Understanding the relationship between tobacco use and mental health in adolescents is especially important because adolescence is a critical period of development during which many risky health behaviors are formed. Additionally, the United States is seeing increases in anxiety disorders, depression, and suicide among adolescents, and changing patterns of tobacco use.
In the new study, researchers used data on tobacco use, symptoms of depression and anxiety, and various demographic characteristics collected in the 2021–2023 National Teen Tobacco Survey. Among 60,072 middle and high school students who completed all surveys, 21.37% used tobacco products: 9.94% used e-cigarettes only, 3.61% used traditional tobacco products only, and 7.80% used both.
Overall, 25.21% of participants reported symptoms related to depression, and 29.55% reported symptoms related to anxiety. Compared with adolescents who did not use tobacco products, those who used e-cigarettes or CTPs had a potentially increased risk of depression and anxiety, and those who used both e-cigarettes and CTPs were most likely to have mental health problems.
The authors conclude: "Although causality cannot be established, the results of this study showed that all forms of tobacco use were significantly associated with mental health problems. Further promotion of mental health support and targeted interventions to combat all forms of tobacco use among adolescents are needed."