Co-occurrence of tobacco product use, substance use, and mental health problems among youth
Conway, K. P., Green, V. R., Kasza, K. A., Silveira, M. L., Borek, N., Kimmel, H. L., ... Compton, W. M. (2018). Co-occurrence of tobacco product use, substance use, and mental health problems among youth: Findings from wave 1 (2013-2014) of the population assessment of tobacco and health (PATH) study. Addictive Behaviors, 76, 208-217. DOI: 10.1016/j.addbeh.2017.08.009
Introduction: Cigarette use is associated with substance use and mental health problems among youth, but associations are unknown for non-cigarette tobacco product use, as well as the increasingly common poly-tobacco use.
Methods: The current study examined co-occurrence of substance use and mental health problems across tobacco products among 13,617 youth aged 12-17 years from Wave 1 (2013-2014) of the nationally representative Population Assessment of Tobacco and Health (PATH) Study. Participants self-reported ever cigarette, e-cigarette, smokeless tobacco, traditional cigar, cigarillo, filtered cigar, hookah, and other tobacco product use; alcohol, marijuana, and other drugs; and lifetime substance use, internalizing and externalizing problems.
Results: In multivariable regression analyses, use of each tobacco product was associated with substance use, particularly cigarillos and marijuana (AOR = 18.9, 95% CI: 15.3-23.4). Cigarette (AOR = 14.7, 95% CI: 11.8-18.2) and cigarillo (AOR = 8.1, 95% CI: 6.3-10.3) use were strongly associated with substance use problems and tobacco users were more likely to report internalizing (AOR = 1.6, 95% CI: 1.4-1.8) and externalizing (AOR = 1.4, 95% CI: 1.3-1.6) problems. Female tobacco users were more likely to have internalizing problems than male tobacco users. Poly-tobacco users were more likely than exclusive users to use substances (AOR = 3.4, 95% CI: 2.7-4.3) and have mental health (AOR = 1.2, 95% CI: 1.0-1.5) and substance use (AOR = 4.7, 95% CI: 3.4-6.6) problems.
Conclusions: Regardless of the tobacco product used, findings reveal high co-occurrence of substance use and mental health problems among youth tobacco users, especially poly-tobacco users. These findings suggest the need to address comorbidities among high risk youth in prevention and treatment settings.