Mental Health Problems and Onset of Tobacco Use Among 12- to 24-Year-Olds in the PATH Study

J Am Acad Child Adolesc Psychiatry. 2018 Dec;57(12):944-954.e4. doi: 10.1016/j.jaac.2018.06.029. Epub 2018 Oct 4.


Objective: To examine whether mental health problems predict incident use of 12 different tobacco products in a nationally representative sample of youth and young adults.

Method: This study analyzed Wave (W) 1 and W2 data from 10,533 12- to 24-year-old W1 never tobacco users in the Population Assessment of Tobacco and Health (PATH) Study. Self-reported lifetime internalizing and externalizing symptoms were assessed at W1. Past 12-month use of cigarettes, electronic nicotine delivery systems (ENDS), traditional cigars, cigarillos, filtered cigars, pipe, hookah, snus pouches, other smokeless tobacco, bidis and kreteks (youth only), and dissolvable tobacco was assessed at W2.

Results: In multivariable regression analyses, high-severity W1 internalizing (adjusted odds ratio [AOR] = 1.5, 95% CI = 1.3-1.8) and externalizing (AOR = 1.3, 95% CI = 1.1-1.5) problems predicted W2 onset of any tobacco use compared to no/low/moderate severity. High-severity W1 internalizing problems predicted W2 use onset across most tobacco products. High-severity W1 externalizing problems predicted onset of any tobacco (AOR = 1.6, 95% CI = 1.3-1.8), cigarettes (AOR = 1.4, 95% CI = 1.0-2.0), ENDS (AOR = 1.8, 95% CI = 1.5-2.1), and cigarillos (AOR = 1.5, 95% CI = 1.0-2.1) among youth only.

Conclusion: Internalizing and externalizing problems predicted onset of any tobacco use. However, findings differed for internalizing and externalizing problems across tobacco products, and by age, gender, and race/ethnicity. In addition to screening for tobacco product use, health care providers should screen for a range of mental health problems as a predictor of tobacco use. Interventions addressing mental health problems may prevent youth from initiating tobacco use.

Keywords: epidemiologic studies; mental health; tobacco; young adult.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Child
  • Cohort Studies
  • Electronic Nicotine Delivery Systems / statistics & numerical data
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Mental Disorders / epidemiology*
  • Mental Disorders / psychology
  • Self Report
  • Substance-Related Disorders / epidemiology*
  • Substance-Related Disorders / psychology
  • Tobacco Products / statistics & numerical data
  • Tobacco Use / epidemiology*
  • Tobacco Use / psychology
  • United States / epidemiology
  • Young Adult