Use of and perceptions about electronic nicotine delivery systems (ENDS) among people with mental health conditions or serious psychological distress, 2018

Drug Alcohol Depend. 2020 Jul 1;212:108049. doi: 10.1016/j.drugalcdep.2020.108049. Epub 2020 May 13.


Background: People with mental health conditions (MHC) experience health disparities related to combustible tobacco use, and recent studies suggest disproportionately high use of electronic nicotine delivery systems (ENDS, e.g., e-cigarettes) among adults with MHC. Continued surveillance of ENDS use by MHC status is needed, as well as in-depth examinations of why adults with versus without MHC are using ENDS.

Methods: Using 2018 U.S. nationally representative data (N = 5878), this study examined associations between MHC and serious psychological distress (SPD) with ENDS use. Among current ENDS users (n = 544), associations between MHC and SPD with perceived benefits and reasons for using ENDS were also investigated.

Results: Both MHC and SPD were associated with higher likelihood of having ever used ENDS, currently using ENDS, and currently using ENDS daily. There was an interaction between SPD and smoking status in predicting current ENDS use such that the association between SPD and higher current ENDS use was stronger among never smokers. Compared to those without MHC, participants with MHC indicated that using ENDS helped them feel more relaxed and that stress management was a more important reason for ENDS use.

Conclusions: U.S. adults with MHC (and particularly never smokers with SPD) report disproportionately high use of ENDS. Individuals with MHC may be particularly likely to use ENDS for relaxation and stress management.

Keywords: Electronic nicotine delivery devices; Mental health conditions; Psychological distress; e-cigarettes.

Publication types

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

MeSH terms

  • Adolescent
  • Adult
  • Cross-Sectional Studies
  • Electronic Nicotine Delivery Systems*
  • Female
  • Humans
  • Male
  • Mental Disorders / epidemiology*
  • Mental Disorders / psychology*
  • Mental Health / trends
  • Middle Aged
  • Perception / physiology
  • Psychological Distress*
  • United States / epidemiology
  • Vaping / epidemiology*
  • Vaping / psychology*
  • Vaping / trends
  • Young Adult