The interplay of electronic cigarette use and mental health: a scoping review of bidirectional associations, underlying mechanisms, and moderating factors

Mohammed Looti; Marwa Abd-alazim; Mohammed Looti; Marwa Abd-alazim

doi:10.48130/jsc-0025-0012

The concurrent rise in e-cigarette use and mental health challenges among youth necessitates a clear synthesis of evidence. This scoping review systematically maps recent literature on their relationship. Following the Arksey and O'Malley framework, and PRISMA-ScR guidelines, Scopus and Web of Science were searched for studies published between 2019 and 2024, yielding 54 studies from 1,853 records. The present analysis revealed a consistent co-occurrence, with higher rates of e-cigarette use among individuals with mental health conditions and vice versa. Several longitudinal studies reported prospective associations in both directions, suggesting a bidirectional link, though causal inference remains limited. Implicated mechanisms include neurobiological pathways (reward/stress circuits), psychological factors like using vaping to cope, and social influences, with age, gender, substance use, and socioeconomic factors acting as moderators. These findings underscore the need for integrated public health strategies combining prevention, regulation, and clinical care for vulnerable populations. Further longitudinal research is crucial to elucidate causal pathways and underlying mechanisms.

HTML

Introduction

The means by which individuals consume nicotine have shifted with the introduction of electronic cigarettes, a change observed with particular frequency among younger cohorts^[1−3]. These devices were initially positioned within the public sphere as a less harmful alternative to combustible cigarettes, and perhaps an aid for smoking cessation, a framing that held significant appeal for adolescents and young adults^[4,5]. It is within this same demographic that a concurrent and well-documented increase in mental health difficulties, including depressive and anxiety-related conditions, has been observed^[6,7]. The possibility that these are merely parallel non-related trends warrants careful consideration, and the subject has indeed attracted international research efforts with studies, for example, exploring the various determinants of e-cigarette uptake in settings as diverse as Turkey^[8]. Existing reviews have certainly explored this area^[9−11], yet the rapid pace of scientific inquiry suggests that a more current analysis is needed. Building upon earlier work that established a preliminary link between these phenomena, this particular review differentiates itself by concentrating strictly on the most recent body of literature spanning from 2019 to 2024, in an effort to map not only the correlational data, but also the proposed mechanisms and moderating factors that shape this complex association.

The initial harm-reduction narrative for e-cigarettes is being challenged by evidence pointing to an intricate, reciprocal relationship with mental health. This evidence suggests that e-cigarette use may trigger or intensify psychological distress, while individuals with pre-existing vulnerabilities appear more disposed to using them^[5,12,13]. It is in response to this complex and evolving landscape that the present scoping review undertakes a systematic mapping of the existing research. The specific focus is a comprehensive overview of this connection derived from literature published between the beginning of 2019 and the close of 2024, sourced from the Scopus and Web of Science databases with the intention of synthesizing the most recent findings into a lucid evidence map designed to inform public health policy, clinical practice, and the direction of future inquiry in a timely fashion.

The matter gains additional weight because the developmental stages of adolescence and young adulthood constitute a crucial window for brain maturation, a period where the still-developing brain shows a pronounced susceptibility to both substance use and the initial presentation of mental illness^[14,15]. A central concern therefore, relates to how nicotine, the principal addictive constituent found in most e-cigarettes, might adversely affect the nervous system during its formation^[12]. The introduction of nicotine during these formative years could plausibly alter normative neurodevelopmental processes, a disruption that may contribute to long-standing cognitive and emotional challenges, and elevate the vulnerability for subsequent psychiatric disorders.

The wide availability of e-cigarettes, alongside youth-centric marketing, has fostered a general belief of reduced harm^[16]. This perception is particularly significant for individuals with psychological difficulties who may vape as a form of self-medication to manage unpleasant emotional states^[17−19], because the immediate albeit temporary relief the behavior provides can act as a powerful reinforcer for its use, which in turn encourages a pattern of dependence with the potential to worsen the underlying conditions it was initially used to soothe.

The analysis is further complicated by the frequent co-occurrence of e-cigarette use with other substances such as alcohol, cannabis, or even traditional cigarettes^[20,21], a pattern of polysubstance use which is consistently linked to more pronounced mental health challenges and less favorable treatment results^[22−25]. It is useful to distinguish here between 'dual use', a term reserved for the combined use of electronic and combustible cigarettes, and the broader category of 'polysubstance use', which encompasses the use of e-cigarettes with other psychoactive agents like cannabis because the specific mixture of substances can yield distinct and possibly amplified effects on psychological well-being. This fact highlights the importance of discerning precisely what is being aerosolized, whether nicotine, cannabis, or another substance, as this variable significantly modifies the observed mental health correlates^[19], and thus requires an analytical framework that carefully considers the specific substances and behaviors involved, instead of treating 'vaping' as a single uniform activity.

It is also important to identify which groups are most affected, and some research points to sexual and gender minorities (SGM) as a population at a disproportionately higher risk for both vaping and certain mental health conditions^[24,26,27], making an understanding of the specific stressors and risk factors that these communities experience an essential consideration for the development of effective interventions. Other life circumstances, from immigration status^[28] to the stress of food insecurity^[29], also appear to be significant factors in the observed relationship between substance use and mental wellness, and there is also a finding from some studies suggesting that individuals with mental illness can sometimes fully grasp the risks of vaping^[18], a point that complicates simple assumptions about their vulnerability.

The existing research on this relationship is distributed across a variety of studies that focus on different populations, use disparate methods, and measure diverse outcomes, and so this scoping review represents an effort to draw these separate findings into a more coherent picture. The goal is to identify where the research aligns, where it conflicts, and to point out the gaps in our current understanding that require more investigation as effective public health policies, prevention strategies, and clinical guidelines must be based on this kind of evidence. By systematically mapping the current knowledge, this review aims to provide a useful resource for researchers, clinicians, policymakers, and educators, and the whole review will address four research questions that give structure to the results, exploring a relationship that is likely due to a mix of neurobiological, psychological, and social factors, and is influenced by key variables like age, and co-occurring substance use.

(1) What are the rates of e-cigarette use among individuals with various mental health disorders, and, reciprocally, what are the rates of mental health disorders among individuals who use e-cigarettes?

(2) What is the body of evidence supporting a reciprocal link between e-cigarette use and mental health?

(3) What are the proposed neurobiological, psychological, and social processes that might account for the association between e-cigarette use and mental health?

(4) Which variables are identified as moderators that alter the magnitude and directionality of the association between e-cigarette use and mental health?

Results

Study selection

The initial database searches identified 1,853 records. After removing duplicates, the screening of 1,426 unique titles and abstracts produced 211 potentially relevant articles for full-text review. An independent assessment by two reviewers followed, and any discrepancies were settled through consensus or, when necessary, consultation with a third reviewer, leading to the exclusion of 157 articles. Articles were removed if they did not examine the relevant relationship, focused solely on traditional tobacco, were non-empirical, or otherwise failed to meet inclusion criteria. This process resulted in a final group of 54 studies for this scoping review. The whole study selection procedure is illustrated in the PRISMA flow diagram (Fig. 1), and the characteristics and core findings of each included study are detailed in Table 1.

Geographical distribution of included studies
The 54 studies included in this review showed an unbalanced geographical representation. A large portion, nearly half (n = 26) came from the US. Further studies were from Canada (n = 6), the UK (n = 2), and Australia (n = 3). A smaller set of studies came from Thailand (n = 2), New Zealand (n = 1), Nigeria (n = 1), and several multi-country collaborations. This distribution, which spans North America, parts of Europe, Asia, and Oceania, provides a degree of generalizability. However, the unique cultural and regulatory contexts of each country must be considered when evaluating the results. The concentration of work in the US suggests a need for more research from other global regions.

Prevalence of e-cigarette use and mental health conditions: detailed findings
The key characteristics and findings of the 54 included studies are systematically summarized in Table 1. One of the most consistent observations, was a higher prevalence of e-cigarette use among individuals with mental health conditions, and the connection was also present in the other direction, with a higher occurrence of mental health conditions found among individuals who use e-cigarettes. The strength of this association did vary across the literature. These differences can be linked to variations in sample population, measurement approaches, or the specific definitions used for 'e-cigarette use', and 'mental health conditions', yet the general direction of the finding remained constant across the studies.

Specific mental health conditions
Depression and anxiety were the most examined conditions, but several investigations also included post-traumatic stress disorder (PTSD)^[24], attention-deficit/hyperactivity disorder (ADHD)^[34], and substance use disorders^[35]. Generally, these studies reported higher rates of e-cigarette use across these populations. Hahn and colleagues^[35], for instance, found that among individuals with HIV, depression, and panic disorder were more frequent in those with a history of vape use. Similarly, Vaziri et al.^[36] noted that substance use was more common than expected in cystic fibrosis patients with abnormal mental health screens, while Schuler et al.^[37] found significant associations between e-cigarette use and PTSD, depression, and anxiety among active-duty military personnel. In university settings, Wamamili et al.^[38] confirmed that students with a history of mental illness had significantly higher prevalence rates for both smoking and vaping.

Severity of mental health symptoms
Some studies went beyond diagnostic categories to examine the association between the severity of mental health symptoms and e-cigarette use^[22,27]. A consistent 'dose-response' relationship was observed, greater symptom severity was associated with a higher likelihood and frequency of using e-cigarettes.

Dual use and polysubstance use
The practice of dual-use (e-cigarettes with combustible cigarettes), and polysubstance use (e-cigarettes with alcohol, cannabis, or other substances) was common in cohorts with mental health conditions^[20−22]. Zvolensky et al.^[13] provided an example, showing that Latinx 'dual users' reported significantly higher levels of anxiety, depression, and other psychological distress markers compared to those who only used combustible cigarettes.

Vaping cessation
A randomized controlled trial by Klein et al.^[39] focused on young adults (18–24) using e-cigarettes for cessation. This group exhibited substantial nicotine dependence and a history of unsuccessful quit attempts, with 29.4% having tried NRT, and also presented with concurrent stress, anxiety, and depression.

Sexual and gender minorities
Research on sexual and gender minority (SGM) populations consistently showed elevated rates of e-cigarette use co-occurring with mental health conditions^[24,26,27]. This suggests specific vulnerabilities within this demographic.

Bidirectional associations
A bidirectional relationship between e-cigarette use and mental health is supported by several longitudinal studies, where each can influence the other. For the purposes of this review, 'bidirectionality' refers to evidence where: (a) baseline mental health symptoms predict future e-cigarette use; and (b) baseline e-cigarette use predicts future mental health symptoms, even if not always within the same study. However, the precise patterns and strength of this connection varied.

Mental health predicting e-cigarette use
A common theoretical view is that vaping is used for self-medication, or as a maladaptive coping strategy^[7,8,40]. People experiencing negative affect, stress, or other mental health symptoms may use e-cigarettes for the calming or mood-altering effects of nicotine. This perspective is supported by research that connects psychological vulnerabilities, such as anxiety sensitivity, to increased e-cigarette use^[13,41].

E-cigarette use predicting mental health
When viewed from the opposite direction, some work suggests that e-cigarette use might itself be a predictor of later mental health difficulties, with the primary line of inquiry focusing on the neurobiological consequences of nicotine exposure, particularly within the context of the still-maturing adolescent brain^[26,42,43], where the central idea is that sustained nicotine intake could potentially disrupt the very neurotransmitter systems responsible for mood regulation, thereby leaving an individual more susceptible to conditions like depression and anxiety, a line of reasoning that is not unlike the extensive evidence linking traditional cigarette smoking to similar outcomes in mental well-being.

Reciprocal relationships
A more intricate reciprocal model is also found within a few studies in which e-cigarette use and mental health problems are viewed as reinforcing one another over time^[44], a dynamic from which it follows that effective interventions would probably need to address both issues simultaneously.

Mental health and vaping cessation
The issue is complicated further by factors related to cessation. Smokers with depression are often motivated to quit but may have more difficulty staying abstinent. Regarding professional support, Tildy et al.^[45] found that while smokers with depression often visited healthcare professionals, they were not always more likely to receive advice to quit. For those who do stop smoking combustible cigarettes, a high likelihood of switching to vaping instead of stopping nicotine entirely seems to exist^[21]. However, Li Lin et al.^[46] noted that having a poor physical or mental health condition did not necessarily increase the probability that an individual would specifically turn to vaping as a method for cessation.

Underlying mechanisms: detailed findings

Neurobiological mechanisms
While most included studies did not directly measure neurobiological changes, a few (e.g., Kang et al.^[42], Keum et al.^[43]) offered plausible mechanisms derived from adjacent literature. They implicate specific brain regions in the connection between e-cigarette use and mental health, including areas central to reward processing (the ventral striatum), the stress response (amygdala), and cognitive control (the prefrontal cortex). However, this review found a lack of studies with direct mapping of these neural correlates through advanced neuroimaging in e-cigarette users. The potential role of other constituents in e-cigarette liquids, such as flavorings or solvents, on brain function also warrants investigation.

Psychological mechanisms
Several psychological constructs were identified as potential mediators or mechanisms explaining the link. Spears et al.^[47] observed that adults with serious psychological distress were particularly inclined to use e-cigarettes for relaxation and stress management. The fear of anxiety-related bodily sensations, or Anxiety Sensitivity, showed a consistent link with both greater e-cigarette use, and more pronounced mental health difficulties^[13,48]. This connects to findings on Distress Tolerance, which was found to be lower among dual users when compared to individuals who only used combustible cigarettes^[13]. Salazar-Londoño et al.^[49] similarly linked risky consumption patterns to symptoms of anxiety and loneliness. Emotion Dysregulation, the difficulty in managing emotional states, was similarly implicated^[41]. Separately, one study found that vape users reported diminished scores on mindfulness, which was inversely related to higher rumination and less self-compassion^[14]. Additionally, Wade et al.^[50] suggested that distinct user profiles exist as users of combustible vs non-combustible products exhibited different mental health correlates. Wattick et al.^[51] further emphasized that social motivations often drive use among college students, acting alongside adverse childhood experiences. Using vaping to manage negative emotions, what we call Coping Motives, proved to be a strong predictor for both continued e-cigarette engagement and poorer mental health trajectories^[52,53].

Social mechanisms
Social factors, such as peer influence, prevailing social norms, and exposure to e-cigarette marketing, were often found to be associated with both e-cigarette use and mental health outcomes, with adolescents and young adults appearing particularly responsive to these external pressures^[54]. Protective factors also play a role, Lilly et al.^[55] found that a positive school climate was associated with fewer symptoms of anxiety and depression, functioning as a protective element against substance use. Similarly, Jones et al.^[56] highlighted that higher self-efficacy and knowledge of risks were associated with a lower prevalence of vaping. The experience of social isolation and loneliness also emerged as a significant element that seemed to amplify both vaping and mental distress, and this relationship became especially pronounced during the time of the COVID-19 pandemic^[52,53,57].

Moderating factors: detailed findings

Age
Of the various moderating factors considered, age stood out as particularly significant, as adolescents and young adults consistently demonstrated a heightened vulnerability, a finding that seems to be a product of both the unique sensitivity of the developing brain to the neurobiological effects of nicotine, and the powerful influence of social dynamics and peer groups that characterize this life stage, and in studies that specifically examined younger adolescent cohorts the role of parental practices concerning tobacco use was also identified as a relevant factor^[15].

Gender
The role of gender as a moderating factor presented a less clear picture across the literature because while some investigations did report differences related to gender, the specific patterns were often inconsistent, with some findings suggesting that females might have a greater vulnerability to the adverse mental health effects of e-cigarettes^[58], even as other studies reported stronger associations among males^[27]. This divergence indicates that more research is certainly needed to clarify these gender-specific dynamics.

Co-occurring substance use
A very strong, and nearly ubiquitous finding across the reviewed studies, was the connection between e-cigarette use and the use of other substances, particularly alcohol and cannabis^[2,23,25]. Hefner et al.^[59] emphasized the need to clarify the relationships between risky alcohol use, nicotine consumption, and mental illness to guide intervention efforts. Adzrago et al.^[60] further identified that frequent e-cigarette use was significantly associated with concurrent alcohol and cannabis consumption, as well as stress related to social distancing. This pattern of polysubstance use was consistently linked to more significant mental health problems, a reality that naturally raises questions about whether specific combinations of substances might produce unique or synergistic effects on an individual's psychological well-being.

Type of substance vaped
The specific substance being vaped seems to matter quite a bit. Studies that made a distinction between nicotine and cannabis often discovered stronger links between vaping cannabis and later mental health issues^[17,40]. This suggests THC's psychoactive properties likely have a considerable, and maybe even separate, role beyond the impact of nicotine alone.

Dual vaping
The behavior of vaping both nicotine and cannabis, often called 'dual vaping', was reported to be quite widespread. In one study, for instance, more than a quarter (26.1%) of the participants said they had done this in the last 30 d^[16]. Two notable predictors were associated with increased odds of dual-vaping: identifying as male, and reporting self-rated anxiety^[16].

[1]	Adzrago D, Sulley S, Williams F. 2024. Immigration status-related exclusive e-cigarette use and cannabis use and their dual use disparities associated with mental health disorder symptoms. Drug and Alcohol Dependence 259:111450 doi: 10.1016/j.drugalcdep.2024.111083 CrossRef Google Scholar
[2]	Leung J, Ellem R, Glasgow S, Rowe AL, Gardner L, et al. 2025. The use and knowledge around vaping and their correlates among university students − a cross-sectional Australian study. International Journal of Mental Health and Addiction 23:3105−23 doi: 10.1007/s11469-024-01281-5 CrossRef Google Scholar
[3]	Hanafin J, Sunday S, Clancy L. 2023. Higher smoking and e-cigarette use among young adults with mental health problems: an analysis of wave 4 of growing up in Ireland, the national longitudinal study of children in Ireland. Tobacco Prevention & Cessation 9:172734 doi: 10.18332/tpc/172734 CrossRef Google Scholar
[4]	Leung J, Tisdale C, Choi J, Ellem R, Davidson L, et al. 2025. E-cigarette use among high school students − a cross-sectional study of associated risk factors for the use of flavour-only and nicotine vapes. International Journal of Mental Health and Addiction 23:236−50 doi: 10.1007/s11469-023-01099-7 CrossRef Google Scholar
[5]	Phetphum C, Prajongjeep A, Phuengnam K. 2024. Relationship between electronic cigarette use, dual smoking habits, and psychological distress among youth in Northern Thailand: a cross-sectional study. Tobacco Induced Diseases 22:82 doi: 10.18332/tid/186860 CrossRef Google Scholar
[6]	Dabravolskaj J, Veugelers PJ, Amores A, Leatherdale ST, Patte KA, et al. 2023. The impact of 12 modifiable lifestyle behaviours on depressive and anxiety symptoms in middle adolescence: prospective analyses of the Canadian longitudinal COMPASS study. International Journal of Behavioral Nutrition and Physical Activity 20:45 doi: 10.1186/s12966-023-01436-y CrossRef Google Scholar
[7]	Bataineh BS, Wilkinson AV, Sumbe A, Clendennen SL, Chen B, et al. 2023. The association between tobacco and cannabis use and the age of onset of depression and anxiety symptoms: among adolescents and young adults. Nicotine & Tobacco Research 25:1455−64 doi: 10.1093/ntr/ntad058 CrossRef Google Scholar
[8]	Ünver Ş. 2025. Investigation of factors affecting tobacco and e-cigarette use in Turkey. Journal of Substance Use 30:181−88 doi: 10.1080/14659891.2024.2335484 CrossRef Google Scholar
[9]	Javed S, Usmani S, Sarfraz Z, Sarfraz A, Hanif A, et al. 2022. A scoping review of vaping, e-cigarettes and mental health impact: depression and suicidality. Journal of Community Hospital Internal Medicine Perspectives 12:6 doi: 10.55729/2000-9666.1053 CrossRef Google Scholar
[10]	Do EK, Tulsiani S, Koris K, Minter T, Hair EC. 2024. Depression, anxiety, stress, and current e-cigarette use: results from the truth longitudinal cohort of youth and young adults (2022−2023). Journal of Affective Disorders 365:628−33 doi: 10.1016/j.jad.2024.08.127 CrossRef Google Scholar
[11]	Ibrahim FM, Shahrour G, Hashim A, Yasin A, Allam AR. 2025. E-cigarette usage and mental health among undergraduate medical and health sciences students. Scientific Reports 15:13169 doi: 10.1038/s41598-025-94545-6 CrossRef Google Scholar
[12]	Cai J, Bidulescu A. 2024. E-cigarette use or dual use of e-cigarette and combustible cigarette and mental health and cognitive impairment: findings from the National Health Interview Survey, 2020−2021. Journal of Affective Disorders 351:878−87 doi: 10.1016/j.jad.2024.01.056 CrossRef Google Scholar
[13]	Zvolensky MJ, Shepherd JM, Clausen BK, Redmond BY, De Dios M, et al. 2024. Combustible cigarette smokers versus dual combustible and electronic users: evaluation of differences in anxiety, depression, and transdiagnostic constructs among Latinx adults. Journal of Ethnicity in Substance Abuse 2024:1−18 doi: 10.1080/15332640.2024.2391309 CrossRef Google Scholar
[14]	Evans SL, Alkan E. 2024. Personality risk factors for vape use amongst young adults and its consequences for sleep and mental health. Healthcare 12:423 doi: 10.3390/healthcare12040423 CrossRef Google Scholar
[15]	Han DH, Shin E. 2024. Parenting practices, mental health, and electronic cigarette use among U. S. young adolescents: a longitudinal panel analysis, 2013−2018. Preventive Medicine 178:107795 doi: 10.1016/j.ypmed.2023.107795 CrossRef Google Scholar
[16]	Liu J, Hanby E, Kingsley M, Winickoff JP, Gundersen DA, et al. 2024. Dual-vaping of nicotine and cannabis among adults who currently use tobacco products in five New England states. Nicotine & Tobacco Research 26:1253−58 doi: 10.1093/ntr/ntae062 CrossRef Google Scholar
[17]	Salinas KZ, Saran S, Saulnier K, Hoglen B, Houser KR, et al. 2024. A comparison of mental health symptoms among adults who vape nicotine, cannabis, or both. Substance Use & Misuse 59:601−7 doi: 10.1080/10826084.2023.2294956 CrossRef Google Scholar
[18]	Trigg J, Calabro R, Anastassiadis P, Bowden J, Bonevski B. 2024. Association of anxiety and depression symptoms with perceived health risk of nicotine vaping products for smoking cessation. Frontiers in Psychiatry 15:1277781 doi: 10.3389/fpsyt.2024.1277781 CrossRef Google Scholar
[19]	Striley CW, Nutley SK, Hoeflich CC. 2022. E-cigarettes and non-suicidal self-injury: prevalence of risk behavior and variation by substance inhaled. Frontiers in Psychiatry 13:911136 doi: 10.3389/fpsyt.2022.911136 CrossRef Google Scholar
[20]	Thepthien BO, Tinn CS, Sharma R. 2024. Establishing the association between traditional tobacco, e-cigarette and dual use and mental health problems among high school students: results from a 2022 behavioral surveillance survey. International Journal of Mental Health and Addiction 22:4148−68 doi: 10.1007/s11469-023-01109-8 CrossRef Google Scholar
[21]	Yimsaard P, Gravely S, Meng G, Fong GT, Cummings KM, et al. 2024. Differences in smoking cessation behaviors and vaping status among adult daily smokers with and without depression, anxiety, and alcohol use: findings from the 2018 and 2020 international tobacco control four country smoking and vaping (ITC 4CV) Surveys. International Journal of Mental Health and Addiction 22:3433−50 doi: 10.1007/s11469-023-01058-2 CrossRef Google Scholar
[22]	Clendennen SL, Chen B, Sumbe A, Harrell MB. 2023. Patterns in mental health symptomatology and cigarette, e-cigarette, and marijuana use among Texas youth and young adults amid the coronavirus disease 2019 pandemic. Nicotine & Tobacco Research 25:266−73 doi: 10.1093/ntr/ntac205 CrossRef Google Scholar
[23]	Oyapero A, Erinoso O, Osoba M, Kareem S. 2023. Predictors of electronic cigarettes use and its association with mental health in Nigeria: a community survey. Population Medicine 5:175938 doi: 10.18332/popmed/175938 CrossRef Google Scholar
[24]	Adzrago D, Tami-Maury I, Schick V, Wilkerson JM. 2021. Co-occurring substance use and psychological distress among exclusive e-cigarette use and other tobacco use among sexual and gender minorities in Texas. Drug and Alcohol Dependence 229:109135 doi: 10.1016/j.drugalcdep.2021.109135 CrossRef Google Scholar
[25]	Williams GC, Patte KA, Ferro MA, Leatherdale ST. 2021. Substance use classes and symptoms of anxiety and depression among Canadian secondary school students. Health Promotion and Chronic Disease Prevention in Canada 41:153−64 doi: 10.24095/hpcdp.41.5.02 CrossRef Google Scholar
[26]	Adzrago D, Harrell MB, Fujimoto K, Jones A, Wilkerson JM. 2023. Association between e-cigarette use behaviors and anxiety/depression among black/African American adults based on sexual identity. International Journal of Environmental Research and Public Health 20:2078 doi: 10.3390/ijerph20032078 CrossRef Google Scholar
[27]	Azagba S, Ebling T, Adekeye OT, Shan L. 2022. Mental health condition indicators and e-cigarette use among sexual minority youth. Journal of Affective Disorders 319:1−7 doi: 10.1016/j.jad.2022.09.032 CrossRef Google Scholar
[28]	Ormiston CK, Pike JR, Sabado-Liwag MD, Kwan P, Xie B, et al. 2024. Generational immigration status modifies the association between psychosocial distress and substance use among alternative high school students. Journal of Adolescent Health 75:610−19 doi: 10.1016/j.jadohealth.2024.06.004 CrossRef Google Scholar
[29]	Pitman SA, Pasch KE, Poulos NS, Velazquez CE. 2024. Food insecurity and substance use among young adults in the United States. Preventive Medicine 189:108148 doi: 10.1016/j.ypmed.2024.108148 CrossRef Google Scholar
[30]	Arksey H, O'Malley L. 2005. Scoping studies: towards a methodological framework. International Journal of Social Research Methodology 8:19−32 doi: 10.1080/1364557032000119616 CrossRef Google Scholar
[31]	Levac D, Colquhoun H, O'Brien KK. 2010. Scoping studies: advancing the methodology. Implementation Science 5:69 doi: 10.1186/1748-5908-5-69 CrossRef Google Scholar
[32]	Peters MDJ, Godfrey CM, Khalil H, McInerney P, Parker D, et al. 2015. Guidance for conducting systematic scoping reviews. International Journal of Evidence-Based Healthcare 13:141−46 doi: 10.1097/xeb.0000000000000050 CrossRef Google Scholar
[33]	Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. 2009. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Medicine 6:e1000097 doi: 10.1371/journal.pmed.1000097 CrossRef Google Scholar
[34]	Bianco CL. 2019. Rates of electronic cigarette use among adults with a chronic mental illness. Addictive Behaviors 89:1−4 doi: 10.1016/j.addbeh.2018.08.033 CrossRef Google Scholar
[35]	Hahn AW, Ruderman SA, Nance RM, Whitney BW, Eltonsy S, et al. 2023. Vaporized nicotine (e-cigarette) and tobacco smoking among people with HIV: use patterns and associations with depression and panic symptoms. Journal of Acquired Immune Deficiency Syndromes 92:197−203 doi: 10.1097/QAI.0000000000003132 CrossRef Google Scholar
[36]	Vaziri S, McGarry ME, Huang CY, Cuneo AA, Willen SM, et al. 2024. Time to be blunt: substance use in cystic fibrosis. Pediatric Pulmonology 59:1015−27 doi: 10.1002/ppul.26880 CrossRef Google Scholar
[37]	Schuler MS, Wong EC, Ramchand R. 2022. Military service branch differences in alcohol use, tobacco use, prescription drug misuse, and mental health conditions. Drug and Alcohol Dependence 235:109461 doi: 10.1016/j.drugalcdep.2022.109461 CrossRef Google Scholar
[38]	Wamamili B, Wallace-Bell M, Richardson A, Grace RC, Coope P. 2021. Associations of history of mental illness with smoking and vaping among university students aged 18−24 years in New Zealand: results of a 2018 national cross-sectional survey. Addictive Behaviors 112:106635 doi: 10.1016/j.addbeh.2020.106635 CrossRef Google Scholar
[39]	Klein EG, Shoben AB, Carpenter KM, Mullis K, Nemeth JM, et al. 2024. A randomized clinical trial of a quitline vaping cessation intervention: baseline characteristics of young adult exclusive e-cigarette users seeking treatment. International Journal of Environmental Research and Public Health 21:809 doi: 10.3390/ijerph21060809 CrossRef Google Scholar
[40]	Mantey DS, Clendennen SL, Chen B, Amin S, Harrell MB. 2024. Cannabis vaping use in emerging adulthood: characterizing transitions between stages of vaping among a diverse cohort in Texas. Social Science & Medicine 361:117326 doi: 10.1016/j.socscimed.2024.117326 CrossRef Google Scholar
[41]	Versella MV, Borges AM, Lin C, Leyro TM. 2019. Co-use of electronic nicotine delivery systems and combustible cigarettes, and their association with internalizing pathology and vulnerabilities. Cognitive Therapy and Research 43:114−20 doi: 10.1007/s10608-018-9971-0 CrossRef Google Scholar
[42]	Kang W, Malvaso A. 2024. Understanding the longitudinal associations between e-cigarette use and general mental health, social dysfunction and anhedonia, depression and anxiety, and loss of confidence in a sample from the UK: a linear mixed effect examination. Journal of Affective Disorders 346:200−5 doi: 10.1016/j.jad.2023.11.013 CrossRef Google Scholar
[43]	Keum BT, Cano MÁ, Valdovinos IC, Boland DZ. 2023. Impact of online and offline racism on cigarette smoking, marijuana use, and vaping via depressive/anxiety symptoms among racially minoritized emerging adults. American Journal of Orthopsychiatry 93:450−59 doi: 10.1037/ort0000691 CrossRef Google Scholar
[44]	Williams GC, Patte KA, Ferro MA, Leatherdale ST. 2021. Associations between longitudinal patterns of substance use and anxiety and depression symptoms among a sample of Canadian secondary school students. International Journal of Environmental Research and Public Health 18:10468 doi: 10.3390/ijerph181910468 CrossRef Google Scholar
[45]	Tildy BE, McNeill A, East K, Gravely S, Fong GT, et al. 2023. Self-reported depression and anxiety and healthcare professional interactions regarding smoking cessation and nicotine vaping: findings from 2018 International Tobacco Control Four Country Smoking and Vaping (ITC 4CV) Survey. Tobacco Prevention & Cessation 9:26 doi: 10.18332/tpc/168288 CrossRef Google Scholar
[46]	Li L, Borland R, O'Connor RJ, Fong GT, McNeill A, et al. 2019. How are self-reported physical and mental health conditions related to vaping activities among smokers and quitters: findings from the ITC four country smoking and vaping wave 1 survey. International Journal of Environmental Research and Public Health 16:1412 doi: 10.3390/ijerph16081412 CrossRef Google Scholar
[47]	Spears CA, Jones DM, Weaver SR, Yang B, Pechacek TF, et al. 2020. Use of and perceptions about electronic nicotine delivery systems (ENDS) among people with mental health conditions or serious psychological distress, 2018. Drug and Alcohol Dependence 212:108049 doi: 10.1016/j.drugalcdep.2020.108049 CrossRef Google Scholar
[48]	Mayorga NA, Chavez J, Garey L, Otto MW, Zvolensky MJ. 2021. Affective vulnerability across non-daily and daily electronic cigarette users. Behavioral Medicine 47:51−59 doi: 10.1080/08964289.2019.1644282 CrossRef Google Scholar
[49]	Salazar-Londoño S, Botero-Rodríguez F, Moreno-Contreras J, Vanegas-Zamora V, Gómez-Restrepo C, et al. 2025. Self-perception of risky consumption and emotional factors associated with electronic nicotine and non-nicotine delivery systems during the SARS-CoV-2 pandemic. Revista Colombiana de Psiquiatría 54:536−41 doi: 10.1016/j.rcp.2023.08.006 CrossRef Google Scholar
[50]	Wade NE, Courtney KE, Doran N, Baca R, Aguinaldo LD, et al. 2022. Young adult e-cigarette and combustible tobacco users attitudes, substance use behaviors, mental health, and neurocognitive performance. Brain Sciences 12:889 doi: 10.3390/brainsci12070889 CrossRef Google Scholar
[51]	Wattick RA, Olfert IM, Olfert MD. 2021. Psychosocial factors associated with e-cigarette use among young adults in a 4-year university in Appalachia. Substance Use & Misuse 56:1182−89 doi: 10.1080/10826084.2021.1914102 CrossRef Google Scholar
[52]	Arterberry BJ, Parks MJ, Patrick ME. 2023. The moderating role of mental health on the association between COVID-related stress, isolation, and economic hardship and using substances to cope. Preventive Medicine Reports 34:102229 doi: 10.1016/j.pmedr.2023.102229 CrossRef Google Scholar
[53]	Bista S, Lechner WV, Anderson M, Kenne KN, Kenne DR. 2023. Cigarette and e-cigarette use as a function of psychological distress following COVID-19 related university campus closures. The American Journal of Drug and Alcohol Abuses 49:239−48 doi: 10.1080/00952990.2023.2171300 CrossRef Google Scholar
[54]	Azagba S, Ebling T, Korkmaz A. 2024. Social media and e-cigarette use: The mediating role of mental health conditions. Journal of Affective Disorders 344:528−34 doi: 10.1016/j.jad.2023.10.053 CrossRef Google Scholar
[55]	Lilly CL, Kristjansson AL, Smith ML, Thrisdottir IE, Havlicak A, et al. 2024. Beyond school climate: validating the school as a protective factor-brief survey. Journal of School Health 94:1079−94 doi: 10.1111/josh.13481 CrossRef Google Scholar
[56]	Jones RD, Asare M, Lanning B. 2021. A retrospective cross-sectional study on the prevalence of e-cigarette use among college students. Journal of Community Health 46:195−202 doi: 10.1007/s10900-020-00869-x CrossRef Google Scholar
[57]	Oliver AL, Kossowsky J, Minegishi M, Levy S, Weitzman ER. 2023. The association of vaping with social/emotional health and attitudes toward COVID-19 mitigation measures in adolescent and young adult cohorts during the COVID-19 pandemic. Substance Abuse 44:73−85 doi: 10.1177/08897077231165860 CrossRef Google Scholar
[58]	Pham T, Williams JVA, Bhattarai A, Dores AK, Isherwood LJ, et al. 2020. Electronic cigarette use and mental health: a Canadian population-based study. Journal of Affective Disorders 260:646−52 doi: 10.1016/j.jad.2019.09.026 CrossRef Google Scholar
[59]	Hefner KR, Sollazzo A, Mullaney S, Coker KL, Sofuoglu M. 2019. E-cigarettes, alcohol use, and mental health: use and perceptions of e-cigarettes among college students, by alcohol use and mental health status. Addictive Behaviors 91:12−20 doi: 10.1016/j.addbeh.2018.10.040 CrossRef Google Scholar
[60]	Adzrago D, Sulley S, Mamudu L, Ormiston CK, Williams F. 2022. The influence of COVID-19 pandemic on the frequent use of e-cigarettes and its association with substance use and mental health symptoms. Behavioral Sciences 12:453 doi: 10.3390/bs12110453 CrossRef Google Scholar

Study (year)	Country	Design	Sample size	Population	Measures of e-cigarette use	Measures of mental health	Key findings related to e-cigarette use and mental health
Lilly et al. (2024)^[55]	USA	Longitudinal	1,349	Middle and high school students	Past-year e-cigarette use	School as a Protective Factor-Brief (SPF-Brief) survey (school climate, anxiety, depression, quality of life)	A school environment perceived as more positive as indicated by higher SPF-Brief scores was associated with fewer reported symptoms of anxiety and depression and this climate appeared to function as a protective element against substance use including e-cigarettes.
Ormiston et al. (2024)^[28]	USA	Longitudinal	1,060	Alternative high school students	Past-year e-cigarette and other substance use	Depression Anxiety Stress Scale-21 (DASS-21)	A more pronounced association between psychosocial distress and the use of substances like e-cigarettes was observed in first- and second-generation immigrant students when compared to their third-generation counterparts.
Liu et al. (2024)^[16]	USA	Cross-sectional	1,547	Adults reporting past 30-d tobacco use	Past 30-d vaping of nicotine, cannabis, CBD, or other substances	Self-rated anxiety	The concurrent vaping of nicotine with cannabis or CBD in the preceding month was a behavior reported by 26.1% of participants and its likelihood was significantly greater among males and individuals reporting higher anxiety.
Thepthien et al. (2024)^[20]	Thailand	Cross-sectional	5,740	High school students	Past 12-month prevalence of conventional cigarette (CC), electronic cigarette (EC), and dual use	Adverse childhood experiences (ACEs), psychological distress (PD), depression, anxiety, and problem gambling (PG) scales	Other substance use mental health difficulties and peer or family smoking were correlates for CC EC and dual use with exclusive EC and dual use being linked to more depressive symptoms and exclusive EC use also associated with greater anxiety.
Yimsaard et al. (2024)^[21]	International	Longitudinal	3,709	Daily smokers	Vaping status at follow-up, quit attempts, 1-month quit success	Validated screening tools for depression, anxiety, and regular alcohol use (baseline)	Smokers who reported depressive symptoms were found to be more likely to make a quit attempt but had lower rates of success while successful quitters with depression or anxiety had a higher likelihood of vaping at the follow-up assessment.
Mantey et al. (2024)^[40]	USA	Longitudinal	2,605	Youth and young adults	Transitions in cannabis vaping (never, ever, current)	Patient Health Questionnaire-9 (PHQ-9) for depression; Generalized Anxiety Disorder-7 (GAD-7) for anxiety	Alcohol use was predictive of cannabis vaping across all racial and ethnic groups and depression was a predictor for the initiation of cannabis vaping among Hispanics and for experimentation among non-Hispanic Black participants.
Pitman et al. (2024)^[29]	USA	Cross-sectional	1,024	Young adults	Current cigarette, ENDS, cannabis, and alcohol use; binge drinking	Food insecurity measure (Hunger Vital Signs), perceived stress, anxiety, depressive symptoms, and insomnia	After accounting for demographics economic factors mental health and discrimination food insecurity remained associated with elevated odds for all types of substance use which included ENDS.
Klein et al. (2024)^[39]	USA	RCT	981	Young adult exclusive e-cigarette users	E-cigarette use behaviors, previous quit attempts, nicotine dependence	Self-reported stress, anxiety, and depression	Among young adults who were seeking treatment to stop vaping a high prevalence of nicotine dependence a history of unsuccessful quit attempts and co-occurring stress anxiety and depression was observed.
Cai & Bidulescu (2024)^[12]	USA	Cross-sectional	56,734	US adults	Current, former, and never e-cigarette use; dual use with cigarettes	National Health Interview Survey measures for anxiety, depression, serious psychological distress (SPD), and cognitive impairment	Compared to never-use current e-cigarette use former use and dual use were each associated with greater odds of experiencing anxiety depression SPD and cognitive impairment.
Vaziri et al. (2024)^[36]	USA	Cross-sectional	226	People with cystic fibrosis (pwCF)	Past 12-month use of marijuana, CBD, e-cigarettes, and cigarettes	Abnormal mental health screen	In this population substance use including e-cigarettes was found to be more common than previously documented and those who used e-cigarettes were significantly more likely to have an abnormal mental health screening outcome.
Phetphum et al. (2024)^[5]	Thailand	Cross-sectional	3,424	Youth	Past 30-d cigarette, e-cigarette, and dual use	Depression and anxiety symptoms scales	Both current e-cigarette users and dual users showed higher odds of depression and e-cigarette users also had higher odds of anxiety whereas smokers of only cigarettes had lower odds of anxiety compared to non-users.
Kang & Malvaso (2024)^[42]	UK	Longitudinal	19,706	UK general sample	E-cigarette use status (at two time points)	General Health Questionnaire (GHQ-12) measuring general mental health, social dysfunction & anhedonia, depression & anxiety, and loss of confidence	Participants who took up e-cigarette use between the two waves showed poorer mental health greater social dysfunction and anhedonia and more loss of confidence when compared to their own status from a year earlier.
Adzrago et al. (2024)^[1]	USA	Cross-sectional	4,766	Adults	Exclusive e-cigarette use, exclusive cannabis use, and dual use	Anxiety/depression	While anxiety/depression was correlated with a higher risk for exclusive cannabis use and dual use irrespective of immigration status its link to exclusive e-cigarette use was only significant for the immigrant population.
Zvolensky et al. (2024)^[13]	USA	Cross-sectional	297	Latinx adult daily cigarette smokers	Current dual use of e-cigarettes with combustible cigarettes	A battery of scales measuring anxiety, depression, emotional dysregulation, anxiety sensitivity, and distress tolerance.	When compared with those who exclusively smoked combustible cigarettes Latinx adults who were dual users showed significantly higher levels of anxiety depression and emotional dysregulation which was also coupled with lower distress tolerance.
Evans et al. (2024)^[14]	USA	Cross-sectional	316	Young adults	Vape use (unspecified)	Five Facet Mindfulness Questionnaire (FFMQ), Rumination scale, reduced Morningness-Eveningness Questionnaire (rMEQ), Self-compassion scale, Hospital Anxiety and Depression Scale (HADS), Pittsburgh Sleep Quality Index (PSQI)	In comparison to non-users individuals who vaped reported lower mindfulness and self-compassion alongside higher rumination and anxiety poorer sleep quality and a stronger inclination toward an evening chronotype.
Trigg et al. (2024)^[18]	Australia	Cross-sectional	3,002	South Australian adults (+15 years)	Vaping, smoking	Patient Health Questionnaire-4 (PHQ-4) for anxiety and depression	Individuals with depression who also vaped tended to perceive greater health risk barriers related to accessing nicotine vaping products (NVPs) through a prescription for the purpose of smoking cessation.
Han et al. (2024)^[15]	USA	Longitudinal	5,114	Young adolescents	E-cigarette use	Internalizing problems (Profile of Mood States anxiety subscale; Centers for Epidemiology Studies of Depression (CES-D) scale) and externalizing problems (Current Symptoms Scale for ADHD; Brief Sensation Seeking Scale)	The availability of tobacco in the home increased the odds of e-cigarette use whereas home rules against non-combustibles decreased them and the protective effect of these rules was stronger for adolescents with internalizing problems but weaker for those with externalizing problems.
Dabravolskaj et al. (2023)^[6]	Canada	Longitudinal	24,274	High school students	Adherence to substance use recommendations (including e-cigarettes)	Center for Epidemiologic Studies Depression Scale Revised (CESD-R-10); Generalized Anxiety Disorder-7 (GAD-7)	Following healthy lifestyle recommendations which included abstaining from e-cigarettes was associated with lower depression and anxiety scores at a one-year follow-up point.
Salinas et al. (2024)^[17]	USA	Cross-sectional	492	Adults who vape nicotine, cannabis, or both	Nicotine, cannabis, and dual vape use behaviors	Patient Health Questionnaire (PHQ-9) for depression; Generalized Anxiety Disorder Scale (GAD-7); Perceived Stress Scale (PSS-10)	Those who engaged in dual use of cannabis and nicotine vapes reported a greater severity of mental health symptoms when compared to individuals who vaped only one of the substances.
Azagba et al. (2024)^[54]	USA	Cross-sectional	23,445	Youth	Past-30-d e-cigarette use	Patient Health Questionnaire-4 (PHQ-4) for anxiety and depression; time on social media	The association between the amount of time spent on social media and the likelihood of past-30-d e-cigarette use was mediated by symptoms of anxiety and depression.
Leung et al. (2024)^[2]	Australia	Cross-sectional	716	University students	Lifetime and past-month vaping (flavor, nicotine, other drugs)	Patient Health Questionnaire-9 (PHQ-9) for depression; Generalized Anxiety Disorder-7 (GAD-7)	Vaping was found to be correlated with being male smoking cigarettes binge drinking and using cannabis and it was also noted that a significant percentage of students were not informed about the legal status or potential health risks of vaping.
Bataineh et al. (2023)^[7]	USA	Longitudinal	60,072	Adolescents and young adults	Lifetime cigarette, e-cigarette, and cannabis use	Depressive and anxiety symptoms	Based on the observed associations it was recommended that mental health screening should occur earlier for tobacco and cannabis users especially for individuals aged 18 and younger.
Arterberry et al. (2023)^[52]	USA	Cross-sectional	1,244	Young adults	Increased vaping, drinking, and marijuana use to cope with COVID-19 isolation	Depression and anxiety symptoms	Stress related to social distancing during the COVID-19 period was associated with an increase in vaping to cope for those with higher depression symptoms and an increase in drinking to cope for those with higher anxiety symptoms.
Tildy et al. (2023)^[45]	International	Cross-sectional	11,040	Adults	Discussing and receiving recommendations for NVPs from a health professional (HP)	Self-reported current depression and/or anxiety	Individuals with anxiety and/or depression who smoked were more likely to visit an HP but it was only those with depression who were more likely to get advice to quit.
Adzrago et al. (2023)^[26]	USA	Cross-sectional	6,267	Black/African American Adults	E-cigarette use status (never, former, current)	Symptoms of anxiety/depression (Patient Health Questionnaire-4, PHQ-4)	Within sexual minorities lesbian/gay individuals showed higher rates of former e-cigarette use whereas bisexual individuals reported higher rates of current e-cigarette use.
Oliver et al. (2023)^[57]	USA	Cross-sectional	474	Adolescents and Young Adults	Prior 12-month substance use, including vaping	Symptoms of depression (Patient Health Questionnaire – 2 item, PHQ-2)	In the context of the COVID-19 pandemic vaping was linked to depressive symptoms and lower adherence to non-pharmaceutical mitigation measures among adolescents and young adults.
Keum et al. (2023)^[43]	USA	Cross-sectional	338	Racially Minoritized Emerging Adults	Recent cigarette smoking, marijuana use, and vaping	Depressive (PHQ-9) and anxiety (GAD-7) symptoms	Experiences of racism both online and offline were indirectly associated with recent marijuana use a relationship that was mediated by depressive and anxiety symptoms.
Leung et al. (2023)^[4]	Australia	Cross-sectional	855	High School Students	E-cigarette use (flavor-only and nicotine)	Depression and anxiety	Risky drinking and smoking cigarettes were identified as strong predictors of concurrent e-cigarette use which points to a high-risk polysubstance use profile.
Hanafin et al. (2023)^[3]	Ireland	Cross-sectional	5,190	Young adults	Ever and current smoking; ever and current e-cigarette use	Self-reported professional diagnosis of a mental health problem (MHP)	The association between mental health problems and the use of e-cigarettes was found to be similar in its nature and magnitude to the well-documented association between MHP and smoking.
Hahn et al. (2023)^[35]	USA	Cross-sectional	7,431	People with HIV	Vaporized Nicotine (VN) and Combustible Cigarette (CC) use	Depression (PHQ-9 score ≥ 10) and Panic Symptoms (Panic Symptomatology)	The observed associations between VN/CC use and symptoms of depression or panic suggest that VN may play a potential role in both self-medication and as a substitute for CC in this specific population.
Clendennen et al. (2023)^[22]	USA	Longitudinal	2,148	Youth and young adults	Cigarette, e-cigarette, and marijuana use	Anxiety symptoms, depressive symptoms, perceived stress	The study's findings indicated a bidirectional relationship where elevated mental health symptoms were predictive of future increases in the use of cigarettes e-cigarettes and marijuana.
Oyapero et al. (2023)^[23]	Nigeria	Cross-sectional	898	Residents	E-cigarette (EC) use	Generalized Anxiety Disorder-7 (GAD-7); Patient Health Questionnaire-9 (PHQ-9)	Smoking cigarettes consuming alcohol being susceptible to future smoking and depression were all identified as strong predictors of e-cigarette use.
Salazar-Londoño et al. (2023)^[49]	Colombia	Cross-sectional	3,850	Young Colombians	Consumption of Electronic Nicotine/Non-nicotine Delivery Systems (ENDS/ENNDS)	Self-reported history of mental/emotional pathology; symptoms of depression, anxiety, stress, and loneliness	Symptoms of anxiety and loneliness were found to be more common among participants who had risky ENDS/ENNDS consumption patterns when compared to those who did not.
Adzrago et al. (2023)^[26]	USA	Cross-sectional	6,268	Black/African American Adults	E-cigarette use behaviors (never, former, current)	Anxiety/depression symptoms (Patient Health Questionnaire-4, PHQ-4); perceived harmfulness of e-cigarettes	E-cigarette use behaviors were found to be significantly associated with anxiety/depression the perceived harmfulness of the product and the interaction between these two variables.
Bista et al. (2023)^[53]	USA	Cross-sectional	4,634	Students	Cigarette or e-cigarette use	Psychological distress	An observable increase in nicotine use which included e-cigarettes was noted in the period immediately after the implementation of campus closures for public health safety reasons.
Adzrago et al. (2022)^[60]	USA	Cross-sectional	5,065	Adults	Past 30-day frequent use of e-cigarettes	Anxiety/depression, alcohol use, cannabis use, COVID-19 impact	The probability of frequent e-cigarette use was higher among individuals with certain risk factors which included frequent consumption of alcohol or cannabis a diagnosis of depression or anxiety and stress related to social distancing.
Azagba et al. (2022)^[27]	USA	Cross-sectional	16,065	Youth	Current e-cigarette use	Self-reported anxiety and depression	It appears that sexual minority males who have co-occurring mental health conditions represent a particularly vulnerable population with respect to e-cigarette use.
Striley et al. (2022)^[19]	USA	Cross-sectional	47,016	College students	Past 30-day use of a vaping product (nicotine or marijuana)	Non-suicidal self-injury (NSSI)	A positive association between past 30-d vaping and NSSI was identified although more research is needed to confirm this finding and to examine any potential confounding variables.
Wade et al. (2022)^[50]	USA	Cross-sectional	201	Emerging Adults	Past 6-month nicotine and tobacco product (NTP) use patterns	Depression and stress symptoms	Users of combustible tobacco seem to be qualitatively different from non-combustible users when considering mental health correlates which suggests the existence of distinct user profiles.
Schuler et al. (2022)^[37]	USA	Cross-sectional	16,699	Armed forces active duty service members	Current e-cigarette use, smoking, and other substance use	Probable post-traumatic stress disorder (PTSD), depression, and anxiety	The differences observed in substance use and mental health between the various service branches were not fully accounted for by demographic or deployment/combat experience variables.
Adzrago et al. (2021)^[24]	USA/Texas	Cross-sectional	1,103	Sexual and gender minorities	Recent tobacco use, including e-cigarettes	Diagnosis of depression, anxiety, or PTSD; hazardous alcohol use; illicit substance use	There is an existing need for tailored tobacco cessation interventions to be implemented within substance use treatment facilities to address the high rates of use among SGM individuals.
Williams et al. (2021a)^[25]	Canada	Cross-sectional	51,767	Secondary school students	Alcohol, cannabis, cigarette, and e-cigarette use	Anxiety and depression symptoms	Dual and polysubstance use were found to be common among Canadian secondary students and anxiety and depression were significantly associated with these use patterns.
Williams et al. (2021b)^[44]	Canada	Longitudinal	738	Secondary school students	Alcohol, cannabis, cigarette, and e-cigarette use	Anxiety and depression	The findings highlight the need for comprehensive programming that addresses multiple substance uses and is also aware of co-occurring mental illness symptoms particularly depression.
Mayorga et al. (2021)^[48]	USA	Cross-sectional	566	Adult e-cigarette users	Electronic Nicotine Delivery System (ENDS) use patterns	Anxiety sensitivity, anxious arousal, general distress, and anhedonia	The results underscore the necessity of incorporating anxiety-related constructs into etiological models to achieve a better understanding of e-cigarette use patterns and behavior.
Wattick et al. (2021)^[51]	USA	Cross-sectional	3398	College students	E-cigarette use and motivations for use	Adverse Childhood Experiences (ACEs), mental health	Efforts aimed at reducing e-cigarette use should also address the co-use of alcohol co-occurring mental health disorders and the social motivations for use.
Jones et al. (2021)^[56]	USA	Cross-sectional	872	College Students	E-cigarette use	Self-efficacy, knowledge, depression, and anxiety symptoms	Modifiable factors such as knowledge about harmful effects and having the self-confidence to refuse use were associated with a lower prevalence of e-cigarette use.
Spears et al. (2020)^[47]	USA	Cross-sectional	5878	Adults	Electronic Nicotine Delivery System (ENDS) use patterns	Serious psychological distress (SPD), mental health conditions (MHC), reasons for use	It seems that individuals with pre-existing mental health conditions may be particularly inclined to use ENDS for the purposes of relaxation and managing stress.
Wamamili et al. (2021)^[38]	New Zealand	Cross-sectional	1293	University Students	Vaping and smoking	History of mental illness (HMI): diagnosis/treatment for depression, anxiety, or other mental health condition in past 12 months	A strong association was found where students who reported a history of mental illness also showed significantly higher prevalence rates for both smoking and vaping.
Pham et al. (2020)^[58]	Canada	Cross-sectional	53,050	General population	E-cigarette use	PHQ-9, self-reported mood/anxiety disorders, perceived mental health, suicidality	E-cigarette use is associated with adverse mental health outcomes and this association was observed to be particularly strong among non-smokers and women.
Bianco et al. (2019)^[34]	USA	Cross-sectional	631	Adults	Lifetime and current e-cigarette use	Chronic mental illness (depression, anxiety, emotional disorder, ADD, bipolar, schizophrenia, etc.)	The findings lend support to previous research by indicating an increased likelihood of both lifetime and current e-cigarette use among individuals who have a chronic mental illness.
Hefner et al. (2019)^[59]	USA	Cross-sectional	631	College Students	Past 30-day e-cigarette and other tobacco use	Self-reported diagnosis of psychiatric and substance use disorders	Additional research is needed to clarify the relationships between risky alcohol and nicotine use and mental illness in order to guide intervention efforts for college students.
Versella et al. (2019)^[41]	USA	Cross-sectional	264	Adult ENDS Users	ENDS and Combustible Cigarette use	Internalizing symptoms (stress, anxiety) and vulnerabilities (Anxiety Sensitivity Index-3, Distress Intolerance Index, Difficulties in Emotion Regulation Scale)	The way internalizing pathology and vulnerabilities present among nicotine users appears to be influenced by both their current use and their past history of nicotine product use.
Li Lin et al. (2019)^[46]	International	Cross-sectional	11,344	Smokers and Quitters	Vaping activities and use as a quitting strategy	Medical diagnosis for nine health conditions, including depression, anxiety, and alcohol problems	The study did not find any systematic evidence to suggest that having a poor health condition related to smoking increased the probability that an individual would turn to vaping as a method for cessation.
Source: Developed by the authors based on data extracted from the included studies.

Supplementary Table S1 Completed PRISMA-ScR Checklist.
Supplementary File 1 Detailed search string used for database selection.

{{lists.name}}

The interplay of electronic cigarette use and mental health: a scoping review of bidirectional associations, underlying mechanisms, and moderating factors

Abstract

Supplementary information

Rights and permissions

References

About this article

Cite this article

Article Metrics

Access History

Other Articles By Authors