Depression or anxiety disorder moderates the relationship between smoking status and e-cigarette use status: a cross-sectional study

Electronic cigarettes (e-cigarettes) deliver nicotine by vaporizing nicotine-containing fluids without involving tobacco combustion and are available in various flavors. In 2021, the age-standardized prevalence of current e-cigarette use among U.S. adults was 6.9%, with nearly half of these individuals using e-cigarettes daily (Erhabor et al, JAMA Netw Open.6:e2340859, 2023). While there is a well-documented relationship between depressive and anxiety disorders and combustible cigarette smoking, less is known about how these mental health conditions relate to e-cigarette use. This study aimed to examine the role of depression or anxiety disorders as moderators of the relationship between smoking status and e-cigarette use among adults. This cross-sectional study used data from the Health Information National Trend Survey (HINTS), Cycle 2, 2018, for secondary data analysis. The HINTS data are nationally representative of adults of adults living in the United States. The independent variable in this study was smoking status (current, former, or never smoked). The dependent variable was e-cigarette use status (current, former, or never). We used SPSS and the PROCESS macro for multinomial logistic regression, assessing e-cigarette use impacts from smoking status and mental health, with significance at p ≤ 0.05. The logistic regression showed that smoking status, depression or anxiety, and their interaction predicted e-cigarette use better than chance (F(6, 2980) = 120.1, p < 0.001, R2 = 0.195). Smoking status was associated with increased odds of e-cigarette use (OR, 1.44; 95% CI 1.34–1.55). Depression or anxiety was also associated with increased odds of e-cigarette use (OR, 1.31; 95% CI 1.18–1.44). The interaction between smoking status and depression or anxiety was significant (b = -0.081, t(2980) = -3.85, p = 0.0001). This study showed that depression or anxiety disorders moderated the relationship between smoking status and e-cigarette use. These findings may inform the development of targeted, theory-based interventions aimed at reducing e-cigarette use among individuals with mental health conditions.