Sex differences in the association between major depression episode and nicotine vaping among United States youth, 2021-2024

Abstract Introduction Nicotine vaping remains frequent among youth and is associated with depressive symptoms. Female youth may be especially at risk of nicotine vaping in relation to high levels of depressive symptoms. This study examines sex differences in the associations between depressive symptoms and nicotine vaping among United States (US) youth. Methods Data were drawn from the US 2021-2024 National Survey on Drug Use and Health (NSDUH) (N=45,618). A multivariable logistic regression model assessed past-month nicotine vaping by past-year Major Depressive Episode (MDE) x sex, adjusted for covariates, and tested a significant interaction effect. Results The sample was 51.1% male, 33.5% aged 16-17, 13.7% non-Hispanic Black, and 26.1% Hispanic; 6.0% reported past-month nicotine vaping and 18.1% past-year MDE. There was a significant past-year MDE x sex interaction in relation to past-month nicotine vaping (p=0.0005). Both female youth who reported past year MDE (AOR=2.77, 95% CI=2.24, 3.43) and male youth who reported past-year MDE (AOR=1.46, 95% CI=1.04, 2.03) were more likely to report higher levels of past-month nicotine vaping compared to those who did not. Female youth with MDEs had the highest reported nicotine vaping use (11.8%) compared to male youth with MDEs (7.5%) and youth without MDEs (3.6-3.8%). Conclusions Findings have implications for clinical guidelines for youth nicotine vaping prevention and cessation, such as integrating depressive symptom treatment and education about alternative (i.e., non-vaping) strategies for coping with depression symptoms. Future research should examine underlying factors in the association between depression and nicotine vaping, especially among female youth.