Mental Illness Increases Likelihood of E-cigarette Use

Patients with mental health disorders are significantly more likely to have used or currently use electronic cigarettes, according to research published in the May 13, 2014, issue of Tobacco Control.

For their study, a team of researchers at the University of California, San Diego School of Medicine delved into 10,041 survey participants’ current and past use of cigarettes, e-cigarettes, and approved pharmacotherapy for smoking cessation. During the survey, participants were also asked to disclose a diagnosis of depression, anxiety, or another psychiatric disorder.

Of the subjects surveyed, those with a mental health condition diagnosis were twice as likely to have tried e-cigarettes (14.8%) than those who had not been diagnosed with such a disorder (6.6%). Additionally, participants with a mental health condition were also more likely to currently use e-cigarettes. Furthermore, more than 40% of current smokers with depression, anxiety, or another psychiatric condition indicated they have tried an e-cigarette, compared to 28.7% of current smokers without a mental health disorder.

Looking ahead, current smokers with a mental health condition were more susceptible to future e-cigarette use (60.5%) than smokers who had not been diagnosed with one (45.3%). However, patients with a mental health disorder were also more likely to have tried or currently use approved pharmacotherapy for smoking cessation.

Distinguishing the participants’ reasons for trying e-cigarettes, the most commonly afforded answers were “just because” (68.9%), “to try and quit smoking cigarettes” (55.2%), “safer than cigarettes” (51.2%), and “convenient to use when I can't smoke” (46.7%), while price in comparison to cigarettes was the least common answer provided (31.3%). The authors found no significant disparity between the responses of participants with a mental health condition and those without one.

Nevertheless, the investigators disclosed a few limitations to their study. For instance, there was no verification process to discern whether a patient legitimately had a mental health condition. Additionally, no definitions were provided for the mental health disorders measured in the study, which the authors said might result in an “overendorsement” in depression reporting. The researchers also noted they did not verify a patient’s self-reported e-cigarette use, although they found no reason for a participant to misreport such information.

"People with mental health conditions have largely been forgotten in the war on smoking. But because they are high consumers of cigarettes, they have the most to gain or lose from the e-cigarette phenomenon," lead author Sharon Cummins, PhD, said in a statement. "Which way it goes will depend on what product regulations are put into effect and whether e-cigarettes ultimately prove to be useful in helping smokers quit."

Based on their findings, the researchers pressed for mental health status to play a role in the implementation of e-cigarette regulations.

“We urge ongoing assessment of mental health status in order to be able to determine if new regulations on pricing, access to e-cigarettes, bans related to e-cigarettes, and the like affect individuals with mental health conditions differentially, and whether differences in use and susceptibility serve to increase or decrease health disparities of this priority population,” the authors concluded.