Mental Health Problems and Onset of Tobacco Use Among 12- to 24-Year-Olds in the PATH Study

Introduction:
This text provides an analysis of a study examining the relationship between mental health problems and the onset of tobacco use among youth and young adults in the United States. The study uses data from the Population Assessment of Tobacco and Health (PATH) Study and investigates the association between internalizing and externalizing problems and the use of various tobacco products. The study also considers the role of demographic factors such as age, gender, and race/ethnicity in this relationship.

Key Points:

* The study uses data from the PATH Study, a nationally representative sample of youth and young adults in the US.
* Internalizing and externalizing problems each independently predicted onset of any tobacco use among youth and young adults.
* Across tobacco products, findings differed for internalizing and externalizing problems, as well as by age, gender, and race/ethnicity.
* Internalizing problems predicted the onset of nearly all tobacco product use assessed among youth and young adults.
* Externalizing problems similarly predicted the onset of any tobacco use among youth and young adults, but the association was driven by the onset of electronic nicotine delivery systems (ENDS) use.
* Age interactions were observed for externalizing psychopathology, with youth with high-severity problems more likely to begin using cigarettes, ENDS, and cigarillos than youth classified as no/low/moderate severity.
* Gender and race/ethnicity interactions were also observed, with white female youth and young adults with externalizing problems more likely to report new ENDS use.

Main Message:
The study highlights the importance of considering mental health problems as a potential etiologic factor for the onset of tobacco use among youth and young adults. The findings suggest that internalizing and externalizing problems are associated with the onset of tobacco use, with differences in the types of products used and demographic factors. The results emphasize the need for early and specific tobacco product use screening, as well as screening across the spectrum of mental health problems, as tools to prevent tobacco product use onset. Providing incentives to providers to link these two screening mechanisms could increase the overall integration of these services in clinical practice.

Green, Victoria R., Kevin P. Conway, Marushka L. Silveira, Karin A. Kasza, Amy Cohn, K. Michael Cummings, Cassandra A. Stanton, et al. “Mental Health Problems and Onset of Tobacco Use Among 12- to 24-Year-Olds in the PATH Study.” Journal of the American Academy of Child & Adolescent Psychiatry 57, no. 12 (December 2018): 944-954.e4. https://doi.org/10.1016/j.jaac.2018.06.029.