Internalizing and externalizing problems as risk factors for initiation and progression of e-cigarette and combustible cigarette use in the US youth population.

Introduction:
This article examines the relationship between internalizing and externalizing problems and the initiation and progression of e-cigarette and cigarette use among US youth. The study uses data from the Population Assessment of Tobacco and Health (PATH) Study Waves 1-2 and employs multinomial logistic and linear regression models to analyze the data.

Key Points:

* The study finds that higher internalizing and externalizing problems are both associated with a higher risk for initiating cigarette smoking and exclusive e-cigarette use.
* However, neither internalizing nor externalizing problems are associated with differential likelihood of initiating exclusive e-cigarette use compared with initiating cigarette smoking.
* Neither internalizing nor externalizing problems are associated with more frequent use of cigarettes or e-cigarettes.
* The study controls for other nicotine product use and sociodemographic variables.
* The sample includes 9258 youth, divided into three samples: those who had never used any nicotine products at Wave 1, those who smoked combustible cigarettes in the past 30 days at Wave 1, and those who used e-cigarettes in the past 30 days at Wave 1.
* The study also investigates whether internalizing and externalizing problems are associated with the frequency of smoking and vaping at Wave 2, controlling for Wave 1 tobacco use and sociodemographic variables.

Main Message:
The study suggests that improving the youth's mental and behavioral health could have a secondary effect on preventing cigarette and e-cigarette use initiation. Schools and community public health practitioners should provide prevention and intervention efforts among the target population. The findings illustrate that the youth with higher levels of internalizing or externalizing problems are more likely to initiate cigarettes or exclusive e-cigarette use, and a more frequent use of e-cigarettes could promote the youth's later engagement in more cigarette smoking behaviors. Therefore, intervention efforts should focus on this high-risk group and address adolescents' vaping behaviors, especially on the higher-risk subpopulations identified based on this study's findings.

Buu A, Hu YH, Wong SW, Lin HC. Internalizing and externalizing problems as risk factors for initiation and progression of e-cigarette and combustible cigarette use in the US youth population. International Journal of Mental Health and Addiction. 2021;19(5):1759-1771. doi:10.1007/s11469-020-00261-9