Trends in Mental Health Symptoms, Nicotine Product Use, and Their Association Over Time Among Adolescents in Canada, England, and the US: Findings From the ITC Adolescents Tobacco and Vaping Survey, 2020–2023

Introduction:
This text provides an analysis of a study examining the relationship between adolescent mental health symptoms and the use of various nicotine products. The study uses data from the International Tobacco Control (ITC) Policy Evaluation Project Adolescents Tobacco and Vaping Survey, conducted over six waves from 2020 to 2023 in Canada, England, and the United States. The study aims to understand the relationship between internalizing mental health symptoms (IMH) and current nicotine use, including exclusive combustible product use, exclusive noncombustible product use, and use of both product types. The study also explores potential moderators such as country and survey wave.

Key Points:

* The study uses data from the ITC Adolescents Tobacco and Vaping Survey, conducted over six waves from 2020 to 2023 in Canada, England, and the United States.
* The study measures IMH symptoms using two items from the Screening Tool for Psychological Distress (STOP-D) and derives four product use categories: no use, exclusive combustible product use, exclusive noncombustible product use, and use of both product types.
* The study examines the association between IMH symptoms and current nicotine use using multinomial logistic regression models, adjusting for covariates.
* The study finds that IMH symptoms are most strongly associated with use of both product types, followed by exclusive noncombustible use and exclusive combustible use.
* The study also finds that the interaction between IMH symptoms and country is statistically significant, with risk ratios being highest for Canada and lowest for the United States.
* The study finds that the interaction between IMH symptoms and survey wave is also statistically significant, with the association between IMH symptoms and nicotine use being moderated by time.
* The study adjusts for wave, gender minority status, sex, race, age, perceived family SES, and country of residence, and uses sample weights constructed based on population estimates for sociodemographic variables and past 30-day smoking.

Main Message:
The study highlights the importance of understanding the relationship between adolescent mental health symptoms and nicotine use. The findings suggest that IMH symptoms are associated with current nicotine use, with a gradient of risk across different product use categories. The study also suggests that the association between IMH symptoms and nicotine use is moderated by country and survey wave, indicating the need for further research to understand the specific factors that may contribute to this relationship. The study emphasizes the need for tailored nicotine cessation interventions that address the mental health challenges confronting adolescents.

Emily E Hackworth, Desiree Vidaña-Pérez, Riley O’Neal, Minji Kim, Jennifer Fillo, David Hammond, James F Thrasher, Trends in Mental Health Symptoms, Nicotine Product Use, and Their Association Over Time Among Adolescents in Canada, England, and the US: Findings From the ITC Adolescents Tobacco and Vaping Survey, 2020–2023, Nicotine & Tobacco Research, Volume 27, Issue 7, July 2025, Pages 1256–1264, https://doi.org/10.1093/ntr/ntaf015