E-cigarettes, alcohol use, and mental health: Use and perceptions of e-cigarettes among college students, by alcohol use and mental health status

Introduction: Electronic cigarettes (e-cigarettes) are popular among college students, who display risky alcohol use patterns. However, little is known about patterns of co-use of e-cigarettes and alcohol. Further, relationships between e-cigarette use and mental illness among college students are unclear. Methods: College student participants (N = 631) at a northeastern U.S. university were invited via email to participate in a survey about e-cigarettes and alcohol use. Mental health was self-reported diagnosis of psychiatric (depression, bipolar disorder, schizophrenia, PTSD, anxiety disorder, personality disorder), and substance (alcohol and other drug) use disorders. Current use of e-cigarette, combustible cigarette, and other tobacco products were assessed via self-reported past 30-day use frequency. Alcohol consumption was assessed via number of self-reported standard alcoholic beverages consumed during a typical drinking episode. Participants also reported regarding co-use of alcohol, e-cigarettes and/or combustible cigarettes. Participants were categorized as non-drinkers, moderate drinkers or binge drinkers, and associations between e-cigarette use, drinking patterns and mental health diagnoses were examined. Results: E-cigarette use was associated with drinking alcohol chi(2) = 18.62, p < .001, and binge drinking (vs. moderate drinking) chi(2) = 12.20, p < .001. Students who had tried e-cigarettes reported drinking more alcohol per episode (chi(2) = 15.94, p < .001). E-cigarette use was more prevalent among those with psychiatric and substance use disorders chi(2) = 11.65, p < .001. Conclusions: Drinking college students (especially binge drinkers) and those with mental illness may have heightened risks for e-cigarette use. More research is needed to elucidate relationships between risky alcohol and/or nicotine use and mental illness, and to guide appropriate prevention and intervention efforts for vulnerable college students.