Internalizing and Externalizing Problems as Risk Factors for Initiation and Progression of E-cigarette and Combustible Cigarette Use in the US Youth Population

This study examined whether internalizing and externalizing problems were associated with initiation and progression of e-cigarette/cigarette use. The youth from the Population Assessment of Tobacco and Health Study Waves 1-2 were included in this study (n = 9258). Multinomial logistic and linear regression were performed to investigate whether Wave 1 internalizing and externalizing problems were associated with Wave 2 initiation and progression of cigarette/e-cigarette use. Higher internalizing and externalizing problems were both associated with higher risk for initiating cigarette smoking and exclusive e-cigarette use. Neither internalizing nor externalizing problems were associated with (1) differential likelihood of initiating exclusive e-cigarette use when compared with initiating cigarette smoking and (2) more frequent use of cigarettes or e-cigarettes. Schools and community public health practitioners should provide prevention and intervention efforts among the target population. Improving the youth's mental and behavioral health could have a secondary effect on preventing cigarette and e-cigarette use initiation.

Automated summary

This study found that internalizing and externalizing problems among youth were associated with increased risk for initiating cigarette smoking and exclusive e-cigarette use, but not with frequency of use. Schools and community public health practitioners should focus on prevention and intervention efforts among youth to improve mental and behavioral health, which could help prevent cigarette and e-cigarette use initiation.