Gender-Moderated Association between Adolescent Mental Health, Conventional Substance Use, and Vaping

Background: Overall, adolescent mental health problems, conventional substance use, and electronic vapor product (EVP) use are highly comorbid. The literature has shown that the recent vaping boom is more appealing to females. However, the previous evidence is still unclear about how the associations between mental health, conventional substance use, and EVP use can be different between female and male adolescents. Thus, it is vital to understand how those comorbidities vary based on gender. The current study aimed to fill this gap by focusing on the moderating effect of gender on the relationships between mental health, conventional substance use, and EVP use. We examined whether there were different effects of mental health problems and current conventional substance use on current EVP use between female and male adolescents. Specifically, based on the literature, we hypothesized that the impact of mental health and conventional substance use on EVP use would be greater for female adolescents than males.

Methods: Data were drawn from the 2019 Youth Risk Behavior System Survey, a national survey with a representative sample of 13,677 high school students in grades 9–12. Control variables were age, gender, and race; independent variables are mental health problems (depression and suicidal ideation) and conventional substance use (current cigarette use, alcohol use, binge drinking, and marijuana use); current electronic vapor product use was a dependent variable; and gender was a moderator. A multivariate hierarchical logistic regression was conducted using SPSS 2.6.

Results: Depression (OR=1.37; 95%CI=1.20–1.56) and suicidal ideation (OR=1.24; 95%CI=1.06–1.45) were significantly associated with current EVP use. Likewise, all the conventional substance use, specifically current cigarette use (OR=3.83; 95%CI=2.72–5.39), alcohol use (OR=4.73; 95%CI=4.09–5.48), binge drinking (OR=2.02; 95%CI=1.66–2.46), and marijuana (OR=7.63; 95%CI=6.61–8.80), were significantly associated with current EVP use. In particular, the impact of depression on EVP use was greater among female students than male students (OR=0.74; 95%CI=0.56–0.97). Female students who had depressive symptoms were more likely to vape than their male counterparts. Conversely, the impact of current cigarette use on EVP use was greater among the male students than the female students (OR=2.27). Current male cigarette smokers were more likely to vape than their female counterparts. Similarly, the impact of current marijuana use on EVP use was greater among the male students than the female students (OR=1.64; 95%CI=1.13–4.57). Current male marijuana users were more likely to vape than their female counterparts.

Conclusion: The results showed a high co-occurrence of mental health problems and EVP use, as well as conventional substance use and EVP use, among adolescents. Furthermore, gender is an important moderating factor that influences the associations between mental health problems, conventional substance use, and EVP use. Specifically, the impact of mental health problems on EVP use was greater among female adolescents than among their male counterparts. Conversely, the impact of current cigarette and marijuana use on EVP use were greater among male adolescents than among their female counterparts. Effective prevention and intervention programs should consider and address these comorbidities for male and female adolescents differently.