Association between e-Cigarette Use and Depression in the Behavioral Risk Factor Surveillance System, 2016-2017

Olufunmilayo H. Obisesan, Mohammadhassan Mirbolouk, Albert D. Osei, Olusola A. Orimoloye, S. M.Iftekhar Uddin, Omar Dzaye, Omar El Shahawy, Mahmoud Al Rifai, Aruni Bhatnagar, Andrew Stokes, Emelia J. Benjamin, Andrew P. Defilippis, Michael J. Blaha

Research output: Contribution to journalArticlepeer-review

92 Scopus citations


Importance: The prevalence of the use of electronic cigarettes (e-cigarettes) in the United States has grown rapidly since their introduction to the market more than a decade ago. While several studies have demonstrated an association between combustible cigarette smoking and depression, the association between e-cigarette use and depression has not been thoroughly studied. Objective: To examine the association between e-cigarette use and depression in a nationally representative sample of the adult population in the United States. Design, Setting, and Participants: Cross-sectional study of the Behavioral Risk Factor Surveillance System database, 2016 to 2017. The Behavioral Risk Factor Surveillance System is the largest national telephone-based survey of randomly sampled adults in the United States. A total of 892394 participants with information on e-cigarette use and depression were included. Data analysis was conducted in May 2019. Exposures: Electronic cigarette use status defined by self-report as never, former, or current use. Main Outcomes and Measures: Self-reported history of a clinical diagnosis of depression. Results: Of the 892394 participants (414326 [29.0%] aged ≥60 years; 502448 [51.3%] women), there were 28736 (4.4%) current e-cigarette users, of whom 13071 (62.1%) were aged between 18 and 39 years. Compared with never e-cigarette users, current e-cigarette users were more likely to be single, male, younger than 40 years, and current combustible cigarette smokers (single, 120797 [24.3%] vs 10517 [48.4%]; men, 318970 [46.6%] vs 14962 [60.1%]; aged 18-39 years, 129085 [32.2%] vs 13071 [62.1%]; current combustible cigarette use, 217895 [7.9%] vs 8823 [51.8%]). In multivariable adjusted models, former e-cigarette users had 1.60-fold (95% CI, 1.54-1.67) higher odds of reporting a history of clinical diagnosis of depression than never users, whereas current e-cigarette users had 2.10 (95% CI, 1.98-2.23) times higher odds. Additionally, higher odds of reporting depression were observed with increased frequency of use among current e-cigarette users compared with never users (daily use: odds ratio, 2.39; 95% CI, 2.19-2.61; occasional use: odds ratio, 1.96; 95% CI, 1.82-2.10). Similar results were seen in subgroup analyses by sex, race/ethnicity, smoking status, and student status. Conclusions and Relevance: This study found a significant cross-sectional association between e-cigarette use and depression, which highlights the need for prospective studies analyzing the longitudinal risk of depression with e-cigarette use. If confirmed by other study designs, the potential mental health consequences may have regulatory implications for novel tobacco products.

Original languageEnglish (US)
Article numbere1916800
JournalJAMA Network Open
Issue number12
StatePublished - Dec 4 2019

ASJC Scopus subject areas

  • Medicine(all)


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