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Mental Health Issues Can Lead to Initiation of Tobacco Use in Teens


Mental health problems in the teen years can be a reason that some teens begin smoking cigarettes and e-cigarettes.  A study in the July 2019 issue of Pediatrics, “Mental Health Problems and Initiation of E-Cigarette and Combustible Cigarette Use,” (published online June 3) looked at 7,702 teens ages 12-17 years old who reported never using tobacco products and followed their behavior reports from 2013 to 2015. Participants were classified along a spectrum for two different types of mental health problems: internalizing problems, which included anxiety, depression and sleep symptoms, and externalizing problems, which included impulsive behavior and disruptive conduct. Researchers found that those with internalizing problems were more likely to start using e-cigarettes only. Those with externalizing problems were more likely to initiate combustible cigarette use and/or e-cigarette use. Researchers suggest that teens with mental health problems may be using tobacco products to self-medicate and improve their moods. They also suggest that those with externalizing problems may have problems with self-regulation and impulse control, making them more likely to engage in risky behaviors such as smoking. The authors conclude that school-based tobacco prevention programs and pediatricians should consider the role mental health problems play in the initiation of tobacco use by teens.


The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit and follow us on Twitter @AmerAcadPeds