Flawed Assumptions Cloud Latest Study Linking Vaping to Teen Anxiety

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Key Points:

• Study Headline: New PLOS Mental Health paper links youth vaping to anxiety and depression, but its design can’t prove cause and effect.

• Key Findings: Dual users of cigarettes and vapes reported the highest mental health symptoms; non-users reported the lowest.

• Method Flaws: Cross-sectional data, “ever use” classification, and no distinction between nicotine, non-nicotine, or marijuana vapes.

• Missing Context: No control for confounding factors like trauma, poverty, or family mental health history.

• Reverse Link Possible: CDC and other studies show many teens vape because of existing mental health struggles, not the other way around.

• Policy Risk: Using flawed data to justify bans could harm youth and limit access for 20 million U.S. adults who quit smoking via vaping.

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A new study published in PLOS Mental Health is receiving widespread media coverage as part of the ongoing youth vaping narrative. Researchers analyzed data from over 60,000 middle and high school students, examining whether those who had ever used combustible cigarettes, e-cigarettes, or both were more likely to report poor mental health compared to non-users.

Before jumping on the latest alarmist headline surrounding tobacco harm reduction, policymakers should understand what this study actually found – and what it did not.

Using data from the National Youth Tobacco Survey (NYTS), the researchers assessed tobacco and vape product use, and measured symptoms of depression, anxiety, and overall psychological distress using the Patient Health Questionnaire (PHQ-4).

They found that the highest rates of anxiety and depression were reported by students who had ever used both cigarettes and e-cigarettes (dual users), with 43.4 percent reporting depressive symptoms and 45.2 percent reporting anxiety. Among those who had ever used e-cigarettes, 35.9 percent reported depression and 40.5 percent reported anxiety. Youth who had ever used only combustible cigarettes reported similar rates – 35.6 percent for depression and 38.4 percent for anxiety. In contrast, non-users reported the lowest rates: 21.8 percent experienced symptoms of depression and 26.4 percent reported anxiety.

But this isn’t the full picture – and the study has several critical limitations that make it unsuitable for drawing causal conclusions.

First, the study is cross-sectional. It simply captures a snapshot in time, meaning it cannot determine whether vaping or smoking leads to poor mental health – or whether youth struggling with mental health are more likely to try tobacco or vaping products.

Second, the researchers relied on survey questions that asked whether students had ever used a cigarette or vape—treating these students as if they were regular users. This is misleading. The NYTS distinguishes between ever use, current use (use on at least one of the past 30 days), and frequent or heavy use (20 or more days in the past month). The study did not take advantage of these distinctions, missing the opportunity to explore potential dose-response relationships or the impact of regular use versus experimentation.

Third, the study did not distinguish between different types of vaping products. Many teens report using vapes without knowing whether they contained nicotine, and some may have used devices containing only flavors – or even marijuana. As a result, the study cannot assess the differential effects of nicotine-containing versus nicotine-free products on mental health.

Additionally, the authors failed to account for other important confounding factors – such as family history of mental illness, socioeconomic hardship, or exposure to trauma – all of which are known to influence adolescent mental health.

Perhaps most notably, other studies have found that coping with anxiety, depression, or stress is one of the most commonly cited reasons youth report for vaping – not because vaping causes those feelings. According to the CDC’s 2021 NYTS, over 40 percent of youth who vape reported doing so because of mental health struggles. A 2022 JAMA Network Open study also found that existing mental health issues were strong predictors of e-cigarette use, especially among females and LGBTQ+ youth.

This latest study should be interpreted with caution and should not be used to justify blanket bans or punitive restrictions on tobacco harm reduction products. More effective strategies for addressing the youth mental health crisis would include school-based mental health screenings, increased access to services, and interventions targeting the underlying causes – such as academic pressure, bullying, or trauma – rather than scapegoating nicotine.

Overstating the risks of vaping not only risks driving these products into illicit markets but also stigmatizes vulnerable youth, pushing them further from the help they need.

It’s also important to note that youth nicotine use – including cigarettes and vaping – is at record lows. Yet studies like this one continue to fuel the long-debunked “youth vaping epidemic” narrative. This misinformation does real harm – not only to public understanding, but also to the more than 20 million U.S. adults who have successfully quit smoking with the help of e-cigarettes.

There is no question that youth mental health is in crisis. But blaming that crisis on vaping – without considering why teens are turning to these products in the first place – oversimplifies a deeply complex issue.

Rather than treating e-cigarettes as the cause of depression and anxiety, we must acknowledge the broader ecosystem of stressors, social inequality, and a mental health system that too often fails young people.

Nothing in this analysis is intended to influence the passage of legislation, and it does not necessarily represent the views of Tobacco Harm Reduction 101.