Social media and e-cigarette use: The mediating role of mental health conditions

Background: In recent years, youth social media use, youth e-cigarette use, and youth mental health conditions have become major public health concerns. We examined the role of mental health condition indicators in the link between youth social media use and e-cigarette use.Methods: We used data from the 2022 National Youth Tobacco Survey (N = 23,445) to measure social media use by time spent, anxiety and depression symptoms by the Patient Health Questionnaire-4, and past-30-day e cigarette use. We applied the potential outcomes framework to examine the relationship between social media use and e-cigarette use mediated by mental health condition indicators.Results: Mental health condition indicators mediated the relationship between social media use and e-cigarette use in a dose-response manner, with higher levels of social media use associated with higher odds of e-cigarette use. With mental health condition indicators as a mediator, those who used social media for 4+ hours/day or 3-4 h/day had significantly higher odds of e-cigarette use than those who used social media sometimes or never. In the sex-stratified analysis, we found that very often social media use was associated with higher odds of e cigarette use for both males and females, compared to sometimes users (OR = 1.53, 95 % CI [1.18,1.96] for males; OR = 2.27, 95 % CI [1.76,2.92] for females). Limitations: Anxiety and depression symptoms were self-reported. Conclusions: This study shows that anxiety and depression symptoms mediate the relationship between social media and e-cigarette use among youth and support the growing concern that frequent social media use may negatively affect youth health.