Patterns in Mental Health Symptomatology and Cigarette, E-cigarette, and Marijuana Use Among Texas Youth and Young Adults Amid the Coronavirus Disease 2019 Pandemic

Introduction This study examined patterns in mental health symptomatology and smoking and vaping behaviors among youth and young adults over a 1-year period from before to during the first year of the Coronavirus Disease 2019 (COVID-19) pandemic. Aims and Methods Participants (n = 2148) were 16-24-year-olds who completed three waves of the Texas Adolescent Tobacco and Marketing Surveillance Study (TATAMS). Descriptive statistics and mixed effects logistic regression models were used to examine changes in anxiety symptoms, depressive symptoms, perceived stress, and cigarette, e-cigarette, and marijuana use from before COVID-19 (fall 2019) to 6-month follow-up (spring 2020) and 12-month follow-up (fall 2020) periods during COVID-19. Longitudinal associations between mental health symptomatology and smoking and vaping were examined. Results Modest increases in symptoms of anxiety and depression were observed from before to during COVID-19. Perceived stress remained high and unchanged. Ever marijuana use increased at 6- and 12-month follow-up, while ever cigarette and e-cigarette use increased significantly only at 12-month follow-up. Marijuana use frequency increased significantly at 6- and 12-month follow-ups. Adjusting for sociodemographic factors, increased symptoms of anxiety and depression predicted increases in ever cigarette, e-cigarette, and marijuana use, and past 30-day cigarette and e-cigarette use, but not past 30-day marijuana use. Higher perceived stress predicted increases in ever use of cigarettes and e-cigarettes and past 30-day cigarette use. Conclusions Changes in mental health symptomatology and smoking and vaping behaviors among young people in Texas varied during this period of the COVID era. Increases in mental health symptomatology predicted increases in cigarette, e-cigarette, and marijuana use behaviors. Implications This study adds to the limited research on the longitudinal impact of anxiety symptoms, depressive symptoms, and perceived stress on cigarette, e-cigarette, and marijuana use from before to during the first year of the COVID-19 pandemic. Findings warrant health messaging and interventions that address the significant impact of worse mental health on increased smoking and vaping behavior, especially during crises like COVID-19 that may exacerbate mental health and substance use behaviors.