Establishing the association between traditional tobacco, e-cigarette and dual use and mental health problems among high school students: results from a 2022 behavioral surveillance survey

This study examined the association among past-year use of conventional cigarette (CC), e-cigarette (EC), dual use (using both CC and EC), with presence of substance use (i.e., alcohol use and marijuana use), having friends and family members who use cigarettes, and mental health problems (e.g., depression, anxiety, psychological distress (PD), problem gambling (PG) and adverse childhood experiences (ACEs)). A secondary analysis was conducted using data from 2022 Bangkok Behavioral Surveillance Survey (BBSS) (6,000 invited, 5,740 completed). Among the respondents, approximately, 14.1% used EC only, 11.0% used CC only, and 7.9% used both in the past year. The use of a substance (e.g., cannabis, alcohol), having mental health problems (e.g., having PD, PG, sleep disturbance, > 4 ACEs) and having friends or family members who use cigarettes were highly associated with use of CC, EC and dual use. Despite the lack of causal conclusions, this unique study presents associations that might have implications for future legislation on EC that impacts Asian youth. We also stress the need for research, particularly in view of the fact that EC is seen as less dangerous than smoking CC, and has essentially replaced smoking in Thailand