Mental Health
Dual use of cigarettes and e-cigarettes among young adults in the United States: associations with mental distress, race and ethnicity, and healthcare access Fahima Nasrin Eva* Fahima Nasrin Eva Eva Florida International University
Objective
This study investigates the relationship between mental distress and dual use of cigarettes and e-cigarettes among U.S. young adults aged 18–24, with particular attention to racial/ethnic differences and indicators of healthcare access.
Method
A cross-sectional analysis of 2024 Behavioral Risk Factor Surveillance System (BRFSS) data was conducted among 19,245 young adults aged 18–24 (weighted N=20.49 million). Survey-weighted logistic regression estimated adjusted odds ratios (aORs) for dual use (vs non-use) in relation to mental distress, depressive disorder, race/ethnicity, and sociodemographic and healthcare-access factors. Analyses accounted for complex survey design, used two-sided p<0.05 to define statistical significance, and were conducted in SAS 9.4.
Result
Among 19,245 adults aged 18–24 in BRFSS 2024, 3.2% were dual users of cigarettes and e-cigarettes. In adjusted models, females had lower odds of dual use than males (AOR 0.43, 95% CI 0.32–0.58, p<0.001), as did non-Hispanic Black versus non-Hispanic White adults (AOR 0.31, 95% CI 0.17–0.57, p<0.001). In contrast, not completing high school (AOR 3.88, 95% CI 2.14–7.03, p<0.001), divorced status (AOR 6.98, 95% CI 3.18–15.34, p<0.001), and rural residence (AOR 2.44, 95% CI 1.56–3.80, p<0.001) were associated with higher odds of dual use. Frequent mental distress (14+ mentally unhealthy days; AOR 2.19, 95% CI 1.42–3.37, p<0.001), depressive disorder (AOR 2.65, 95% CI 1.95–3.62, p<0.001), inability to afford a doctor (AOR 1.50, 95% CI 1.05–2.12, p=0.024), and long intervals since routine checkup (≥2 years; AOR 2.85–2.90, all p<0.001) were associated with dual use.
Conclusion
Dual cigarette and e-cigarette use was relatively uncommon but highly concentrated among men, those with lower educational attainment, divorced and rural residents, and young adults experiencing frequent mental distress, depressive disorder, and healthcare barriers. Mental distress remained a strong correlate of dual use across racial/ethnic groups.
