Mental Health and the Association between Asthma and E-cigarette Use among Young Adults in The United States: A Mediation Analysis

Abdullah M M Alanazi; Mohammed M Alqahtani; Gregory Pavela; Eric W Ford; Adam M Leventhal; Peter S Hendricks

doi:10.3390/ijerph17238799

Mental Health and the Association between Asthma and E-cigarette Use among Young Adults in The United States: A Mediation Analysis

Int J Environ Res Public Health. 2020 Nov 26;17(23):8799. doi: 10.3390/ijerph17238799.

Authors

Abdullah M M Alanazi^{1

2}, Mohammed M Alqahtani^{1

2}, Gregory Pavela³, Eric W Ford⁴, Adam M Leventhal^{5

6}, Peter S Hendricks³

Affiliations

¹ Rehabilitation Science, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
² Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia.
³ Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
⁴ Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
⁵ Department of Preventive Medicine, University of Southern California, Los Angeles, CA 90089, USA.
⁶ Department of Psychology, University of Southern California, Los Angeles, CA 90089, USA.

Abstract

Background: Asthma is associated with a greater likelihood of e-cigarette use among young adults, which may increase the risk of pulmonary complications. Because substance use trajectories emerge in early adulthood, it is important to identify factors that may be important in addressing this new public health threat. One such factor may be poor mental health.

Methods: Data were extracted from the 2018 Behavioral Risk Factor Surveillance System (BRFSS). Current and former asthma status was measured by self-reported lifetime and current asthma status; mental health functioning was measured by the number of self-reported bad mental health days during the past 30 days; e-cigarette use was measured by self-reported current e-cigarette use. We tested the hypothesis that mental health mediates the association between asthma status and e-cigarette use among young adults using structural equation modeling.

Results: The prevalence of e-cigarette use was significantly higher among young adults with current (9.90%) or former asthma (13.09%) than those without asthma (9.58%). Furthermore, the number of bad mental health days in the past 30 days was significantly greater among young adults with current or former asthma than among those without asthma (Mean (Standard Deviation): 6.85 (0.42), 4.18 (0.85) versus 3.83 (0.17)), respectively. Finally, we found a statistically significant indirect effect of asthma on the likelihood of e-cigarette use through mental health such that the higher prevalence of e-cigarette use among those with current or former asthma was statistically accounted for by a greater number of bad mental health days in the past 30 days.

Conclusions: Consistent with mediation, poorer mental health accounted for the higher prevalence of e-cigarette use among those with asthma. However, longitudinal studies are needed to interrogate causal relationships, including the effects of e-cigarette use on mental health. Mental health services may play an important role in improving health and wellbeing in this vulnerable population.

Keywords: addiction; asthma; e-cigarettes; mediation; mental health; substance use.

MeSH terms

Adolescent
Asthma* / epidemiology
Asthma* / psychology
Electronic Nicotine Delivery Systems*
Female
Humans
Male
Mediation Analysis
Mental Health*
United States / epidemiology
Vaping* / psychology
Young Adult