BACKGROUND/AIM: Understanding the social context of e-cigarette use in the United States (U.S.) remains a high priority.
METHODS: In this cross-sectional study, we included 68,356 adults aged =18 from the All of Us research program’s COVID-19 Participant Experience (COPE) survey who had complete e-cigarette use information. Multivariable-adjusted logistic regression was used to examine the association between e-cigarette use (current, former, and never), psychological distress, and substance use.
RESULTS: In the sample, most were male (66.3 %) and white (81.9 %), with 2.9 % reporting former and 2.3 % current e-cigarette use. Individuals reporting former or current e-cigarette use had a higher prevalence of psychological distress (e.g., depressive symptoms: never 49.6 %, former 70.2 %, current 73.4 %) and substance use (e.g., cannabis: never 9.8 %, former 37.0 %, current 42.6 %) than never e-cigarette use. Compared with never use, current e-cigarette use was associated with higher odds of depressive symptoms (aOR, 1.53 95 % CI: 1.34–1.74), anxiety (aOR1.36, 1.19–1.57), suicidal ideation (aOR1.55, 1.32–1.82), stress (aOR1.41, 1.24–1.59), as well as, cannabis (aOR 2.72, 2.40–3.08), opioids (aOR1.92, 1.56–2.36), stimulants (aOR2.33, 1.91–2.83), sedatives (aOR1.68, 1.43–1.98), hallucinogens (aOR1.94, 1.28–2.90), and cocaine use (aOR1.85, 1.21–2.79). Similar significant associations were observed in former, occasional and daily e-cigarette use, with comparable estimates across sexes.
CONCLUSION: In this unique well-powered All of US dataset, there was a significant cross-sectional association between e-cigarette use, psychological distress, and substance use, indicating that the social context of e-cigarette use is closely linked to key well-being domains. These data provide high precision estimates that can be used to inform interventions aimed at creating awareness of e-cigarette use correlates.
Association of e-cigarette use, psychological distress, and substance use: Insights from the All of Us Research Program
Addictive Behaviors, 166, 108322. doi: 10.1016/j.addbeh.2025.108322.