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Tobacco Use and Mental Health Across the Age Continuum: A Study of Youth and Adults from the Population Assessment of Tobacco and Health Study Open Access

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Despite population-level declines in cigarette smoking in the U.S. over the last five decades, there is overwhelming evidence that tobacco use is disproportionately high among those with mental health problems. Yet, research on why and how mental health problems influence tobacco use behavior across the age continuum is limited. In three papers, this dissertation uses data from the Population Assessment of Tobacco and Health (PATH) study to address these gaps in the literature.Paper 1 examined predictors of initiation of use of e-cigarettes and other tobacco products among youth with mental health problems between two study waves. Risk factors for initiation of e-cigarette use among youth with severe internalizing problems included older age, being non-Hispanic White, a higher sensation seeking score and ever alcohol use; risk factors for initiation of e-cigarette use among youth with severe externalizing problems included receptivity to pro-tobacco marketing, being non-Hispanic White and poor school performance. There was some overlap in risk factors for onset of e-cigarette use for those with different levels of severity of mental health problems. These findings suggest that e-cigarette prevention strategies for the general youth population may be effective for youth with mental health problems.Paper 2 examined whether receptivity to pro-tobacco marketing moderates the relationship between mental health problems and tobacco use among young adults. For all products, receptivity was positively associated with tobacco use. A significant interaction was detected between cigarette advertising receptivity and internalizing problems, such that the magnitude of the relationship between receptivity to cigarette advertising and cigarette use was stronger for those with severe internalizing problems compared to those with low internalizing problems. These findings suggest that young adults with severe internalizing problems may be more vulnerable to the effects of pro-tobacco marketing, which could exacerbate disparities in cigarette use based on severity of internalizing problems.Paper 3 used latent class analysis to explore the complex interplay of symptoms of different mental health problems and how they relate to tobacco use behavior among adults. Three latent classes were identified based on symptoms of internalizing, externalizing and substance use problems. The “normative” class reported low prevalence of all symptoms, the “severe internalizing and non-violent externalizing” class reported severe internalizing problems and non-violent externalizing problems and the “severe” class reported high prevalence of all symptoms. Tobacco use was highest for the “severe” class and lowest for the “normative” class across products. Individuals with severe psychiatric comorbidities may be at elevated risk of tobacco-related morbidity and mortality and would likely benefit from targeted tobacco control interventions.Overall, the findings from this dissertation highlight the fact that individuals with mental health problems are a heterogeneous population and that mental health problems are complex in how they interact with each other and how they impact tobacco use behavior. Additionally, findings from this dissertation show that tobacco-related risk factors and behaviors are not uniform across tobacco products. Tobacco prevention interventions for individuals with mental health problems need to be designed with the specific tobacco product of interest in mind and must demonstrate an understanding that there is great variation in the type, severity and number of mental health problems among individuals.

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