Youth Smoking and Vaping Social Norms and Associations with Stress, Anxiety, and Depression Symptoms

Smoking and vaping are more common among people with poorer mental health but less is known about smoking/vaping norms and mental health. In 2022, 12,820 16- to 19-year-olds were surveyed in England, Canada, US. Logistic regressions assessed associations between four social norms (perceiving that: friends smoke[/vape], peers approve of smoking[/vaping]) and self-reported stress, depression symptoms, anxiety symptoms, and country, adjusting for smoking/vaping/sociodemographics. All smoking and vaping norms were more positive in England than Canada and US (p<.050). Perceiving friends smoke was associated with higher stress (AOR=1.15[1.02-1.30]) and depression (AOR=1.15[1.04-1.28]) symptoms. Perceiving friends vape was associated with higher stress (AOR=1.26[1.12-1.41]), depression (AOR=1.31[1.19-1.45]) symptoms, and anxiety (AOR=1.26[1.14-1.40]) symptoms. Perceiving peers approve of smoking was associated with higher stress (AOR=1.14[1.01-1.29]) and depression (AOR=1.26[1.13-1.40]) symptoms. Perceiving peers approve of vaping was associated with higher depression (AOR=1.20[1.09-1.32]) and anxiety (AOR=1.41[1.28-1.55]) symptoms. Overall, among youth, poorer mental health was associated with positive smoking and vaping norms.