Poly-tobacco use and mental health in South Korean adolescents

INTRODUCTION With the advent of new tobacco products, poly-tobacco use among adolescents is increasing.Smoking among adolescents negatively impacts both their physical and mental health.This study aimed to determine poly-tobacco use among adolescents in South Korea and to identify the mental health problems caused by single-, dual-, and poly-tobacco use.METHODS Data from 54948 adolescents in the 2020 Korea Youth Behavior Webbased Survey were included.Mental health variables of our primary outcome were loneliness, anxiety, and depression.Descriptive statistics, Rao-Scott χ 2 test and complex sample multivariable logistic regression analysis were conducted to determine the association between the type of tobacco product use and mental health.RESULTS Among the subjects, 95.2% were non-tobacco users, followed by single (3.0%), dual (1.1%), and poly users (0.7%).The subjects with poly-tobacco use had significantly higher rates of loneliness (33.2%, p<0.001), anxiety (22.3%, p<0.001), and depression (49.9%, p<0.001) than those who used fewer tobacco products.Subjects who used poly-tobacco products were 2.13 (95% CI: 1.61-2.83)times more likely to report loneliness, 1.52 (95% CI: 1.12-2.07)times more likely to report anxiety, and 2.18 (95% CI: 1.68-2.82)times more likely to report depression than non-tobacco users.CONCLUSIONS Among adolescents, poly-tobacco use is associated with symptoms of loneliness, depression, and anxiety, which are internalized mental health problems.Poly-tobacco use warrants early assessment of high-risk groups, education on the need for tobacco-use cessation, and active intervention for the psychological difficulties that these high-risk groups experience.