{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T19:12:29Z","timestamp":1787166749188,"version":"build-2736575974"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T00:00:00Z","timestamp":1753228800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosmentalhealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Ment Health"],"abstract":"<jats:p>Adolescence is a critical period for mental health development. There are increasing rates of anxiety, depression, and suicide among adolescents in the United States (U.S.). Tobacco use, especially electronic cigarettes (e-cigarettes) and dual use with combustible tobacco products (CTP), poses a significant threat to adolescent mental health. This study examines the association between various tobacco use profiles and mental health outcomes among U.S. middle and high school students. Data from the 2021\u20132023 National Youth Tobacco Survey were analyzed. Three-quarters of eligible students completed the survey across the three years. Depression and anxiety symptoms were assessed using the Patient Health Questionnaire (PHQ-4), with scores of \u22653 indicating probable cases, generating two binary variables (&lt;3 vs.\u2009\u2265\u20093). Overall psychological distress was categorized into normal (0\u20132), mild (3\u20135), moderate (6\u20138), and severe (9\u201312) based on PHQ-4 total scores. Tobacco use was categorized as ever e-cigarette-only, ever CTP-only, ever dual use, and non-use. Descriptive statistics and weighted multivariable logistic and ordinal regression models estimated odds ratios (OR) and 95% confidence intervals (CI), adjusting for potential confounders. Among the 60,072 adolescents analyzed, 15,222 (25.21%) had depression and 17,790 (29.55%) had anxiety symptoms. Compared to adolescents who were non-users, those who were ever dual users had the highest odds, with adjusted OR of 1.90 (95%CI:1.58-1.94) for symptoms of depression, 1.58 (95%CI:1.40-1.78) for symptoms of anxiety, and 1.75 (95%CI:1.58-1.94) for overall psychological distress. Odds were also significantly higher for adolescents who exclusively used e-cigarettes compared to non-users and those who exclusively used CTP compared to non-users. This study highlights a significant association between tobacco use and poor mental health among adolescents. These results contribute to evidence informing future research and policy on adolescent tobacco use and mental health.<\/jats:p>","DOI":"10.1371\/journal.pmen.0000370","type":"journal-article","created":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T17:22:07Z","timestamp":1753291327000},"page":"e0000370","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmen.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["Mental health outcomes associated with electronic cigarette use, combustible tobacco use, and dual use among U.S. adolescents: Insights from the National Youth Tobacco Survey"],"prefix":"10.1371","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-2820-1960","authenticated-orcid":true,"given":"Noor","family":"Abdulhay","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. 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