Understanding Gender-Specific Cycles of Nicotine Dependence and Mental Health: Evidence for Dynamic and Reciprocal...

Nicotine dependence is a significant public health issue linked to various psychosocial problems. However, previous research has largely examined these relationships in a unidirectional manner or at the between-person level, overlooking the potential for within-person fluctuations over time. This study uses a longitudinal approach to investigate the bidirectional associations between nicotine dependence, internalizing problems, and externalizing problems among adults. In addition, we examine gender as a potential moderator of these relationships.

Using data from the Population Assessment of Tobacco and Health (PATH) Study (2013-2021), we analyzed four waves of data from a nationally representative sample of 9,620 adults. A random intercept cross-lagged panel model (RI-CLPM) was used to distinguish between-person and within-person associations while accounting for individual variability over time. A multigroup RI-CLPM was conducted to assess gender differences.

At the between-person level, nicotine dependence was positively associated with both internalizing and externalizing problems. At the within-person level, significant bidirectional associations were observed between nicotine dependence and internalizing problems, as well as between internalizing and externalizing problems. Gender moderated these associations, with females showing stronger links between nicotine dependence and internalizing problems, whereas males exhibited stronger associations between nicotine dependence and externalizing behaviors.

These findings highlight the complex, dynamic interplay between nicotine dependence and psychosocial problems, emphasizing the need for tailored interventions that account for both within-person fluctuations and gender differences. Understanding these mechanisms can inform more effective prevention and treatment strategies targeting nicotine dependence and associated mental health challenges.