Social Media and E-Cigarette Use in Youth: Does Depression Play a Mediating Role?

About 28% of middle and high school students report the use of e-cigarettes per the 2019 NYTS survey. Social media can seclude a youth into limited set of beliefs, including affirmation for e-cigarette use. Internalizing problems like depression may be due to overuse of social media, and youth with depressive symptoms are more likely to use e-cigarettes to cope. National Youth Tobacco Survey (NYTS) 2023 data was used (n = 18 143) in a cross-sectional design. Ever e-cigarette use was the binary (Y/N) dependent variable. Independent variable, social media use, was categorized as "never," "nondaily," "daily." Mediator variable, presence of recent depression was binary (Y/N). Survey weight adjusted logistic regression and path analysis were employed to identify direct and indirect effects (mediated via recent depression) of social media use on ever e-cigarette use. Social media use (nondaily, aOR = 1.58, P = .032; daily, aOR = 1.91, P < .001; both vs never) and recent depression (yes vs no, aOR = 2.00, P < .001) were independently associated with ever e-cigarette use. In the path analysis, likelihood of social media use (nondaily, aOR = 1.58, P = .037; daily, aOR = 1.88, P < .001; both vs never) and depression (yes vs no, aOR = 1.99, P < .001) being associated with e-cigarette use remained similar to findings of logistic regression. In the mediation analysis, direct effect estimates (nondaily, aOR = 1.52, P = .065; daily, aOR = 1.84, P < .001; both vs never) were consistent with the path analysis results. Compared to direct effect, lower effect size estimates were observed for depression mediated indirect effect (nondaily, aOR = 1.09, P = .057; daily, aOR = 1.10, P < .001; both vs never). We observed that policy changes regarding monitoring of youth's social media use is needed to prevent youth from e-cigarette use.