Life satisfaction across patterns of cigarette and e-cigarette use among adolescents: evidence from a national...

Evidence on how adolescent vaping relates to subjective wellbeing remains mixed. We compared life satisfaction across mutually exclusive patterns of cigarette and e-cigarette use in England.

We analysed cross-sectional data from the 2023 Smoking, Drinking and Drug Use among Young People in England survey. After exclusions for missing nicotine-use data (n = 761) and invalid life satisfaction responses (n = 2,242), 14,463 adolescents aged 11-15 years were included. Current nicotine-use pattern was classified as: no current nicotine use, exclusive e-cigarette use, exclusive cigarette smoking, or dual use. Linear regression with robust standard errors estimated crude and adjusted mean differences in life satisfaction (0-10) relative to non-use. Models adjusted for age, gender, ethnicity and family affluence; additional analyses used ordered logistic regression and tested interactions.

Most pupils reported no current nicotine use (n = 13,275; 91.8%); 866 (6.0%) were exclusive e-cigarette users, 61 (0.4%) exclusive cigarette smokers, and 261 (1.8%) dual users. Compared with non-users, adjusted mean life satisfaction was lower among exclusive e-cigarette users (β =  - 1.20; 95% CI -1.40 to -1.01), exclusive cigarette smokers (β =  - 1.09; 95% CI -1.94 to -0.25), and dual users (β =  - 1.29; 95% CI -1.71 to -0.88). Predicted adjusted means were 6.74 for non-users and 5.54, 5.65, and 5.45 for exclusive e-cigarette users, exclusive cigarette smokers, and dual users, respectively. Associations were similar for boys and girls and across family affluence (interaction p = 0.187 and p = 0.848), but differed by ethnicity (p = 0.0007), with wider confidence intervals in some subgroups. Ordered logistic regression was consistent: adjusted odds ratios for higher life satisfaction were 0.45 (95% CI 0.40-0.51) for exclusive e-cigarette use, 0.51 (0.27-0.95) for exclusive cigarette smoking, and 0.44 (0.32-0.59) for dual use.

Current nicotine use, whether vaping, smoking, or both, was associated with lower life satisfaction, with dual users reporting the lowest adjusted levels. Given the cross-sectional design and potential residual confounding, longitudinal studies with repeated measures are needed to clarify whether nicotine use precedes lower life satisfaction, whether lower life satisfaction predicts subsequent nicotine use, or whether both reflect shared psychosocial and social risk factors.