Psychological distress, perceived psychological reward, and nicotine dependence among young people

E-cigarettes (ECs) remain the most commonly used tobacco product among young people in the United States (US). Psychological distress (PD) is prevalent and associated with EC use and nicotine dependence, although underlying factors are unclear. Psychological reward (PR)-positive internal sensations associated with EC use-may account for the association between PD and nicotine dependence. This study examined whether PR was statistically associated with the relationship between PD and nicotine dependence. Given the cross-sectional design, analyses assessed associations rather than causal or temporal pathways.

Young people aged 14-25 years in the US who had recently initiated EC use participated in a study of nicotine product trajectories. After providing consent or assent, participants completed an online survey. Measures included PD (anxiety and depression symptoms), PR (feeling calm, less irritable, better able to concentrate, more awake, and less hungry after EC use), and nicotine dependence (Hooked on Nicotine Checklist). The indirect association between PD and nicotine dependence through PR was examined using linear regression.

The direct association between PD and nicotine dependence remained significant (b = 0.22), as did the estimated indirect association through PR (b = 0.06, 95% CI [0.01, 0.10]).

Findings indicate cross-sectional associations among PD, PR of EC use, and nicotine dependence in young people. Addressing PD may be relevant to efforts to reduce nicotine dependence; longitudinal and experimental studies are needed to determine whether PD management influences dependence.