title: Patterns of electronic cigarette use and level of psychological distress.
abstract: BACKGROUND
  Psychological distress has been correlated with higher levels of nicotine dependence. To date, the possible association between individuals' levels of psychological distress and e-cigarette use has not been investigated, despite the dramatic growth of e-cigarette use in the US. We examined this possible association using a nationally representative sample of US adults.
  
  
  METHODS
  A total of 36,697 adults from the 2014 National Health Interview Survey (NHIS) were included. The Kessler 6 scale was used to measure psychological distress. Multivariate logistic regression analysis was conducted to assess the association between level of psychological distress and e-cigarette use.
  
  
  RESULTS
  Both e-cigarette and cigarette use varied according to level of psychological distress as well as multiple socio-demographic characteristics. In a multivariate model, psychological distress was significantly associated with the following groups: (a) exclusive e-cigarette ever-use (aOR = 3.7; 95% CI = 1.6, 8.6), (b) current dual use of e-cigarettes and cigarettes (aOR = 4.6; 95% CI = 3.1, 6.7), (c) former cigarette use and ever use of e-cigarette (aOR = 3.2; 95% CI = 2.2, 4.8) and (d) current use of cigarettes only (aOR = 2.1; 95% CI = 1.7, 2.6).
  
  
  CONCLUSIONS
  These are the first data to demonstrate that, as is true for cigarettes, e-cigarette use is associated with increased levels of psychological distress. Further large-scale, longitudinal studies are needed to determine the direction of this relationship and to evaluate the long-term positive and negative consequences of such use.
authors.affiliation: Department of Pediatrics, New York University School of Medicine, New York, New York, United States of America.|Department of Population Health, New York University School of Medicine, New York, New York, United States of America.
authors.forename: Su Hyun
authors.identifier: http://orcid.org/0000-0002-5527-7520
authors.initials: SH
authors.lastname: Park
authors.affiliation: Department of Pediatrics, New York University School of Medicine, New York, New York, United States of America.|Brooklyn College, New York, New York, United States of America.
authors.forename: Lily
authors.initials: L
authors.lastname: Lee
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, New York, United States of America.|College of Global Public Health, New York University, New York, New York, United States of America.|New York University/ Abu Dhabi Public Health Research Center, Abu Dhabi, United Arab Emirates.
authors.forename: Jenni A
authors.initials: JA
authors.lastname: Shearston
authors.affiliation: Department of Pediatrics, New York University School of Medicine, New York, New York, United States of America.|Brooklyn College, New York, New York, United States of America.|New York University/ Abu Dhabi Public Health Research Center, Abu Dhabi, United Arab Emirates.|Department of Environmental Medicine, New York University, New York, New York, United States of America.
authors.forename: Michael
authors.initials: M
authors.lastname: Weitzman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D066300:Electronic Nicotine Delivery Systems / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D013315:Stress, Psychological / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult