A Comparison of Mental and Behavioral Health Risks Factors Associated With Current Dual Use of Electronic Cigarette and Conventional Tobacco Cigarettes With Exclusive Tobacco Cigarette Use and Nonuse Among Adults in the United States.

BACKGROUND AND OBJECTIVES While health risks associated with tobacco cigarette use are well-known, additional risks of dual use are poorly understood. This study compared mental and behavioral health risk factors associated with the current dual use of e-cigarettes and conventional tobacco cigarettes with current exclusive users of tobacco cigarettes and nonusers of either e-cigarettes or tobacco cigarettes. METHODS Data from the 2016 National Behavioral Risk Factor Surveillance System (BRFSS) were analyzed (N = 277,034). Current dual use was defined as the current use of tobacco cigarettes and the use of e-cigarettes, everyday or some days. Multivariate logistic regression analysis was used to assess associations between dual use and mental and behavioral health risks compared with exclusive tobacco cigarette users and nonusers. RESULTS Compared with nonusers, current dual use was associated with increased odds of having more than 14 days of self-reported poor physical health (adjusted odd ratio [AOR], 1.9; P < .01), more than 14 days of self-reported poor mental health (AOR, 1.8; P < .01), a diagnosis of depression (AOR, 2.2; P < .001); using smokeless tobacco products (AOR, 1.6; P < .05), alcohol use (AOR, 1.6; P < .01), and marijuana use (AOR, 8.3; P < .001) than current exclusive users of tobacco cigarettes. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE The concurrent use of e-cigarettes and tobacco cigarettes is associated with increased odds of having behavioral and mental health problems. These findings may be indicative of increased health risks associated with dual use, compared with the exclusive use of tobacco cigarettes, and have important implications for public health interventions and policies aimed at mitigating health risk behaviors. (Am J Addict 2020;00:00-00).