Psychosocial correlates of cigarette smoking and e-cigarette use among adults in participating United States jurisdictions: analysis of the 2023 BRFSS
Abstract
Background: Cigarette smoking and e-cigarette use remain important public health concerns. Psychosocial conditions may be related to tobacco-use patterns, but stress, loneliness, social and emotional support, and life satisfaction have rarely been evaluated jointly for both current cigarette- and e-cigarette-use intensity within the same contemporary survey framework.
Objective: To examine adjusted associations of stress, loneliness, social and emotional support, and life satisfaction with current cigarette- and e-cigarette-use intensity among adults represented by participating 2023 BRFSS jurisdictions contributing to the common-file Social Determinants analytic branch.
Methods: We conducted a cross-sectional analysis of the 2023 Behavioral Risk Factor Surveillance System (BRFSS). Because the focal psychosocial exposures were collected through an optional module, the final analysis was restricted to the common-file Social Determinants branch from 35 participating jurisdictions (common-scope n = 263,695), rather than the full 433,323-record source file. Current cigarette and e-cigarette outcomes were defined as not current, some-day current, and everyday current use. The complex survey design was incorporated using the final survey sampling weight, survey strata, and primary sampling units. Primary survey-weighted proportional-odds models adjusted for demographic, socioeconomic, and healthcare-access confounders. Household income was the only analysis variable multiply imputed; the tobacco outcomes and four focal psychosocial exposures were required to be observed.
Results: The primary cigarette analysis base included 203,054 respondents and the e-cigarette base 203,835 respondents. Greater stress was associated with higher cigarette-use intensity (OR = 1.143, 95% CI 1.108–1.178; BH q < 0.001) and e-cigarette-use intensity (OR = 1.285, 95% CI 1.237–1.336; BH q < 0.001). Higher life satisfaction was inversely associated with cigarette use (OR = 0.883, 95% CI 0.836–0.932; BH q < 0.001) and e-cigarette use (OR = 0.878, 95% CI 0.818–0.943; BH q < 0.001). Loneliness was positively associated with e-cigarette-use intensity (OR = 1.064, 95% CI 1.018–1.113; BH q = 0.009) but not cigarette-use intensity. Social and emotional support was not independently supported for either primary outcome after BH correction. When stress was set from never to always, the standardized probability of any current use increased by 5.08 percentage points for cigarette smoking and 6.20 percentage points for e-cigarette use. Sensitivity analyses did not overturn the principal findings.
Conclusion: In participating 2023 BRFSS jurisdictions, stress and life satisfaction were associated with current cigarette- and e-cigarette-use intensity, while loneliness showed an outcome-specific association with e-cigarette use and social/emotional support was not independently supported. Because the data are cross-sectional and module-limited, the findings should be interpreted as associations rather than causal effects or nationally representative estimates for all U. S. adults.
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BibTeX
@article{jowf2026psychosocial,
title = {{Psychosocial correlates of cigarette smoking and e-cigarette use among adults in participating United States jurisdictions: analysis of the 2023 BRFSS}},
author = {Ghazi I. Al Jowf},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1906665},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1906665/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Psychosocial correlates of cigarette smoking and e-cigarette use among adults in participating United States jurisdictions: analysis of the 2023 BRFSS
AU - Ghazi I. Al Jowf
PY - 2026
DA - 2026/10/23
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1906665
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1906665/full
AB - Background: Cigarette smoking and e-cigarette use remain important public health concerns. Psychosocial conditions may be related to tobacco-use patterns, but stress, loneliness, social and emotional support, and life satisfaction have rarely been evaluated jointly for both current cigarette- and e-cigarette-use intensity within the same contemporary survey framework. Objective: To examine adjusted associations of stress, loneliness, social and emotional support, and life satisfaction with current cigarette- and e-cigarette-use intensity among adults represented by participating 2023 BRFSS jurisdictions contributing to the common-file Social Determinants analytic branch. Methods: We conducted a cross-sectional analysis of the 2023 Behavioral Risk Factor Surveillance System (BRFSS). Because the focal psychosocial exposures were collected through an optional module, the final analysis was restricted to the common-file Social Determinants branch from 35 participating jurisdictions (common-scope n = 263,695), rather than the full 433,323-record source file. Current cigarette and e-cigarette outcomes were defined as not current, some-day current, and everyday current use. The complex survey design was incorporated using the final survey sampling weight, survey strata, and primary sampling units. Primary survey-weighted proportional-odds models adjusted for demographic, socioeconomic, and healthcare-access confounders. Household income was the only analysis variable multiply imputed; the tobacco outcomes and four focal psychosocial exposures were required to be observed. Results: The primary cigarette analysis base included 203,054 respondents and the e-cigarette base 203,835 respondents. Greater stress was associated with higher cigarette-use intensity (OR = 1.143, 95% CI 1.108–1.178; BH q < 0.001) and e-cigarette-use intensity (OR = 1.285, 95% CI 1.237–1.336; BH q < 0.001). Higher life satisfaction was inversely associated with cigarette use (OR = 0.883, 95% CI 0.836–0.932; BH q < 0.001) and e-cigarette use (OR = 0.878, 95% CI 0.818–0.943; BH q < 0.001). Loneliness was positively associated with e-cigarette-use intensity (OR = 1.064, 95% CI 1.018–1.113; BH q = 0.009) but not cigarette-use intensity. Social and emotional support was not independently supported for either primary outcome after BH correction. When stress was set from never to always, the standardized probability of any current use increased by 5.08 percentage points for cigarette smoking and 6.20 percentage points for e-cigarette use. Sensitivity analyses did not overturn the principal findings. Conclusion: In participating 2023 BRFSS jurisdictions, stress and life satisfaction were associated with current cigarette- and e-cigarette-use intensity, while loneliness showed an outcome-specific association with e-cigarette use and social/emotional support was not independently supported. Because the data are cross-sectional and module-limited, the findings should be interpreted as associations rather than causal effects or nationally representative estimates for all U. S. adults.
SN - 2296-2565
ER -