The Age to Vape: Nicotine Use and Behavior Associations in Young Adults
- 1Family and Community Medicine, University of Maryland School of Medicine, Baltimore, USA
- 2Family Medicine, University of Maryland School of Medicine, Baltimore, USA
Abstract
Background: Youth and young adult use of electronic nicotine delivery systems (ENDS) continues to rise. Early nicotine exposure is linked to long‑term neurobehavioral risks, and emerging evidence suggests that vaping may co‑occur with mental health and substance‑related disorders. However, limited clinical data exist on how ENDS use aligns with psychiatric and substance‑related diagnoses in young adults.
Methods: This cross‑sectional study analyzed electronic health record (EHR) data from 41,270 patients aged 18-24 years within the University of Maryland Medical System (UMMS) who completed the E‑cigarette and Vaping Assessment Tool (EVAT) between August 2020 and June 2024. ENDS use (current/former vs. never) was examined in relation to International Classification of Diseases, 10th Revision (ICD‑10) diagnoses for depressive episode (F32), anxiety disorder (F41), cannabis‑related disorder (F12), and alcohol‑related disorder (F10). Associations were assessed using chi‑square tests and multivariable ordinal logistic regression adjusting for age, sex, and race/ethnicity.
Results: Overall, 19.0% of young adults reported using ENDS. ENDS use increased with diagnostic burden, rising from 17.1% among those with no diagnoses to 58.3% among those with four diagnoses. Patients with anxiety, depression, cannabis‑related disorder, or alcohol‑related disorder consistently demonstrated higher ENDS use, with the highest prevalence (66.7%) observed among those with combined anxiety, cannabis, and alcohol‑related disorders. In adjusted models, having one or more diagnoses significantly increased the odds of ENDS use in both age groups, with the strongest effect among 18-20‑year‑olds with three diagnoses (OR ≈ 6.0).
Conclusions: ENDS use is strongly associated with psychiatric and substance‑related disorders among young adults, with risk increasing alongside the number of diagnoses. These findings underscore the need for integrated screening of vaping behaviors within mental health and substance‑use encounters, as well as concurrent assessment of behavioral health conditions among ENDS users. Embedding standardized vaping assessments into EHR workflows may support earlier identification of nicotine dependence and facilitate timely referral to cessation and addiction services.
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BibTeX
@article{kernan2026vape,
title = {{The Age to Vape: Nicotine Use and Behavior Associations in Young Adults}},
author = {Colleen Kernan and Carissa S Kwan and Elena Klyushnenkova and Niharika Khanna},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.117213},
url = {https://europepmc.org/article/PMC/PMC13721598},
note = {CC BY},
}
RIS
TY - JOUR
TI - The Age to Vape: Nicotine Use and Behavior Associations in Young Adults
AU - Colleen Kernan
AU - Carissa S Kwan
AU - Elena Klyushnenkova
AU - Niharika Khanna
PY - 2026
DA - 2026/09/30
JO - Cureus
DO - 10.7759/cureus.117213
UR - https://europepmc.org/article/PMC/PMC13721598
AB - Background: Youth and young adult use of electronic nicotine delivery systems (ENDS) continues to rise. Early nicotine exposure is linked to long‑term neurobehavioral risks, and emerging evidence suggests that vaping may co‑occur with mental health and substance‑related disorders. However, limited clinical data exist on how ENDS use aligns with psychiatric and substance‑related diagnoses in young adults. Methods: This cross‑sectional study analyzed electronic health record (EHR) data from 41,270 patients aged 18-24 years within the University of Maryland Medical System (UMMS) who completed the E‑cigarette and Vaping Assessment Tool (EVAT) between August 2020 and June 2024. ENDS use (current/former vs. never) was examined in relation to International Classification of Diseases, 10th Revision (ICD‑10) diagnoses for depressive episode (F32), anxiety disorder (F41), cannabis‑related disorder (F12), and alcohol‑related disorder (F10). Associations were assessed using chi‑square tests and multivariable ordinal logistic regression adjusting for age, sex, and race/ethnicity. Results: Overall, 19.0% of young adults reported using ENDS. ENDS use increased with diagnostic burden, rising from 17.1% among those with no diagnoses to 58.3% among those with four diagnoses. Patients with anxiety, depression, cannabis‑related disorder, or alcohol‑related disorder consistently demonstrated higher ENDS use, with the highest prevalence (66.7%) observed among those with combined anxiety, cannabis, and alcohol‑related disorders. In adjusted models, having one or more diagnoses significantly increased the odds of ENDS use in both age groups, with the strongest effect among 18-20‑year‑olds with three diagnoses (OR ≈ 6.0). Conclusions: ENDS use is strongly associated with psychiatric and substance‑related disorders among young adults, with risk increasing alongside the number of diagnoses. These findings underscore the need for integrated screening of vaping behaviors within mental health and substance‑use encounters, as well as concurrent assessment of behavioral health conditions among ENDS users. Embedding standardized vaping assessments into EHR workflows may support earlier identification of nicotine dependence and facilitate timely referral to cessation and addiction services.
SN - 2168-8184
ER -