Adolescents using nicotine face higher risks of mental health problems

Adolescents who use nicotine are more likely to report symptoms of anxiety, depression, and other mental health problems than their peers who do not use nicotine. Girls appear to be particularly vulnerable, according to three recent studies from the University of Gothenburg.

In one study of nearly 3,000 Swedish high school students, almost 80 percent of the girls who used nicotine reported clinically relevant symptoms of anxiety. The associations were found for both traditional tobacco products and tobacco-free nicotine products such as nicotine pouches and e-cigarettes.

The researchers also followed approximately 1,500 adolescents in southern Sweden over time, from lower secondary school through high school. Depressive symptoms and suicidal ideation were more common among adolescents who smoked. Girls who increased their tobacco use over time were also more likely to experience worsening sleep problems, anxiety, low mood, and difficulties concentrating. The researchers say the marked differences between girls and boys warrant further investigation.

Girls may be particularly vulnerable

Johanna Andersson, physician and PhD student at the Sahlgrenska Academy, University of Gothenburg, is one of the lead authors:

"We see clear differences between girls and boys, with girls who smoke appearing to be particularly vulnerable. At the same time, we need a better understanding of how nicotine pouches affect mental health, especially among adolescent girls, where the use of nicotine pouches has increased so rapidly," she says.

The findings come from questionnaire-based studies and long-term follow-up of adolescents, combined with experiments in rats examining how nicotine affects neuronal signaling. In the animal study, published in the journal Neuropharmacology, the researchers found that nicotine affected the amygdala, a brain region that plays a key role in emotional regulation and stress responses. The effects were most pronounced in female rats.

Nicotine alters neuronal communication

Nicotine altered communication between neurons and produced long-lasting changes in brain activity that persisted even after the nicotine had left the body.

Louise Adermark, Professor at the Sahlgrenska Academy, University of Gothenburg, is one of the principal investigators behind the studies.

One of the key findings is that we see similar patterns across several different studies using different types of data. However, we still cannot determine cause and effect. The animal studies demonstrate biological changes in the brain that could contribute to increased vulnerability to anxiety and stress-related symptoms."

Louise Adermark, Professor, Sahlgrenska Academy, University of Gothenburg

The researchers emphasize that socioeconomic factors, stress, alcohol use, other substance use, and individual vulnerability also influence the risk of both mental health problems and nicotine use. At the same time, they say the findings raise questions about how new nicotine products affect the developing brain and whether girls may be particularly sensitive to the effects of nicotine.