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Sex-specific associations between tobacco use and youth mental health: prospective and cross-sectional findings from Swedish adolescents

Year: 2026

Type: article

Abstract: Introduction Tobacco use is disproportionately common among individuals with mental health problems, yet the direction of this association remains unclear. It is also uncertain whether this relationship varies by sex or by type of tobacco product. This study aimed to further characterize the association between tobacco use and mental health symptoms during adolescence, with a particular focus on sex differences and product type. Methods Data were drawn from the Swedish prospective cohort Longitudinal Research on Development In Adolescence. Tobacco use (cigarette smoking and/or Swedish snus) was examined longitudinally from ages 12/13 to 17 in relation to psychosomatic symptoms, and cross-sectionally at age 17 with respect to depressive symptoms and suicidal ideation. Results Longitudinal analyses performed on 1592 adolescents showed that tobacco initiation was associated with worsening of psychosomatic health, particularly among girls. Cross-sectional analyses at age 17 showed that tobacco use was associated with higher odds of depressive symptoms and suicidal ideation after adjusting for sex, self-rated socioeconomic status, and risk consumption of alcohol. In sex-stratified cross-sectional analyses, tobacco use (cigarettes and/or snus) was associated with psychological distress especially among girls. Similarly, dual product use and high frequency of use were associated with higher levels of psychosomatic symptoms in girls only. Exclusive snus was uncommon and findings inconclusive. Conclusions These findings highlight pronounced sex differences in the association between tobacco use and adolescent mental health, with greater vulnerability observed among girls. Further research is needed to clarify the role of snus in mental health outcomes, particularly in female populations. Implications Given the high prevalence of both tobacco use and mental health problems among youths, and their substantial impact on public health, a deeper understanding of the association between these factors is warranted. By demonstrating sex differences in the relationship between tobacco use and mental health problems during adolescence, the present study contributes important evidence to inform the development of targeted preventive strategies and evidence-based policy making.

Source: Nicotine & Tobacco Research

DOI: 10.1093/ntr/ntag148

Authors: Johanna Andersson, Kristina Berglund, Robin Irmel, Louise Adermark

Institution: University of Gothenburg

Language: English

Topic: Smoking Behavior and Cessation

Subfield: Physiology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $5,392