Skip to main content

Association between e-cigarette use and depression in US cancer survivors: a cross-sectional study



Though prior studies have observed significant association between e-cigarette use and mental health outcomes including depression in the general population, the relationship between e-cigarette use and clinical depression in the cancer survivor subpopulation is unknown. The purpose of this study was to examine the cross-sectional association between e-cigarette use and self-reported clinical depression among cancer survivors.


Pooled data from the 2017 and 2018 Behavioral Risk Factor Surveillance Survey were used. Multivariable logistic regression was used to analyze the independent association between e-cigarette use and self-reported clinical depression in a sample of 7,498 cancer survivors.


Among cancer survivors in this study, 22.1% reported a history of clinical diagnosis of depression. The overall prevalence rates for current and former e-cigarette use were 2.6% and 10.5%, respectively. Analysis showed 51.3% of current users, 40% of former users, and 19.1% of those who had never used e-cigarettes self-reported a history of clinical depression. In the multivariable analysis, the odds of self-reported clinical depression were significantly higher for survivors who were current users (OR = 2.85; 95% CI: 1.38–5.90) and former users (OR = 1.63; 95% CI: 1.05–2.55) compared to never e-cigarette users.


Findings from this study suggest a statistically significant association between e-cigarette use and depression in cancer survivors. Future studies should focus on examining the longitudinal association between e-cigarette use and depression in cancer survivors.

Implications for Cancer Survivors

Study findings reemphasized the need for interventions to support cancer survivors with evidence-based treatments for depression as well as the need for clinicians to screen for psychological distress and/or e-cigarette use and make appropriate recommendations.

This is a preview of subscription content, access via your institution.

Fig. 1

Data availability

The data for this study is publicly available at


  1. Siegal RL, Miller KD, Jemal A. Cancer statistics. Cancer J Clin. 2020.

    Article  Google Scholar 

  2. Risk Factors: Age. National Cancer Institute. Updated March 5, 2021. Accessed June 7, 2021.

  3. American Cancer Society. Cancer treatment & survivorship facts & figures 2019–2021. Atlanta: American Cancer Society; 2019.

    Google Scholar 

  4. Winer E, Gralow J, Diller L, et al. Clinical cancer advances 2008: major research advances in cancer treatment, prevention, and screening–a report from the American Society of Clinical Oncology [published correction appears in J Clin Oncol. 2009 Jun 20;27(18):3070-1]. J Clin Oncol. 2009;27(5):812–26.

    Article  PubMed  Google Scholar 

  5. Brandenbarg D, Maass SWMC, Geerse OP, et al. A systematic review on the prevalence of symptoms of depression, anxiety and distress in long-term cancer survivors: implications for primary care. Eur J Cancer Care (Engl). 2019;28(3):e13086.

    Article  Google Scholar 

  6. Yan R, Xia J, Yang R, et al. Association between anxiety, depression, and comorbid chronic diseases among cancer survivors. Psychooncology. 2019;28(6):1269–77.

    Article  PubMed  Google Scholar 

  7. Seitz DC, Besier T, Debatin KM, et al. Posttraumatic stress, depression and anxiety among adult long-term survivors of cancer in adolescence. Eur J Cancer. 2010;46(9):1596–606.

    Article  PubMed  Google Scholar 

  8. Hawkins NA, Soman A, Buchanan Lunsford N, Leadbetter S, Rodriguez JL. Use of medications for treating anxiety and depression in cancer survivors in the United States. J Clin Oncol. 2017;35(1):78–85.

    Article  PubMed  Google Scholar 

  9. Mirbolouk M, Charkhchi P, Kianoush S, et al. Prevalence and distribution of e-cigarette use among U.S. adults: behavioral risk factor surveillance system, 2016. Ann Intern Med. 2018;169(7):429–38.

    Article  PubMed  Google Scholar 

  10. Obisesan OH, Mirbolouk M, Osei AD, et al. Association between e-cigarette use and depression in the behavioral risk factor surveillance system, 2016–2017. JAMA Network Open. 2019;2(12).

  11. Sanford NN, Sher DJ, Xu X, Aizer AA, Mahal BA. Trends in smoking and e-cigarette use among us patients with cancer, 2014–2017. JAMA Oncol. 2019.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Antwi GO, Lohrmann DK, Jayawardene W, Chow A, Obeng CS, Sayegh AM. Associations between e-cigarette and combustible cigarette use among U.S. cancer survivors: implications for research and practice. J Cancer Surviv. 2019;13(2):316–25.

    Article  PubMed  Google Scholar 

  13. Leventhal AM, Strong DR, Sussman S, Kirkpatrick MG, Unger JB, Barrington-Trimis JL, Audrain-McGovern J. Psychiatric comorbidity in adolescent electronic and conventional cigarette use. J Psychiatry Res. 2016;2016(73):71–8.

    Article  Google Scholar 

  14. Goniewicz ML, Gupta R, Lee YH, et al. Nicotine levels in electronic cigarette refill solutions: a comparative analysis of products from the U.S., Korea, and Poland. Int J Drug Policy. 2015;26(6):583–8.

    Article  Google Scholar 

  15. Saeed OB, Chavan B, Haile ZT. Association between e-cigarette use and depression in US adults [published online ahead of print, 2020 Jan 14]. J Addict Med. 2020.

    Article  PubMed  Google Scholar 

  16. Centers for Disease Control and Prevention. The Behavioral Risk Factor Surveillance System (BRFSS) OVERVIEW: BRFSS. 2018. Published July 2019. Accessed June 7, 2021.

  17. US Centers for Disease Control and Prevention. Weighting the BRFSS Data. Accessed September 26, 2020.

  18. Leventhal AM, Zvolensky MJ. Anxiety, depression, and cigarette smoking: a transdiagnostic vulnerability framework to understanding emotion-smoking comorbidity. Psychol Bull. 2015;141(1):176–212.

    Article  PubMed  Google Scholar 

  19. Dawkins L, Acaster S, Powell JH. The effects of smoking and abstinence on experience of happiness and sadness in response to positively valenced, negatively valenced, and neutral film clips. Addict Behav. 2007;32(2):425–31.

    Article  PubMed  Google Scholar 

  20. Paterson NE. The neuropharmacological substrates of nicotine reward: reinforcing versus reinforcement-enhancing effects of nicotine. Behav Pharmacol. 2009;20(3):211–25.

    CAS  Article  PubMed  Google Scholar 

  21. Lechner WV, Janssen T, Kahler CW, Audrain-McGovern J, Leventhal AM. Bi-directional associations of electronic and combustible cigarette use onset patterns with depressive symptoms in adolescents. Prev Med. 2017;96:73–8.

    Article  PubMed  Google Scholar 

  22. Fluharty M, Taylor AE, Grabski M, Munafò MR. The association of cigarette smoking with depression and anxiety: a systematic review. Nicotine Tob Res. 2017;19(1):3–13.

    Article  PubMed  Google Scholar 

  23. Park EM, Rosenstein DL. Depression in adolescents and young adults with cancer. Dialogues Clin Neurosci. 2015;17(2):171–80.

    Article  Google Scholar 

  24. Biddle S. Physical activity and mental health: evidence is growing. World Psychiatry. 2016;15(2):176–7.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Clement S, Schauman O, Graham T, et al. What is the impact of mental health-related stigma on help seeking? A systematic review of quantitative and qualitative studies. Psychol Med. 2015;45(1):11–27.

    CAS  Article  PubMed  Google Scholar 

  26. Lazar M, Davenport L. Barriers to health care access for low income families: a review of literature. J Community Health Nurs. 2018;35(1):28–37.

    Article  PubMed  Google Scholar 

  27. Kaiser Family Foundation. Gender differences in health care, status, and use: spotlight on men’s health. Accessed November 19, 2020.

  28. Stiles B. Can vaping lead to lung disease? Health Matters. Accessed December 15, 2019.

  29. Muthumalage T, Lamb T, Friedman MR, Rahman I. E-cigarette flavored pods induce inflammation, epithelial barrier dysfunction, and DNA damage in lung epithelial cells and monocytes. Sci Rep. 2019;9:19035.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  30. Soulakova JN, Hartman AM, Liu B, Willis GB, Augustine S. Reliability of adult self-reported smoking history: data from the tobacco use supplement to the current population survey 2002–2003 cohort. Nicotine Tob Res. 2012;14(8):952–60.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Hatziandreu EJ, Pierce JP, Fiore MC, Grise V, Novotny TE, Davis RM. The reliability of self-reported cigarette consumption in the United States. Am J Public Health. 1989;79(8):1020–3.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations



Conceptualization and design: Godfred Antwi and Darson Rhodes.

Data preparation and analysis: Godfred Antwi.

Interpretation of data: Godfred Antwi and Darson Rhodes.

Manuscript writing: Godfred Antwi and Darson Rhodes.

Manuscript editing and review: Godfred Antwi and Darson Rhodes.

Corresponding author

Correspondence to Godfred O. Antwi.

Ethics declarations

Ethical approval

This study was deemed exempt for review by the Institutional Review Board at SUNY Brockport.

Consent to participate

Not applicable.

Consent to publish

The authors transfer to the publisher the sole and exclusive publication rights.

Competing interests

The authors declare no competing interests.

Animal research

Not applicable.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Antwi, G.O., Rhodes, D.L. Association between e-cigarette use and depression in US cancer survivors: a cross-sectional study. J Cancer Surviv (2022).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI:


  • Cancer survivors
  • Electronic cigarettes (e-cigarettes)
  • Depression
  • Nicotine