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Estimates from the 2020 NSDUH for the average number of initiates per day also could be misleading because 2020 included periods when people in certain states and localities were under increased restrictions to contain the spread of COVID-19

Compared to adolescents who had not used any tobacco products, users of e-cigarettes or CTPs displayed a potentially heightened risk of depression and anxiety, whilst those who used both CTPs and e-cigarettes had the highest odds of reporting mental health struggles The authors conclude that while causality cannot be determined, the results from this study showed that all forms of tobacco use were significantly associated with mental health issues

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