Heated Tobacco Product Use and Mental Health: Korean National Health and Nutrition Examination Survey (2018-2020)

Abstract

The relationship between mental health and heated tobacco products' (HTPs) use remains unclear. We obtained data from the Korea National Health and Nutrition Examination Survey (2018-2020) on 18,231 participants aged >= 19 years. We examined the association between participants' type of tobacco use (non-tobacco, combustible cigarette (CC) only, or HTP use [with or without CCs]) and their mental health using logistic regression analysis. Among 18,231 participants, 18.41% was current tobacco users and 38.32% was lifetime tobacco users. Approximately 18.38% (18.14%) current (lifetime) tobacco users were current (lifetime) HTP users. Lifetime HTP users had higher odds of reporting perceived stress ( adjusted odds ratio: 1.91, 95% confidence interval: [1.61-2.25]), depressive mood (1.79 [1.17-2.73]), suicidal ideation (2.09 [1.08-4.04]), Patient Health Questionnaire-9 (PHQ-9) >= 10 (3.68 [2.38-5.71]), and doctor-diagnosed depression (2.52 [ 1.75-3.62]) than non-tobacco users, and reporting perceived stress (1.18 [1.004-1.38]), depressive mood (1.53 [1.03-2.26], and PHQ-9 >= 10 (1.67 [ 1.12-2.49]) than lifetime CC only users. Finally, lifetime HTP only users had increased odds of doctor-diagnosed depression (4.30 [ 1.41-13.16]) than lifetime CC only users. Lifetime HTP users are more likely to experience poor mental status than non-tobacco and CC only users.