Halladay Jillian, Visontay Rachel, Sunderland Matthew, Rowe Amy-Leigh, Smout Scarlett, Devine Emma, Stockings Emily, Andrews Jack L, Champion Katrina E, Gardner Lauren, Newton Nicola, Teesson Maree, Slade Tim
School of Nursing, McMaster University, Ontario, Canada; The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, New South Wales, Australia; Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, Ontario, Canada.
The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, New South Wales, Australia.
Addict Behav. 2025 Oct;169:108380. doi: 10.1016/j.addbeh.2025.108380. Epub 2025 May 12.
The epidemiological landscape of adolescent smoking, vaping, and emotional problems has drastically changed over the past two decades. Whether and why these problems co-occur remains unclear, though this understanding is crucial for global policy and prevention efforts. The nature of co-occurring problems may be influenced by different researcher decisions when defining, operationalizing, and modeling these relationships. This study uses multiverse analysis (also known as specification curve analysis or vibration of effects), which models all justifiable measurement and analytic specifications in a single sample, to unpack the impact of researcher decisions when modeling these relationships.
Multiverse analyses were done with 3,648 unique models using a longitudinal sample of 6,639 Australian adolescents (aged ∼14.7-15.7, 2021-2022).
Consistent co-occurrence of smoking or vaping and emotional problems was seen across unadjusted or only demographic-adjusted cross-sectional models (100 %). However, the temporality of relationships, choice of confounders, and operationalization of emotional problems substantially impacted findings. Emotional problems appeared to lead to reports of past 6 month smoking more-so than the reverse (88 % vs. 9 % unadjusted/demographic-adjusted), depression-focused measures yielded more consistent associations with smoking or vaping than anxiety-focused, and certain confounders (i.e., conduct, ADHD, other substances) explained most of the associations between adolescent smoking or vaping and emotional problems. Decision related to missingness or binary versus continuous outcomes did not meaningfully impact findings.
While adolescent smoking or vaping and emotional problems commonly co-occur, methodological choices regarding timing, definitions, and confounding significantly influence the perceived strength of these relationships. Hence, such nuances demand careful consideration when interpreting evidence for policy.
在过去二十年中，青少年吸烟、吸电子烟及情绪问题的流行病学态势发生了巨大变化。尽管对于全球政策制定和预防工作而言，理解这些问题是否共同出现以及为何共同出现至关重要，但目前尚不清楚。这些共同出现问题的本质可能会受到研究人员在定义、操作化及构建这些关系模型时所做的不同决策的影响。本研究采用多宇宙分析（也称为规格曲线分析或效应波动分析），该方法在单个样本中对所有合理的测量和分析规格进行建模，以剖析研究人员在构建这些关系模型时的决策影响。
使用来自6639名澳大利亚青少年（年龄约14.7 - 15.7岁，2021 - 2022年）的纵向样本，进行了3648个独特模型的多宇宙分析。
在未经调整或仅进行人口统计学调整的横断面模型中（100%），吸烟或吸电子烟与情绪问题始终共同出现。然而，关系的时间顺序、混杂因素的选择以及情绪问题的操作化对研究结果有重大影响。情绪问题似乎比相反情况更易导致过去6个月吸烟的报告（未经调整/人口统计学调整的比例分别为88%对9%），聚焦抑郁的测量方法与吸烟或吸电子烟的关联比聚焦焦虑的方法更一致，某些混杂因素（即品行问题、注意力缺陷多动障碍、其他物质使用）解释了青少年吸烟或吸电子烟与情绪问题之间的大部分关联。与缺失值或二元与连续结果相关的决策对研究结果没有显著影响。
虽然青少年吸烟或吸电子烟与情绪问题通常共同出现，但在时间、定义和混杂因素方面的方法选择会显著影响这些关系的感知强度。因此，在解释政策证据时，需要仔细考虑这些细微差别。
