Use of Electronic and Conventional Cigarettes and Self-Rated Mental Health in High School Students.

Youth tobacco use remains a significant public health concern, particularly in urban communities disproportionately burdened by health disparities. In Baltimore City, where tobacco-related harms are elevated, understanding the relationship between tobacco use-including e-cigarettes-and mental health among high school students is essential for guiding equitable prevention and cessation strategies. The CEASE (Communities Engaged and Advocating for a Smoke-free Environment) program, in collaboration with the American Lung Association's Not On Tobacco (N-O-T) initiative, developed an online school-based survey to inform community-responsive interventions. This study aimed to examine the associations between cigarette use, including conventional cigarette use, and self-rated mental health among high school students in Baltimore City. High school students in Baltimore City completed an anonymous online survey that assessed demographic characteristics, tobacco knowledge and use, mental health, and related behaviors. Self-rated mental health was dichotomized as poor versus fair/good. Tobacco use categories included current use of e-cigarettes and conventional cigarettes. Logistic regression models were used to examine associations between tobacco use and self-rated mental health, adjusting for age, gender, race, and parental education. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported. No statistically significant associations were found between self-rated mental health and e-cigarette use and conventional tobacco use after adjusting for covariates. The absence of a significant association may reflect unique aspects of the social context in Baltimore City, where youth may not use tobacco products as a coping mechanism for mental health challenges. Alternatively, it may be due to limitations in measurement, particularly the use of a single-item mental health assessment. These findings should be considered preliminary. Future research using more comprehensive mental health measures and larger samples is warranted to further explore these complex relationships.