Adolescents who use nicotine are more likely to experience symptoms of anxiety, depression, and other mental health problems than their peers who do not use nicotine, according to three studies from the University of Gothenburg.
The research also suggests that adolescent girls who use nicotine may be particularly vulnerable.
In one study of nearly 3,000 Swedish high school students, almost 80 per cent of girls who used nicotine reported clinically significant symptoms of anxiety. The association was found among users of both traditional tobacco products and newer tobacco-free nicotine products, including nicotine pouches and e-cigarettes.
Researchers also followed about 1,500 adolescents in southern Sweden from lower secondary school through high school. They found that depressive symptoms and suicidal thoughts were more common among adolescents who smoked.
Girls whose tobacco use increased over time were also more likely to experience worsening sleep problems, anxiety, low mood and difficulties concentrating.
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Johanna Andersson, a physician and PhD student at the Sahlgrenska Academy, University of Gothenburg, said the differences between boys and girls warranted further investigation.
“We see clear differences between girls and boys, with girls who smoke appearing to be particularly vulnerable,” Andersson said.
She said more research was needed to understand how nicotine pouches affect mental health, particularly among adolescent girls, where their use has increased rapidly.
The studies combined questionnaire-based research and long-term follow-up of adolescents with laboratory experiments examining nicotine’s effects on the brain.
In an animal study published in Neuropharmacology, researchers found that nicotine affected the amygdala, a brain region involved in emotional regulation and responses to stress. The effects were particularly pronounced in female rats.
Nicotine also altered communication between neurons and caused lasting changes in brain activity that remained after the substance had left the body.
Professor Louise Adermark of the Sahlgrenska Academy, one of the principal investigators, said similar patterns were observed across the different studies.
“One of the key findings is that we see similar patterns across several different studies using different types of data,” Adermark said.
However, she stressed that the research does not establish a direct cause-and-effect relationship between nicotine use and mental health problems.
“We still cannot determine cause and effect,” she said. “The animal studies demonstrate biological changes in the brain that could contribute to increased vulnerability to anxiety and stress-related symptoms.”
The researchers noted that multiple factors, including socioeconomic circumstances, stress, alcohol consumption, other substance use, and individual vulnerability, influence mental health and nicotine use.
Nevertheless, they said the findings raise concerns about the effects of nicotine on the developing adolescent brain, particularly as newer products become increasingly available.
Further research will be needed to determine whether girls are especially sensitive to nicotine’s effects and to clarify the long-term mental health implications of products such as nicotine pouches and e-cigarettes.
The researchers said understanding these relationships could help inform efforts to address nicotine use and mental health among young people.
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