It has been long-established that mental health and behavioral problems such as alcohol and drug abuse are risk factors that push teens to smoke. A new study finds that less destructive kids will opt for e-cigarettes instead of cancer-causing cigarettes.

That's a win for the future of public health, where smoking is linked to numerous maladies.

 In recent years, smoking has declined in middle and high school students, but the use of electronic cigarettes in this group tripled from 2013 to 2014, according to the Centers for Disease Control and Prevention. The hope is that they are using them to wean off cigarettes and will not cause a nicotine addiction that pushes young people into smoking. 

Surveyed teens who picked up vaping had emotional and behavioral problems that fell midway between smokers and teens who neither vaped nor smoked. Credit: USC Photo/Gus Ruelas

the study surveyed 3,310 ninth-grade students in 10 Los Angeles-area high schools. The students answered questions about conventional or e-cigarette use, anxiety disorders, depression, bipolar disorder, substance use and abuse, and traits such as impulsivity, which are linked with poor mental health. Teenagers who used prescription drugs to get high and those with more symptoms of depression, social phobia, generalized anxiety disorder, panic disorder, obsessive-compulsive disorder and other emotional issues were more likely to smoke than to vape e-cigarettes. 

The litany of emotional issues did not greatly affect nonsmokers. On the other hand, adolescents who both vaped and smoked had the poorest mental health, the survey found, the first time researchers identified mental and behavioral conditions associated with e-cigarette-only use as well as dual use -- that is, both vaping and smoking.

Successful public campaigns have made smoking less socially acceptable and has successfully deterred the majority of young people from smoking, particularly lower-risk teens without mental health and behavioral problems. The same cannot be said about vaping.

"In the past three years, there have been dramatic increases in recreational use of e-cigarettes among teens," said Adam Leventhal, lead author and associate professor of preventive medicine and psychology at the Keck School of Medicine of USC. "Our study raises questions of whether e-cigarettes may be recruiting lower-risk teens with fewer mental health problems who might not have been interested in any nicotine or tobacco products if e-cigarettes did not exist. Electronic cigarettes could be bringing a population of lower-risk teens into nicotine use."