Vaping and mental health

Various studies have examined links between vape use and mental health, and data shows there is a greater chance of anxiety, stress, depression, and substance use in vape-using young adults [8,9], as well as higher levels of perceived stress. Studies suggest that young people may smoke to self-regulate negative feelings such as stress, depression, and anger [14]. Indeed, young adults with low self-control and poorer emotion regulation [15] are more likely to vape. Mindfulness, an enhanced attention to and awareness of present-moment experience [16], could represent a protective characteristic as it appears to be positively associated with affect regulation competencies [16]. Indeed, studies suggest that trait mindfulness has a negative relationship with cigarette smoking frequency [17]and dependence [18]. However, this relationship has not been tested in relation to vaping. Rumination (perseverative cognition focused on negative content) is associated with various unhealthy behaviours, including smoking [19]. This is unsurprising given that rumination results in emotional distress, and the reduction and regulation of negative affect is a major motivator of nicotine use [14]. Again, however, potential links between ruminative tendencies and vape use have not been investigated to date. Here, we also consider the role of self-compassion (mindful awareness of oneself and treating oneself kindly during difficult and challenging experiences), since self-compassion is associated with health-promoting behaviours such as reduced cigarette smoking [20], as well as better emotion regulation. Another important factor that needs exploring in relation to vape use is that of chrono-type. Chronotype, or circadian/diurnal preference, refers to individual difference’s inactivity-rest cycles over the 24-hour period [22]. Evening ness, a preference for a later sleep period and activity in the evening, is known to be connected with higher stimulant consumption (e.g., alcohol, caffeine, and tobacco) as well as poorer mental health [23]. A recent review found robust links with smoking but noted a lack of studies on vape use [24].A later sleep time might provide an additional opportunity to vape, contributing to more frequent use and dependence. Therefore, we here test the hypothesis that vape use is more prevalent amongst evening types. The effect of vaping on sleep quality also needs more exploration. The stimulant properties of nicotine may give rise to sleep difficulties, such as falling or staying asleep. Indeed, cigarette users report less total sleep and higher insomnia symptoms. These findings are in line with the notion that vape use, like cigarette use, might serve as a means to self-regulate negative affect [14]. This negative reinforcement model suggests that a need to avoid negative sensations via self-medication is the most salient motivator of chronic substance use [40].Mindfulness promotes better affect regulation and the ability to view aversive feelings as transient [16]. Individuals with higher levels of trait mindfulness are therefore less likely to engage in substance use coping behaviours [18,41]. While previous work has shown poor self-control and emotion regulation abilities amongst young adults who vape [15],this is the first study to show that lower levels of trait mindfulness are present amongst vape users. We also show for the first time that higher levels of trait rumination are presenting vape users. Rumination, which consists of repetitive and intrusive thoughts about past negative emotional experiences, is associated with higher levels of distress. Thus, vape use could be a means to self-medicate against this distress amongst high ruminators. Further, there is an inverse relationship between rumination and mindfulness; it is theorised that higher-trait mindfulness allows people to notice ruminative thoughts at an earlier stage and thus disengage from self-perpetuating ruminative thought patterns [42]. Hence, the current findings are in line with a negative reinforcement model of vape use and the theoretical relationships between the rumination and mindfulness constructs. Self-compassion was also seen to be lower among vape users. Self-compassion enhances emotional resilience by promoting a supportive self-response in times of difficulty. Itis conceptually related to mindfulness, since mindfulness enhances awareness of one’s own suffering while self-compassion helps to address it. Studies have shown a close relationship between the mindfulness and self-compassion constructs, which combine to promote emotional well-being [43]. Self-compassion has been linked to better health behaviours, and an intervention study found that training smokers to self-regulate from a self-compassionate stance helped them reduce cigarette smoking.  
In line with some previous studies showing poorer mental health amongst vape users, the vape-user group was found to have significantly higher levels of anxiety; nearly all vape users reported clinically significant anxiety symptoms. This is again in line with the negative reinforcement model, suggesting that vaping might be used as a means of self-medication against unpleasant feelings of anxiety in particular. We also investigated how chronotype and sleep quality differ amongst vape users. Evening types tend to report higher substance use; they are more likely to smoke cigarettes [24],but there is a lack of studies on vaping. We found a significant over-representation of evening types amongst vape users: nearly ¾ were evening types as compared to only 40%of non-users. As noted in the introduction, a later sleep time might provide an additional opportunity to vape. Vape users also reported (at trend) higher levels of loneliness; this could be related to evening Ness since it has been shown that young adult evening types report lower levels of social support [45]. We also found significant links to sleep quality. While cigarette use has been associated with higher insomnia symptoms [25], there is little work in relation to vaping. The current findings align with those of another study in college students [27], showing that vape users report significantly more sleep difficulties. While the stimulative properties of nicotine might be responsible for impaired sleep, an inverse relationship is also possible, since one study in adolescents showed that sleep deprivation increases vape use risk, perhaps to help compensate for daytime dysfunction.