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Depression Linked to E-Cigarette Use, But Not in the Way You Might Think

Researchers at the University of Texas Health Science Center at Houston recently published a study on the longitudinal relationship between e-cigarette use and elevated depressive symptoms among young adults. Their results are interesting, although unsurprising, but they way the university and the media have chosen to report the findings of this research is the textbook definition of “misleading”.

depressionIn 2014, a survey conducted by the Media Insight Project found that 6 in 10 Americans only read news headlines, without actually bothering to go over the actual news article. Authors added that the ratio is likely much higher, as some people feel too embarrassed to admit that they only read headlines. This may seem completely unrelated to the topic of this particular article, but I just wanted to put into perspective how important headlines are nowadays and how easily they can be abused to misinform the general public.

Here’s the title chosen by the Media Relations department at the University of Texas Health Science Center at Houston for their article on this study examining the relation between depression and e-cigarettes: “Depression Linked to E-Cigarette Use Among College Students“. What do you make of that? When I first saw that headline in my Google Alerts feed, I was like “what, now they’re trying to say that e-cigarettes cause depression in youth?” Only that’s not what the study is about at all.

The study itself is entitled “Depressive Symptoms Predict Current E-Cigarette Use Among College Students in Texas“. That sounds completely different, doesn’t it? At the very least, it clearly implies that depression predicates the use of electronic cigarettes, instead of leaving it up for interpretation, or actually suggesting that the opposite is true. Now, the content of that article published by UTHealth clears things up, IF you bother to read it, but what about the people who just read the headline? What are they left with?

Now, let’s see what the study was actually about. Lead author Frank Bandiera, Ph.D., assistant professor in the Department of Epidemiology, Human Genetics and Environmental Sciences at UTHealth School of Public Health, and his team set out to examine the longitudinal relationship between e-cigarette use and elevated depressive symptoms in youths. According to the study abstract, “the main objective of the current study was to establish a potential bi-directional relationship between e-cigarette use and elevated depressive symptoms among college students in Texas, across a 1 year period of time.”

Researchers surveyed 5445 college students from 24 colleges around Texas, with 6-month and 1-year follow-ups. After analyzing the collected data, they found that students who experienced elevated levels of depressive symptoms were significantly more likely than students who did not experience elevated levels of depressive symptoms to start using e-cigarettes six months later. They clearly state that the use of e-cigarettes did not appear to cause the elevated depression levels among the students.

“We don’t know why depression leads to e-cigarette use. It may be self-medication. Just like with cigarettes, when students feel stressed out, using e-cigarettes may make them feel better. Or it could be that since e-cigarettes have been marketed as a smoking cessation device, depressed students may be using e-cigarettes to help them quit smoking traditional cigarettes,” said lead author Frank Bandiera.

So that’s the link between depression and e-cigarette use among youths. Severely depressed students are turning to electronic cigarettes to either alleviate their symptoms or as a way to quit smoking. Why couldn’t they have just put that in the headline?

Bandiera also said that he was somewhat surprised by the results of the study because he was expecting a reciprocal relationship, just like studies have identified between elevated depression symptoms and tobacco cigarettes. That wasn’t the case here though. “Since e-cigarettes typically deliver less nicotine per puff than cigarettes, it is possible that the lower content of nicotine in e-cigarettes could explain the null findings,” the assistant professor wrote in the paper.

The link between depression and nicotine-containing e-cigarettes isn’t that surprising, to be honest. Previous research has shown that people suffering from depression are twice as likely to smoke as those without symptoms of depression. Now that they have a viable alternative to smoking, it makes sense that they would try it as a means of nicotine delivery.

Also, nicotine has been known to be very effective at helping people cope with depression. During a 2006 study, a group of non-smoking depression sufferers were assigned nicotine patches and regular band-aids as placebos. After eight days, those who had worn the actual nicotine patches reported a “significant” decline in depressive symptoms. And that’s just one of many studies to confirm the benefits of nicotine in depression.

So despite the ominous title, this is actually a very positive study. On the one-hand, it found that e-cigarette use does not appear to lead to elevated depression levels among, and also that students may be using them to give up smoking. Now, anti-nicotine zealots may not see that as a positive, but any believer in tobacco harm reduction would tell you otherwise. Considering that we have growing scientific evidence that e-cigarettes are far less harmful than tobacco analogs, this can definitely be considered a good thing.

But all this just makes it harder for me to get over the unfortunate headline choice by UTHealth. And before you say I’m overreacting, let me just give you one example. Supposed I did a study on cancer and e-cigarettes, where I found that cancer sufferers turn to vaping for whatever reason. But then I go and report the findings using the headline “Cancer Linked to E-cigarette Use”. Would that be ok? Would you say that it clearly reflects my findings? I didn’t think so.

Unfortunately, the media have already picked up this story and they are using the exact headline thought up by UTHealth. I can only hope that most people actually read the article or the study itself, although research clearly shows that that hardly ever happens in this fast world.

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