Young People, Mental Health and Smoking
Welcome to our briefing that explores the link between mental health and smoking for young people.
Introduction to smoking and mental health
There are strong links between smoking and mental health issues, often starting during childhood or adolescence and increasing with age.
Smoking and mental health share risk factors including adverse childhood experiences and those associated with growing up in deprivation, care experience and being a young carer.
There is no evidence that smoking directly causes mental health issues, although some evidence indicates smoking may influence the development of depression and schizophrenia. There is strong evidence, however, that smoking can worsen mental health.
Children and young people who smoke generally have lower mental well-being and poorer general health compared to their non-smoking peers. Many young people wrongly believe that smoking or using e-cigarettes helps them to cope better with stress.
Young people in Scotland with mental health issues are twice as likely to smoke compared to those without.
Nicotine is highly addictive so people who smoke need to deal with repeating cycles of cravings with come with feelings of stress and irritability due to nicotine withdrawal.
Research by ASH Scotland published in 2021 found that many young people are not aware of the negative impacts smoking can have on mental health and wellbeing.
Children with behavioural syndromes, which can contribute to psychological issues, are more likely to smoke. People with attention deficit hyperactivity disorder (ADHD) tend to start smoking younger and progress to daily smoking faster.
Research suggests that nicotine can affect adolescents’ brain development, increasing the risk of future substance use, exacerbating difficulties in managing emotions and increasing the risk of depression.
Smoking prevalence and uptake
Three-quarters of people who smoke start before the age of 18. Children and young people who experience or are at risk of poor mental health are at particular risk of taking up smoking and tend to do so at a younger age.
The 2022 Scottish Health and Wellbeing Census showed that 6% of young people (13 and 15-year-olds) with a long-term health condition smoked compared to 1.9% of those without.
A 2017 survey in England showed that children and young people aged 11–16 with a mental health condition were 10 times more likely to smoke or vape regularly than those without.
Young people in Scotland (16-24-year-olds) with mental health issues, including depression and anxiety, are twice as likely to smoke. Young people with mental health issues are more likely to transition from youth experimentation to adult smoking and long-term smoking addiction.
Research shows that professionals working to support people regarding their mental health hold attitudes and misconceptions that may undermine the delivery of smoking cessation interventions.
E-cigarettes
- Children and young people who experience mental health issues are more likely to use e-cigarettes. The 2022 Scottish Health and Wellbeing Census found that 12.3% of 13 and 15-year-olds with a long-term health condition vaped compared to 5.1% of those without.
- Anecdotal evidence suggests that nicotine addiction/craving from e-cigarettes negatively impacts behaviour, attention and focus both at home and in school, and may have direct negative impacts on mental health and educational outcomes.
- A study published in 2024 found 18-25-year-olds in England that used e-cigarettes were more likely to have poorer sleep quality and higher anxiety symptoms.
- A 2021 systematic review of 40 research articles found that youth e-cigarette use is associated with greater mental health problems.
- Common reasons young people report for using e-cigarettes include helping to cope with stress, anxiety, nerves or mental health.
Cessation and prevention
- Stopping smoking can be challenging but the benefits of succeeding include alleviating depression, anxiety or stress, and improving quality of life compared to people who continue to smoke.
- People with mental health diagnoses tend to smoke more and find it harder to quit.
- 63 per cent of people aged 16-24 and 30 per cent of 15-year-olds in Scotland who smoke want to stop.
- Research suggests that young people who understand the risks of smoking are better equipped to remain smoke-free. Many young people who smoke, however, are not aware of where or how to access stop-smoking support.
You can download a PDF file of the 'Young people, mental health and smoking' factsheet which includes references.
