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Associations of Nicotine Use with Reduced Wellbeing and Increased Problem Behaviors Among German Adolescents.

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Title: Associations of Nicotine Use with Reduced Wellbeing and Increased Problem Behaviors Among German Adolescents.
Authors: Hanewinkel, Reiner (AUTHOR), Hansen, Julia (AUTHOR)
Source: Substance Use & Misuse. 2026, Vol. 61 Issue 10, p1640-1644. 5p.
Subjects: Smoking cessation products, High schools, World Health Organization, Smoking cessation, Cross-sectional method, Mental health, Research funding, Data analysis, Electronic cigarettes, Smoking, Nicotine, Questionnaires, Multiple regression analysis, Psychological well-being, Evaluation of medical care, Internalizing behavior, Disease prevalence, Descriptive statistics, Teenagers' conduct of life, Odds ratio, Statistics, Externalizing behavior, Comparative studies, Confidence intervals, Social classes, Adolescence
Geographic Terms: United States, Germany
Abstract: Introduction: Among US-adolescents, nicotine use, especially dual use of e-cigarettes and cigarettes is associated with poor mental health outcomes. This study examines associations between different nicotine use profiles and wellbeing and problem behaviors among German adolescents. Methods: A school-based survey was conducted in secondary schools between November 2024 and February 2025 in 116 schools from 14 out of 16 federal German states. Symptoms of internalizing and externalizing behavioral problems were assessed using the Strengths and Difficulties Questionnaire. Wellbeing was assessed with the WHO-5 Well-Being Index. Nicotine use (past 30-day use) was categorized into four groups: monthly use of e-cigarettes only, monthly use of combustible cigarettes only, monthly dual use, and nonuse. Results: A total of 25,128 adolescents with a mean age of 13 years with 52% being female participated. Compared with individuals who did not report e-cigarette and/or cigarette use, adolescents engaging in monthly dual use had the highest odds, with an adjusted OR of 2.11 (95% CI: 1.80–2.47) for reduced wellbeing and 3.65 (95% CI: 2.95–4.52) for externalizing behavioral problems. Regarding internalizing behavioral problems, individuals reporting cigarette use (OR = 2.23, 95% CI: 1.60–3.10) and dual use (OR = 1.90, 95% CI: 1.58–2.27) had the highest odds, with no significant difference between them. Conclusions: German adolescents who use nicotine, especially dual use of e-cigarettes and cigarettes, are at an increased risk for internalizing and externalizing behavioral problems and have lower overall well-being. Due to design limitations, we are unable to draw causal conclusions. [ABSTRACT FROM AUTHOR]
Copyright of Substance Use & Misuse is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Associations of Nicotine Use with Reduced Wellbeing and Increased Problem Behaviors Among German Adolescents.
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  Data: <searchLink fieldCode="AR" term="%22Hanewinkel%2C+Reiner%22">Hanewinkel, Reiner</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Hansen%2C+Julia%22">Hansen, Julia</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Substance+Use+%26+Misuse%22">Substance Use & Misuse</searchLink>. 2026, Vol. 61 Issue 10, p1640-1644. 5p.
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  Data: <searchLink fieldCode="DE" term="%22Smoking+cessation+products%22">Smoking cessation products</searchLink><br /><searchLink fieldCode="DE" term="%22High+schools%22">High schools</searchLink><br /><searchLink fieldCode="DE" term="%22World+Health+Organization%22">World Health Organization</searchLink><br /><searchLink fieldCode="DE" term="%22Smoking+cessation%22">Smoking cessation</searchLink><br /><searchLink fieldCode="DE" term="%22Cross-sectional+method%22">Cross-sectional method</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+health%22">Mental health</searchLink><br /><searchLink fieldCode="DE" term="%22Research+funding%22">Research funding</searchLink><br /><searchLink fieldCode="DE" term="%22Data+analysis%22">Data analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Electronic+cigarettes%22">Electronic cigarettes</searchLink><br /><searchLink fieldCode="DE" term="%22Smoking%22">Smoking</searchLink><br /><searchLink fieldCode="DE" term="%22Nicotine%22">Nicotine</searchLink><br /><searchLink fieldCode="DE" term="%22Questionnaires%22">Questionnaires</searchLink><br /><searchLink fieldCode="DE" term="%22Multiple+regression+analysis%22">Multiple regression analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Psychological+well-being%22">Psychological well-being</searchLink><br /><searchLink fieldCode="DE" term="%22Evaluation+of+medical+care%22">Evaluation of medical care</searchLink><br /><searchLink fieldCode="DE" term="%22Internalizing+behavior%22">Internalizing behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Disease+prevalence%22">Disease prevalence</searchLink><br /><searchLink fieldCode="DE" term="%22Descriptive+statistics%22">Descriptive statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Teenagers'+conduct+of+life%22">Teenagers' conduct of life</searchLink><br /><searchLink fieldCode="DE" term="%22Odds+ratio%22">Odds ratio</searchLink><br /><searchLink fieldCode="DE" term="%22Statistics%22">Statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Externalizing+behavior%22">Externalizing behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Comparative+studies%22">Comparative studies</searchLink><br /><searchLink fieldCode="DE" term="%22Confidence+intervals%22">Confidence intervals</searchLink><br /><searchLink fieldCode="DE" term="%22Social+classes%22">Social classes</searchLink><br /><searchLink fieldCode="DE" term="%22Adolescence%22">Adolescence</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22United+States%22">United States</searchLink><br /><searchLink fieldCode="DE" term="%22Germany%22">Germany</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Introduction: Among US-adolescents, nicotine use, especially dual use of e-cigarettes and cigarettes is associated with poor mental health outcomes. This study examines associations between different nicotine use profiles and wellbeing and problem behaviors among German adolescents. Methods: A school-based survey was conducted in secondary schools between November 2024 and February 2025 in 116 schools from 14 out of 16 federal German states. Symptoms of internalizing and externalizing behavioral problems were assessed using the Strengths and Difficulties Questionnaire. Wellbeing was assessed with the WHO-5 Well-Being Index. Nicotine use (past 30-day use) was categorized into four groups: monthly use of e-cigarettes only, monthly use of combustible cigarettes only, monthly dual use, and nonuse. Results: A total of 25,128 adolescents with a mean age of 13 years with 52% being female participated. Compared with individuals who did not report e-cigarette and/or cigarette use, adolescents engaging in monthly dual use had the highest odds, with an adjusted OR of 2.11 (95% CI: 1.80–2.47) for reduced wellbeing and 3.65 (95% CI: 2.95–4.52) for externalizing behavioral problems. Regarding internalizing behavioral problems, individuals reporting cigarette use (OR = 2.23, 95% CI: 1.60–3.10) and dual use (OR = 1.90, 95% CI: 1.58–2.27) had the highest odds, with no significant difference between them. Conclusions: German adolescents who use nicotine, especially dual use of e-cigarettes and cigarettes, are at an increased risk for internalizing and externalizing behavioral problems and have lower overall well-being. Due to design limitations, we are unable to draw causal conclusions. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
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  Data: <i>Copyright of Substance Use & Misuse is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1080/10826084.2026.2617436
    Languages:
      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 5
        StartPage: 1640
    Subjects:
      – SubjectFull: Smoking cessation products
        Type: general
      – SubjectFull: High schools
        Type: general
      – SubjectFull: World Health Organization
        Type: general
      – SubjectFull: Smoking cessation
        Type: general
      – SubjectFull: Cross-sectional method
        Type: general
      – SubjectFull: Mental health
        Type: general
      – SubjectFull: Research funding
        Type: general
      – SubjectFull: Data analysis
        Type: general
      – SubjectFull: Electronic cigarettes
        Type: general
      – SubjectFull: Smoking
        Type: general
      – SubjectFull: Nicotine
        Type: general
      – SubjectFull: Questionnaires
        Type: general
      – SubjectFull: Multiple regression analysis
        Type: general
      – SubjectFull: Psychological well-being
        Type: general
      – SubjectFull: Evaluation of medical care
        Type: general
      – SubjectFull: Internalizing behavior
        Type: general
      – SubjectFull: Disease prevalence
        Type: general
      – SubjectFull: Descriptive statistics
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      – SubjectFull: Teenagers' conduct of life
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      – SubjectFull: Odds ratio
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      – SubjectFull: Statistics
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      – SubjectFull: Externalizing behavior
        Type: general
      – SubjectFull: Comparative studies
        Type: general
      – SubjectFull: Confidence intervals
        Type: general
      – SubjectFull: Social classes
        Type: general
      – SubjectFull: Adolescence
        Type: general
      – SubjectFull: United States
        Type: general
      – SubjectFull: Germany
        Type: general
    Titles:
      – TitleFull: Associations of Nicotine Use with Reduced Wellbeing and Increased Problem Behaviors Among German Adolescents.
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              M: 08
              Text: 2026
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