Psychological health issues are important factors leading to early exposure to tobacco and smoking at a younger age. This study focuses on vocational school students to explore the effects of anxiety and depression on their smoking behavior and explore effective ways to control smoking.

To explore the effects of depression and anxiety on smoking behavior among vocational school students, providing evidence for corresponding control measures.

In October 2021, a random cluster sampling method was used to select 5 074 vocational school students in Shanghai for a questionnaire survey, which included students' basic information, depression and anxiety status, and tobacco use. The depression status was assessed using the Patient Health Questionnaire-2 (PHQ-2) Chinese version, and the anxiety status was assessed using the Generalized Anxiety Disorder-7 (GAD-7) scale. Tobacco use was divided into four categories based on the World Health Organization's "Global Youth Tobacco Survey Questionnaire": "never use" "only use cigarettes" "only use e-cigarettes" and "dual use". A multivariate Logistic regression model was used to explore the influence of depression and anxiety on tobacco use.

A total of 4 890 vocational school students were surveyed and the response rate for the survey was 96.37%. The rates of cigarette use, e-cigarette use and dual use were 11.23% (271/4 890) , 8.40% (133/4 890) and 5.69% (278/4 890) respectively. Among them, 747 (15.28%) , 1 259 (25.75%) and 556 (11.37%) had depression, mild and moderate to severe anxiety respectively. Multiple Logistic regression analysis showed that depression increases the risk of vocational school students using only cigarettes (OR=1.64, 95%CI=1.20-2.25) , electronic cigarettes (OR=1.88, 95%CI=1.24-2.84) and dual use (OR=2.32, 95%CI=1.72-3.12) . Mild anxiety increases the risk of dual use (OR=1.81, 95%CI=1.34-2.44) , while moderate to severe anxiety increases the risk of using only cigarettes (OR=1.61, 95%CI=1.11-2.33) , electronic cigarettes (OR=2.19, 95%CI=1.37-3.50) , and dual use (OR=3.05, 95%CI=2.16-4.31) Risk. After gender stratification, it was found that depression increased the risk of male students using only cigarettes and dual use (P<0.05) , and increased the risk of female students using only e-cigarettes and dual use (P<0.05) . Moderate to severe anxiety increased the risk of male students using three types of tobacco (P<0.05) , and the risk of dual use for female students was higher than that for male students (OR values were 5.24 vs 2.77, P<0.05) .

Depression and anxiety can increase the risk of smoking behavior in vocational school students. Schools and families should strengthen mental health education of adolescents, find and guide adolescents' negative emotions in time, and strengthen the management of e-cigarette tobacco control on the basis of traditional tobacco control, to prevent dual tobacco use behavior and promote the healthy growth of adolescents.