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.

心理健康问题是导致青少年提前接触烟草、吸烟低龄化的重要因素，本研究聚焦职校学生，探寻焦虑和抑郁情绪对该群体吸烟行为的影响。

探讨职校生抑郁和焦虑情绪对吸烟行为的影响，为制定针对性的控烟措施提供依据。

于2021年10月，采用随机整群抽样法在上海市抽取职校学生5 074名进行问卷调查，内容包括学生的基本情况、抑郁和焦虑情况、烟草使用情况。其中，抑郁情况采用患者健康问卷2条目中文版（PHQ-2）评估，焦虑情况采用广泛性焦虑量表（GAD-7）评估，烟草使用情况根据WHO的"全球青少年烟草调查问卷"划分为"均不使用""仅使用卷烟""仅使用电子烟""双重使用"4类。采用多分类Logistic回归模型探讨抑郁和焦虑对烟草使用的影响。

共回收有效问卷4 890份，问卷有效回收率为96.37%。职校生的卷烟使用率为11.23%（271/4 890），电子烟使用率为8.40%（133/4 890），双重使用率为5.69%（278/4 890）。分别有747名（15.28%）、1 259名（25.75%）、556名（11.37%）职校生检出抑郁情绪、轻度焦虑情绪、中重度焦虑情绪。多分类Logistic回归分析结果显示：抑郁情绪会增加职校生仅使用卷烟（OR=1.64，95%CI=1.20~2.25）、仅使用电子烟（OR=1.88，95%CI=1.24~2.84）和双重使用（OR=2.32，95%CI=1.72~3.12）的风险；轻度焦虑会增加职校生双重使用（OR=1.81，95%CI=1.34~2.44）的风险，中重度焦虑会增加职校生仅使用卷烟（OR=1.61，95%CI=1.11~2.33）、仅使用电子烟（OR=2.19，95%CI=1.37~3.50）和双重使用（OR=3.05，95%CI=2.16~4.31）的风险。按性别分层后发现：抑郁情绪会增加男生仅使用卷烟和双重使用的风险（P<0.05），增加女生仅使用电子烟和双重使用的风险（P<0.05）；中重度焦虑会增加男生3种烟草使用行为的风险（P<0.05），对女生双重使用的影响高于对男生双重使用的影响（OR值为5.24比2.77，P<0.05）。

抑郁和焦虑情绪会增加职校生吸烟行为的发生风险，学校和家庭应加强青少年心理健康教育，及时发现和疏导青少年的不良情绪，并在传统烟草控烟工作基础上，加强对电子烟的控烟管理，防止出现烟草共用行为，促进青少年健康成长。