The intersection of substance consumption and psychological well-being among college students represents a growing area of concern for public health professionals. Although researchers have documented connections between individual substance use and mental health challenges, less attention has been paid to how using multiple substances simultaneously affects psychological outcomes across different demographic groups. This investigation examined how exclusive, dual, and combined use of alcohol, cannabis, and e-cigarettes relates to depressive symptoms and anxiety levels among American college students, with particular focus on variations by race, ethnicity, and gender.
Drawing from responses of 83,467 undergraduate participants (60,746 females and 22,721 males) in the 2020–2021 Healthy Minds Survey—a digital questionnaire administered at numerous American universities, researchers analyzed substance consumption patterns as primary variables and assessed mental health through standardized depression (PHQ-9) and anxiety (GAD-7) measures. Statistical analyses using logistic regression models were conducted separately by gender, controlling for demographic characteristics, economic pressures, social connections, survey response weighting, and institutional clustering.
Results revealed notable correlations between combined substance use and psychological distress. Students engaging in dual cannabis-e-cigarette use or combining all three substances showed elevated likelihood of meeting clinical thresholds for anxiety and depression relative to alcohol-only users, with this pattern holding across genders. Female participants displayed particularly elevated risk for both conditions, while males showed especially heightened vulnerability to depression. Non-users of any substances demonstrated substantially reduced odds of experiencing these mental health concerns. Additional analysis uncovered demographic variations: African American students showed lower risk for both anxiety and depression compared to White peers, whereas Middle Eastern/Arab American females exhibited increased anxiety likelihood. These results underscore that mental health outcomes depend not just on whether substances are used, but which specific combinations are consumed and how these effects differ by demographic characteristics.
Key Finding: Combined use of multiple substances, particularly cannabis with e-cigarettes, correlates with increased anxiety and depression risk among college students, with patterns varying by gender and racial/ethnic background.
Lui, C. K., Jacobs, W., & Yang, J. S. (2025). Patterns of Alcohol, Cannabis, and E-Cigarette Use/Co-Use and Mental Health Among U.S. College Students. Substance Use & Misuse, 60(1), 108–119. https://doi.org/10.1080/10826084.2024.2409723
