A cross-sectional study: Association between tobacco/alcohol usage and mental health with disabilities

Yi Huang, Travis Loux

Research output: Contribution to journalArticlepeer-review


Tobacco and alcohol use are significant public health issues that have been linked to numerous negative mental health outcomes. Numerous studies have established the significant association between tobacco/alcohol usage and mental issues. Smoking tobacco has been linked to a higher risk of developing anxiety disorders and depression. Nicotine, the addictive substance in tobacco, can temporarily alleviate stress and anxiety, but its long-term use can lead to increased anxiety and depression symptoms. Alcohol consumption is also a known factor for both depression and anxiety disorders. Its abuse can disrupt the brain's chemistry, leading to mood swings, increased anxiety and depressive symptoms. However, there has been relatively less focus on understanding how disability status influence the association between tobacco/alcohol usage and mental health. For individuals with disabilities, these risks are often compounded by a range of factors, such as social isolation, poverty, and limited access to healthcare. In this paper, 27,170 participants with/without disability were used to examine the association between tobacco and alcohol usage and mental health outcomes. Objective: This cross-sectional study aims to investigate the relationship between tobacco and alcohol use and mental health outcomes among individuals with and without disabilities, using data from the 2020 National Survey on Drug Use and Health (NSDUH). Methods: In this study, we conducted bivariate analysis to compare baseline covariates between respondents reporting serious mental issues and those not. To mitigate nonresponse bias, we applied multiple imputation by chained equations before modeling. Linear regression models were subsequently employed to explore the association between tobacco/alcohol usage and K6 scores, considering differences by disability status. The research design was cross-sectional, involving a substantial cohort of 27,170 participants. Results: Our findings indicate that both tobacco and alcohol use, along with disability, are associated with higher K6 scores, indicative of poorer mental health. Specifically, the interaction between disability and tobacco usage contributes to additional points on the K6 score. However, when excluding tobacco consumption, the interaction term between alcohol use and disability status was not found to be statistically significant. Conclusions: Based on nationally representative survey data, our study reveals that individuals using tobacco and alcohol are more likely to report symptoms of serious mental health issues compared to non-users. Furthermore, we highlight the interaction effect between disability and tobacco consumption, which amplifies the risk of poor mental health among this vulnerable population.

Original languageEnglish
Article number200302
JournalMental Health and Prevention
StatePublished - Dec 2023


  • Disability
  • Mental health
  • Tobacco/Alcohol consumption


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