Eating disorder symptoms and comorbid mental health risk among teens recruited to a digital intervention research study via two online approaches.

INTRODUCTION: It is crucial to identify and evaluate feasible, proactive ways to reach teens with eating disorders (EDs) who may not otherwise have access to screening or treatment. This study aimed to explore the feasibility of recruiting teens with EDs to a digital intervention study via social media and a publicly available online ED screen, and to compare the characteristics of teens recruited by each approach in an exploratory fashion. METHOD: Teens aged 14-17 years old who screened positive for a clinical/subclinical ED or at risk for an ED and who were not currently in ED treatment completed a baseline survey to assess current ED symptoms, mental health comorbidities, and barriers to treatment. Bivariate analyses were conducted to examine differences between participants recruited via social media and those recruited after completion of a widely available online EDs screen (i.e., National Eating Disorders Association [NEDA] screen). RESULTS: Recruitment of teens with EDs using the two online approaches was found to be feasible, with 934 screens completed and a total of 134 teens enrolled over 6 months: 77% (n = 103) via social media 23% (n = 31) via the NEDA screen. Mean age of participants (N = 134) was 16 years old, with 49% (n = 66) identifying as non-White, and 70% (n = 94) identifying as a gender and/or sexual minority. Teens from NEDA reported higher ED psychopathology scores (medium effect size) and more frequent self-induced vomiting and driven exercise (small effect sizes). Teens from NEDA also endorsed more barriers to treatment, including not feeling ready for treatment and not knowing where to find a counselor or other resources (small effect sizes). DISCUSSION: Online recruitment approaches in this study reached a large number of teens with an interest in a digital intervention to support ED recovery, demonstrating the feasibility of these outreach methods. Both approaches reached teens with similar demographic characteristics; however, teens recruited from NEDA reported higher ED symptom severity and barriers to treatment. Findings suggest that proactive assessment and intervention methods should be developed and tailored to meet the needs of each of these groups. PUBLIC SIGNIFICANCE: This study examined the feasibility of recruiting teens with EDs to a digital intervention research study via social media and NEDA's online screen, and demonstrated differences in ED symptoms among participants by recruitment approach.

Factors associated with not ready to stop using substances among adults with an unmet treatment need: findings from the National Survey of Drug Use and Health 2015-2019.

Background: A better understanding of factors associated with not ready to stop using substances may inform provider engagement with clients who have an unmet treatment need.Objectives: This study explores how treatment barriers, the number of SUD symptoms, and types of substances used are associated with not ready to stop using substances among adults with an unmet treatment need.Methods: The data came from the 2015-2019 National Survey on Drug Use and Health. Eligible adults met DSM-IV criteria for substance abuse and dependence and reported an unmet need for treatment. Among our sample (N = 1,017), a majority self-identified as male (weighted 59.3%). We employed multivariable logistic regression to examine individual-level factors associated with not being ready to stop using substances.Results: About 38% of the respondents reported that they were not ready to stop using substances. Reporting access barriers (aOR = 0.44, 95% CI: 0.29, 0.68) and attitudinal barriers (aOR = 0.47, 95% CI: 0.28, 0.80) was associated with a lower odds of not ready to stop using. Each additional increase in SUD symptoms was associated with 23% higher odds of not being ready to stop using (aOR = 1.22, 95% CI: 1.12, 1.34). Having a diagnosis of alcohol and/or marijuana abuse or dependence was associated with higher odds of not being ready to stop using when compared to respondents without these diagnoses (aOR = 2.13, 95% CI: 1.33, 3.40; aOR = 1.82 95% CI: 1.11, 2.99).Conclusion: Not ready to stop using substances may be impacted by the type of SUD, number of SUD symptoms, and certain barriers like access and attitude to care.

How do teens with a history of suicidal behavior and self-harm interact with social media?

BACKGROUND: This study examines how engagement with depression-related social media content varies by teens who report suicidal ideation, suicide attempts, and nonsuicidal self-injury (NSSI) versus those who had not experienced each behavior. METHODS: Teens aged 15-17 years old (N = 93) were recruited from social media platforms from October 2016 to August 2018. Participants were asked three open-ended questions about the advantages and disadvantages of networking about depression-related content on social media. We conducted a qualitative analysis to capture themes in responses by question item. Univariate analyses were conducted to compare differences in the frequency of themes endorsed among the behavioral groups versus their counterparts. RESULTS: Among participants (female, 73%; non-White, 45%; sexual minority, 57%), most (93%, n = 87) endorsed depressive symptoms. Sixty-five percent (n = 60) endorsed suicidal ideation within the past year, who were more likely to indicate unhelpful social interactions (p = .02) as a disadvantage of following depression content than peers who did not endorse suicidal ideation within the past year. Eighty percent (n = 74) endorsed lifetime experience of NSSI, who were more likely to indicate negative impact on relationships (p = .01) from posting depression content than peers who did not experience NSSI. Fifty-eight percent (n = 54) endorsed a lifetime suicide attempt, who were more likely to mention offering solutions (p = .03) to someone posting concerning content than peers who did not endorse a lifetime suicide attempt. CONCLUSIONS: This study provides diverse and unique perspectives on how engagement with depression-related social media varies by mental health behaviors and informs the use of social media for recruitment and outreach for teens.

Association between Sexual Violence Victimization and Electronic Vaping Product Use among Adolescents: Findings from a Population-based Study.

BACKGROUND: Although studies have investigated the association between sexual violence (SV) victimization and substance use, few studies have examined the association between SV victimization and electronic vaping product (EVP) use among adolescents in the United States. The objective of this study was to examine the cross-sectional association between SV victimization and EVP use among adolescents. METHODS: Data were pooled from the 2017 and 2019 Youth Risk Behavior Survey. An analytic sample of 28,135 adolescents (51.2% female) was analyzed using binary logistic regression. The outcome variable investigated was EVP use, and the main explanatory variable was SV victimization. RESULTS: Of the 28,135 adolescents, the prevalence of past 30-day EVP use and SV victimization was 22.7% and 10.8%, respectively. Controlling for other factors, adolescents who experienced SV had 1.52 times higher odds of being EVP users when compared to their counterparts who did not experience SV (AOR = 1.52, p < .001, 95% CI = 1.27-1.82). Other factors associated with EVP use included cyberbullying victimization, symptoms of depression, and current use of cigarettes, alcohol, and marijuana. CONCLUSIONS: Experiencing SV was associated with EVP use. Future studies that employ longitudinal designs may offer more insight into the mechanisms underlying the association between SV victimization and EVP use. In addition, school-based interventions that focus on sexual violence prevention and reducing substance use among adolescents are warranted.

Suicidal Ideation among Youths at Risk of School Dropout: Impact of Student Demographics, Stressors, and Academic Self-Concept.

In the United States, suicidal ideation is an issue for high school-age youths. Research supports that youths who have learning difficulties and who are at risk of high school dropout are at greater risk for suicidal ideation. Although alternative high schools address both student academics and emotional health, they are underused, nonclinical settings for understanding and addressing suicidal ideation. This study aimed to examine the impact of student identity, external stressors, and academic self-concept on suicidal ideation among sexual and ethnic minority and underserved students enrolled in an alternative education public high school. The student sample (N = 103) completed a onetime survey comprised of the Suicidal Ideation Questionnaire-Junior, the Cultural Assessment of Risk of Suicide, the Coddington Life Events Scale for Adolescents, and the Piers Harris 2. Results of hierarchical linear regression indicated that identifying as nonheterosexual and experiencing discrimination were associated with greater student reporting of suicidal ideation. Identifying as Latino and other non-White was associated with lower reporting of suicidal ideation. Controlling for student demographics and external stressors, positive academic self-concept was associated with a lower reporting of suicidal ideation. Findings have future implications for health social work, suicide prevention and intervention, and education policy.

Hotline Use in the United States: Results from the Collaborative Psychiatric Epidemiology Surveys.

Crisis hotlines are a fixture in providing mental health services to individuals experiencing mental and behavioral problems in the United States (U.S.). Despite this, and the growing need for easily-accessible, anonymous, and free services amidst the suicide and opioid crises, there is no study reporting U.S. national prevalence and correlates of hotline use. Data on n = 18,909 participants from the Collaborative Psychiatric Epidemiology Surveys (CPES), a group of three nationally-representative, population-based studies, were used to estimate the prevalence of lifetime and past 12-month hotline use. A series of logistic regression models examined sociodemographic, clinical history and service use correlates of hotline use. Lifetime and past 12-month hotline use was estimated at 2.5% and 0.5%, respectively. Being female, having a mental or behavioral disorder, experiencing suicidality, or interacting with other formal and informal sectors of the mental health service system were significant correlates of use. This study provides the first national estimates of crisis hotline usage in the U.S. Hotlines are more likely to be used by certain sociodemographic subgroups, but these differences may be due to differing psychiatric history and service use patterns. Efforts should be made to ensure that crisis hotlines are being utilized by other marginalized populations at high risk of suicide or overdose amidst the current public health crises in the U.S., such as racial/ethnic minorities or youth. To evaluate the role that crisis hotlines play in the mental health service system, national surveys should aim to monitor trends and correlates over time.

Leveraging social media to explore the barriers to treatment among individuals with depressive symptoms.

BACKGROUND: Individuals with depression may not seek treatment for their symptoms due to several types of barriers to treatment. In support of the growing research on mental health care access and the role of social media, this study aimed to increase knowledge of these barriers among social media users. METHODS: Participants were recruited from several social media platforms, including Instagram, Facebook, Twitter, Reddit, Tumblr, and online depression forums. Eligible participants had endorsed having posted about feeling sad or depressed on social media, or followed social media groups that post about depression-related topics. Participants completed an online survey about their depression symptoms, interest in treatment, and potential barriers to accessing treatment. RESULTS: Of the participants reaching criteria for depression, those with major depression were more likely to seek out treatment, to report an unmet need for treatment, and have a higher risk of suicide. For participants with major depression, barriers to treatment were more likely to be attitudinal, while participants with mild depression experienced more structural barriers. CONCLUSIONS: This study demonstrates several barriers to treatment that occur for individuals struggling with depression, and that online platforms are effective mediums to recruit individuals with depression symptoms who seek mental health support.

The Role of Technology and the Continuum of Care for Youth Suicidality: Systematic Review.

BACKGROUND: Youth suicide is a global public health issue, and using technology is one strategy to increase participation in preventive interventions. However, there is minimal knowledge on how technology-enhanced interventions for youth correspond to the stages of care, from illness or risk recognition to treatment follow-up. OBJECTIVE: This systematic review aims to examine the efficacy of technology-enhanced youth suicide prevention and interventions across the continuum of care. METHODS: Four electronic databases were searched up to spring 2019 for youth suicide preventive interventions that used technology. The review was not restricted by study design and eligible studies could report outcomes on suicidality or related behaviors, such as formal treatment initiation. An adapted version of the Methodological Quality Ratings Scale was used to assess study quality. RESULTS: A total of 26 studies were identified. The findings support the emerging efficacy of technology-enhanced interventions, including a decline in suicidality and an increase in proactive behaviors. However, evidence suggests that there are gaps in the continuum of care and recent study samples do not represent the diverse identities of vulnerable youth. CONCLUSIONS: The majority of identified studies were conducted in school settings and were universal interventions that aligned with the illness and risk recognition and help-seeking stages of the continuum of care. This field could be strengthened by having future studies target the stages of assessment and treatment initiation, include diverse youth demographics, and examine the varying roles of providers and technological components in emerging interventions.

Trajectories of Well-Being Among Latina Adolescents Who Attempt Suicide: A Longitudinal Qualitative Analysis.

Significant research questions persist regarding the short- and long-term outcomes of Latina adolescents who attempt suicide. To address these limitations, we utilize an ecodevelopmental framework to identify potential factors that shape differential outcomes following a suicide attempt. Through an exploratory, longitudinal, qualitative research design, we investigate two research questions: How do trajectories of well-being vary among Latina teens after a suicide attempt? What risk and protective factors might contribute to different trajectories? We conducted qualitative interviews with 17 Latina participants living in predominantly low-income households in New York City. Interviews took place within the 6 months following their suicide attempts, and again, 12 months later. Analysis revealed three distinct trajectories after a suicide attempt: resilience, tenuous growth, and chronic stress. Our findings elucidate potential factors that contribute to resilience following a suicide attempt and underscore the importance of prevention and intervention programs that foster adolescents' connectivity across ecodevelopmental contexts.

"I Just Kept It to Myself": The Shaping of Latina Suicidality Through Gendered Oppression, Silence, and Violence.

Suicide is a critical issue among Latina youth. In this study, we use family case analysis to explore how gendered oppression, silencing, and violence shape suicidal behaviors among a sample of Latina daughters (n = 10), and their parents. For comparison, we include family narratives from Latina adolescents with no histories of suicide attempts (n = 10). Results suggest how secrets and silence, as indicative of gendered oppression, may catalyze a suicide attempt. The risks are particularly salient when daughter and mother both have experienced violence that conflicts with gendered cultural scripts. Findings highlight the importance of parental engagement and exploration of histories of violence in the treatment of Latina suicide attempters. Future research should incorporate the risk factors of gendered oppression and violence to better understand the development of suicidality among Latina women.

El suicidio es un problema crítico entre las jóvenes latinas. En este artículo, usamos un análisis de casos familiares para averiguar cómo la opresión de género, el silenciamiento y la violencia determinan conductas suicidas entre una muestra de hijas latinas (n = 10) y sus padres. Para comparar, incluimos relatos familiares de adolescentes latinas sin historias de intentos de suicidio (n = 10). Los resultados sugieren cómo los secretos y el silencio, como indicadores de la opresión de género, pueden catalizar un intento de suicidio. Los riesgos son particularmente prominentes cuando la madre y la hija han sufrido una violencia que contradice los guiones culturales de género. Los resultados destacan la importancia de la participación de los padres y del análisis de las historias de violencia en el tratamiento de mujeres latinas que han intentado suicidarse. Las investigaciones futuras deberían incorporar los factores de riesgo de la opresión de género y de la violencia para comprender mejor el desarrollo de las tendencias suicidas entre las mujeres latinas.

Afrocentric Norms and Substance Use Behaviors Among Black Young Adults.

Despite not displaying higher overall rates of substance use compared to White Americans, the social consequences of substance use disorders for Black Americans, particularly among Black American men, are more damaging. Furthermore, recent data suggest an uptick in substance use-related deaths among Black Americans, raising serious concerns about a growing health disparity that warrants the need for studies to identify factors associated with prevention. For decades, Black cultural theorists have argued that Afrocentric norms are important buffers against maladaptive behaviors in Black Americans, but the association in the context of substance use is still an emerging area. The present study investigated the associations between Afrocentric norms, Afrocentric self-regard, internalized negative stereotypes, and substance use attitudes and behaviors among Black young adults. Self-report questionnaires were administered to measure internalized negative stereotypes, Afrocentric norms, Afrocentric self-regard, substance use attitudes, and substance use from a sample of Black young adults (N = 619). Favorable attitudes toward substance use were found to be positively associated with internalized negative stereotypes but were inversely associated with Afrocentric norms and Afrocentric self-regard. Similarly, substance use reports within the past 30 days were inversely associated with Afrocentric norms, but the relationship to cannabis use was non-significant. Gender differences between Black men and women were also found. Implications for social work are discussed.

Leveraging Digital Media to Promote Youth Mental Health: Flipping the Script on Social Media-Related Risk.

Purpose of Review: Despite growing public concern about the negative impact of digital media for mental health problems, there are key ways in which digital media can be leveraged to prevent such outcomes. This article reviews research exploring the ways that digital media, particularly social media, can be used to prevent negative mental health outcomes and promote youth mental health and well-being. Recent findings: Research indicates that media can be protective against mental health problems and promote mental health by enabling social support and destigmatizing mental illness, especially for youth with limited resources. Media also can be leveraged to identify those at risk, to educate, provide resources, and promote well-being, and to track symptoms and intervene to prevent or mitigate negative mental health outcomes. There is limited research on interventions designed to reduce the negative effects of digital media on mental health, especially those that harness media itself, a critical area of future research. Summary: This article provides a summary of the current evidence on this topic, highlights key directions for future research, and provides evidence-based recommendations for adolescents, families, educators, clinicians, industry, and policy-makers to prevent mental health problems related to media.

Young Adults' Experiences with Cannabis Retailer Marketing and Related Practices: Differences Among Sociodemographic Groups and Associations with Cannabis Use-related Outcomes.

OBJECTIVES: Limited cannabis retail surveillance has been conducted, particularly assessing retailer practices in relation to consumer sociodemographic factors or use-related outcomes. This study examined young adults': exposure to promotions, health claims, warnings, and age restrictions at cannabis retailers; demographic correlates of retail exposures; and retail exposures in relation to use-related outcomes. STUDY DESIGN: This study used the cross-sectional quantitative analysis. METHODS: We analyzed 2023 survey data among 876 young adults in states with legal non-medical cannabis, reporting past-month cannabis use and past-year retailer visits. RESULTS: In this sample (Mage = 27.1, 44.1% male, 31.7% sexual minority, 17.7% Black, 11.2% Asian, 25.1% Hispanic), 46.7% "at least sometimes" noticed free samples, 76.5% price promotions, 37.4% subpopulation-targeted promotions; 72.5% health claims on products/ads, 63.1% signage, and 70.5% from budtenders; 72.5% warnings on labels, 65.5% signage, and 38.9% from budtenders; and > 80% age verifications. Multivariable analyses identified sociodemographic correlates of exposure outcomes: greater promotion exposure was associated with Black race; greater health claim exposure with being heterosexual, Black, and less educated; less warning exposure with less education; and less age restriction exposure with being younger, male, and Black. Retail exposures were associated with use-related outcomes: more frequent cannabis use was associated with less health claim exposure; greater perceived social acceptability with greater promotion and age restriction exposure; greater perceived risk with greater warning and less age restriction exposure; more problematic use and driving after use with greater promotion and less age restriction exposure. CONCLUSIONS: Cannabis retail exposure disparities and their associations with use-related outcomes highlight the importance of regulatory and prevention efforts.

Principal component regression analysis of familial psychiatric histories and suicide risk factors among adults with opioid use disorder.

This study explores familial psychiatric risk factors that are closely linked to suicide risk among patients with opioid use disorder (OUD) as measured by the Family History Assessment Module (FHAM). Data was derived from adults diagnosed with OUD (N = 389). To analyze the covariance between the 11 items of the FHAM, principal component analysis was applied to infer principal components (PC) scores. Log-binominal regression was conducted to quantify the associations between PC scores and mental health symptoms (e.g., lifetime suicidal attempt, P30D suicidal ideation, depression, and anxiety). Analyses revealed that the first 3 three PCs could account for 56% of the total variance of the FHAM items within the data. Family history of substance misuse (PC1) was positively associated with lifetime suicide attempts and severe anxiety. Family history of serious mental illness (PC2) and of suicidal behavior (PC3) were not significantly associated with any outcomes. Our findings suggest current suicide risk is associated with an array of familial psychiatric issues among people with OUD. However, family history of suicide attempts and death by suicide has less bearing on current suicide risk in OUD patients whereas family history of substance use confers significant risk. Findings underscore suicide-related preventive interventions as necessary components of treatment plans among people with OUD, who commonly report family histories of substance misuse.

A Community-Engaged Approach to Understanding Suicide in a Small Rural County in Georgia: A Two-Phase Content Analysis of Individual and Focus Group Interviews.

Suicide is a significant public health problem, with disproportionate rates in rural areas. Rural communities face substantial structural and cultural barriers to suicide prevention. This study aimed to gain a deeper understanding of the need for suicide prevention and gauge the appropriateness of prevention efforts in the context of a rural Georgia county by leveraging existing community resources and knowledge. Twenty one-on-one, semi-structured interviews and two focus groups were conducted, with participants recruited via purposive snowball sampling. Data analysis included qualitative deductive and inductive content analysis from individual interviews and focus groups with community stakeholders. The findings highlight how rural contexts exacerbate drivers of death by suicide and how the substantial loss of community members to suicide contributes to the ongoing crisis and reduces available support. Access to mental health care often depended on a connection to an established public system such as schools, a military base, or Veterans Administration. There were perceived gaps in crisis and post-crisis services, with participants actively trying to address these gaps and build community support through coalition building. This study contributes knowledge to contextual drivers of suicide in rural areas beyond individual-level risk factors. Community-engaged suicide prevention research in rural areas is promising, but there is a need to develop interventions to best support coalition building and capacity development.

Self-Identified Stage in Recovery and Substance-Use Behaviors among Pregnant and Postpartum Women and People with Opioid Use Disorder.

Opioid use among pregnant and postpartum women and people (PPWP) has significant health repercussions. This study explores how substance-use behaviors may vary by stage in recovery among PPWP with opioid use disorder (OUD). We recruited 29 PPWP with OUD. "High-risk" participants self-identified as "not being engaged in treatment" or "new or early in their recovery" (n = 11); "low-risk" participants self-identified as being "well-established" or "in long-term recovery" (n = 18). Participants were queried regarding sociodemographic, mental health, and drug-misuse factors; urine drug screens were collected at baseline. Univariate group comparisons between high-risk and low-risk PPWP were conducted. High-risk PPWP were more likely to self-identify as non-Hispanic African American and more likely to report current opioid use, other illicit drugs, and tobacco. High-risk PPWP had higher opioid cravings versus low-risk PPWP. High-risk PPWP were more likely to screen positive on urine tests for non-opioid drugs and on concurrent use of both non-opioid drugs and opioids versus low-risk participants. PPWP earlier in recovery are at higher-risk for opioid and other illicit drug misuse but are willing to disclose aspects of their recent use. PPWP early in recovery are an ideal population for interventions that can help facilitate recovery during the perinatal period and beyond.

Perceived racial discrimination and polysubstance use among racial/ethnic minority adolescents in the United States.

OBJECTIVE: Polysubstance use among adolescents is a significant public health concern, yet most studies on adolescent substance use focus on a singular substance. This study is one of the first to investigate the association between perceived racial discrimination (PRD) in school and polysubstance use among racial/ethnic minority adolescents using a nationally representative sample. METHODS: Data was from the 2021 Adolescent Behaviors and Experiences Survey. The sample included 4145 racial/ethnic minority adolescents (52.8% female). Hierarchical binary logistic regression was used to examine the association between PRD in school and polysubstance use among racial/ethnic minority adolescents. RESULTS: About 12% of racial/ethnic minority adolescents engaged in polysubstance use and 23.4% reported experiencing PRD in school sometimes/most of the time/always. Controlling for other factors, experiencing PRD in school sometimes/most of the time/always was associated with 1.52 times higher odds of polysubstance use when compared to adolescents who never experienced PRD in school (OR=1.52, p=.044, 95% CI=1.01-2.30). Cyberbullying victimization, symptoms of depression, and being emotionally abused by a parent during COVID-19 were also associated with polysubstance use. CONCLUSION: Controlling for demographic characteristics and psychosocial stressors, PRD in school was significantly associated with higher odds of polysubstance use among racial/ethnic minority adolescents. The findings of this study could inform clinicians and policymakers of the association between PRD in school and polysubstance use, which could contribute to early identification of polysubstance use among racial/ethnic minority adolescents.

An Examination of Suicidal Behavior among Black College Students with Exposure to Police Violence.

There is limited research about suicidal behaviors among Black emerging adults (peak age of suicide risk) who report exposure to police violence. The current study applies an integrated approach to examine individual, immediate environment, and community-based risk and protective factors of suicide among Black college students who reported previous exposure to police violence. A purposive sample of Black college students (N = 300) was analyzed using bivariate analyses and binary logistic regression. Outcome variables investigated were lifetime suicidal ideation and suicide attempt. Twenty-eight percent of participants reported lifetime suicidal ideation and 14 percent reported lifetime attempts. Female students were significantly more likely to report lifetime suicidal ideation and recent symptoms of anxiety and to engage in emotional social support than male peers. Logistic regression results demonstrated that higher income and greater depression symptoms were associated with lower reporting of lifetime suicidal ideation. Reporting of more grit, the trait of perseverance and passion for long-term goals, was associated with a lower reporting of both lifetime suicidal ideation and suicide attempt. Findings have implications for how social workers in higher education are encouraged to address suicidal behavior among Black students, including the cultivation of grit.

Use of electronic vaping products and mental health among adolescent high school students in the United States: The moderating effect of sex.

Although studies have investigated the association between conventional tobacco smoking and mental health outcomes among adolescents in the United States, few studies have examined the association between electronic vaping products (EVPs) and mental health among adolescents. This study aimed to investigate the cross-sectional association between EVPs use, symptoms of depression, and suicidal behaviors among adolescents. Data were pooled from the 2017 and 2019 Youth Risk Behavior Survey. An analytic sample of 14,285 adolescents (50.3% female) was analyzed using binary logistic regression. The outcome variables investigated were symptoms of depression, suicidal ideation, suicide plan, and suicide attempts, and the main explanatory variable was EVPs use. Of the 14,285 adolescents, 22.2%, 19.2%, and 58.8% were current, former and never users of EVPs, respectively. Controlling for other factors, current users of EVPs were significantly more likely to report having symptoms of depression (AOR = 1.82, 95% CI = 1.58-2.09), having suicidal ideation (AOR = 1.55, 95% CI = 1.30-1.86), making a suicide plan (AOR = 1.62, 95% CI = 1.34-1.97), or attempting suicide (AOR = 1.75, 95% CI = 1.41-2.18) when compared to never users of EVPs. Gender moderated the association between EVPs use, symptoms of depression, suicidal ideation, and suicide plan. Racial minority identity, sexual minority identity, sexual violence victimization, victim of school and cyberbullying, alcohol use, and cigarette smoking were all significantly associated with depression and suicidal behaviors. Study findings support the association between EVPs use and adolescent mental health. Future studies that employ longitudinal designs may offer more insight into the mechanisms underlying this association.