Alexithymia mediates the association between childhood trauma and adolescent E-cigarette use

Background Adolescent electronic cigarette use (e-cigarette) is a public health concern and factors associated with vaping remain to be understood. Childhood emotional abuse/neglect is a risk factor for e-cigarettes. Yet, pathways by which trauma impacts use remain unclear. Alexithymia (i.e., difficulties identifying and describing feelings) is one possible link. Indeed, emotional abuse/neglect leads to difficulties identifying and verbalizing emotions. This impairment may lead to distress and promote e-cigarette use as a coping strategy. Methods Using parallel mediation, this study examined the degree to which alexithymia, assessed using the Toronto Alexithymia Scale, mediates the link between emotional abuse/neglect, assessed using the Child and Adolescent Trauma Screen, and e-cigarette use. The sample (n = 166) consisted of adolescents from a larger multi-wave study. Results Emotional abuse/neglect predicted difficulty describing feelings (effect = 0.23, p = 0.001), which in turn predicted e-cigarette use (effect = 0.30, p = 0.004). Moreover, difficulty describing feelings mediated the link between emotional abuse/neglect and e-cigarette use (sum of indirect 95% CI [1.68, 16.48]). Difficulty identifying feelings was not a significant mediator and the externally-oriented thinking subscale was excluded due to low reliability. Conclusions As e-cigarettes are often used in social contexts, teens who experience difficulty describing feelings may vape as a means of connecting emotionally with others. Moreover, nicotine, found in most e-cigarettes, releases dopamine and noradrenaline in the brain modulating action, learning, and memory processes; plausibly, improving verbalization of emotions. Programming which identifies nuances in alexithymia among adolescents with emotional abuse/neglect could mitigate e-cigarette use or delay initiation.