BACKGROUND-AIM:
Daily smoking has decreased while the use of other tobacco and nicotine products has increased. Individuals with psychological distress smoke generally more than those without. The use of other nicotine products is less studied in this group. The aim of this study was to examine the prevalence of daily use of any nicotine products by mental health status and to compare changes in the proportion of daily smoking among those using daily nicotine products by mental health status.

METHODS:
Two cross-sectional population-based Finnish surveys conducted in 2017 (sample n=10247, participation rate 58.1%) and 2022 (sample n=18468, 46.3%) were used, including 20–74-year-old respondents. The category for daily smoking included those who reported smoking cigarettes, pipes or cigars daily, while category for daily nicotine use included those who reported daily use of snus, e-cigarettes, nicotine pouches, heated tobacco products or nicotine replacement therapy. Psychological distress was measured with Mental Health Inventory-5 (MHI-5, score ≤52). Age-and sex-adjusted margins with prevalence differences are reported, utilising multiple imputed data with population weights.

RESULTS:
The prevalences for daily nicotine product use, daily smoking and experiencing psychological distress were 17.4% (n=1649), 13.6% (n=1311) and 11.4% (n=1073), respectively. Among individuals without psychological distress, the prevalence of daily use of any nicotine product was 16.7% in 2017 and 15.4% in 2022, while the corresponding prevalences for individuals reporting psychological distress were 28.9% and 25.5%, respectively. The proportion of daily smoking among those with daily use of any nicotine product decreased among individuals without psychological distress from 85.4% (in 2017) to 66.5% (in 2022) (change over time p<0.0001), while the corresponding adjusted prevalences among individuals with psychological distress were 89.2% and 78.4% (change over time p=0.048). The change in the proportion of daily smoking among those using any nicotine product daily did not differ between these two groups between 2017 and 2022 (contrast: 0.08; 95% confidence interval: -0.038, 0.195).

CONCLUSIONS:
Daily nicotine use is more frequent, and daily smoking remains to constitute a greater proportion of the total nicotine use, among individuals with psychological distress than among individuals without psychological distress. The proportion of daily smoking in relation to daily use of any nicotine products has decreased among individuals with and without psychological distress while no differences in changes in this proportion were observed between these groups. Cessation of all tobacco and nicotine products should be supported irrespective of the mental health status of the person, while possible differences in the products used should be acknowledged.