Moderating Factors of Co-occurring GD/IGD and ENDS Use among College Students

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Introduction: Research has found extensive similarities between symptoms of gaming disorder/Internet gaming disorder (GD/IGD) and symptoms of other addictive disorders, including the presence of cravings, tolerance, and inability to stop despite adverse consequences (Müller & Montag, 2017). Significant associations between GD/IGD and financial strain, occupational difficulties, sleep deprivation, malnutrition, obesity, and the development and/or exacerbation of other mental illness have been found, contributing to growing concern over the detrimental impact of GD/IGD (Kohorst et al., 2018). Video gaming is also associated with increased use of substances, including nicotine as found in electronic nicotine delivery systems (ENDS; Cranwell et al., 2016). The harmful consequences of ENDS use may exacerbate the health risks associated with GD/IGD, especially in connection to sleep, nutrition, and mental health. There is extensive overlap between the demographic and psychosocial characteristics of typical video gamers and typical users of ENDS, including being young, male, highly impulsive, sensation-seeking, and having a diagnosis of attention-deficit hyperactivity disorder (ADHD), which may account for the rates of concurrent dependence (Von der Heiden et al., 2019; Mathews, 2019). However, definitive characteristics of individuals demonstrating symptoms of both GD/IGD and ENDS dependency remain unknown. The present study aims to explore the demographic and psychological associations of co-occurring symptoms of GD/IGD and ENDS dependency.

Method:Participants (n = 2,174) were college students age 18-24 (M=19.25) recruited as part of a multi-university study examining psychological variables within young adults. Participants completed a battery of self-report questions assessing for demographic characteristics, symptoms of ADHD, and level of impulsivity and sensation seeking as measured by the Adult ADHD Self-Report Scale, Brief Sensation Seeking Scale, and Barratt Impulsiveness Scale Version 11, respectively. ENDS dependency was evaluated through the PROMIS E-cigarette Dependence Scale, and GD/IGD was measured by the Video Game Dependency Scale. Pearson correlations, chi-square tests, MANCOVAS, and moderation analyses were used to evaluate this data.

Results:Results found that 7.3% of the sample met criteria for probable ENDS dependency, 4.7% of the sample endorsed symptoms of GD/IGD dependency, and 1.4% of the sample endorsed both dependencies. Age, gender, and race/ethnicity were all associated with increased risk of concurrent GD/IGD and ENDS dependency. The moderating effect of ADHD symptoms on the relation between GD/IGD and ENDS dependency was significant, ΔR2 = .067, F(1, 1036) = 24.75, p < .001, indicating that the relation between GD/IGD and ENDS dependency was stronger when participants endorsed more symptoms of ADHD. Impulsivity and sensation seeking also had significant interaction effects on the relation between ENDS dependency and GD/IGD.

Conclusion:Ultimately, there is ample evidence that ENDS dependency and GD/IGD occur at significant levels on college campuses. Heightened impulsivity and sensation seeking and the diagnosis of ADHD significantly correspond with increased rates of GD/IGD and ENDS dependency. These results are supported by prior research findings that impulsivity and sensation seeking are risk factors for many behavioral health concerns, including engagement in risky sexual behaviors and substance addiction. Future research examining protective factors and treatment of co-occurring GD/IGD and ENDS dependency is warranted.


Cranwell, J., Whittamore, K., Britton, J., & Leonardi-Bee, J. (2016). Alcohol and tobacco content in UK video games and their association with alcohol and tobacco use among young people. Cyberpsychology, Behavior and Social Networking, 19(7), 426-434. https://doi.org/10.1089/cyber.2016.0093

Kohorst, M. A., Warad, D. M., Nageswara Rao, A. A., & Rodriguez, V. (2018). Obesity, sedentary lifestyle, and video games: The new thrombophilia cocktail in adolescents. Pediatric Blood & Cancer, 65(7), e27041.

Mathews, C. L., Morrell, H. E. R., & Molle, J. L. (2019). Video game addiction, ADHD symptomatology, and video game reinforcement. The American Journal of Drug and Alcohol Abuse, 45(1), 67-76. https://doi.org/10.1080/00952990.2018.1472269

Müller, M., & Montag, C. (2017). The relationship between internet addiction and alcohol consumption is influenced by the smoking status in male online video gamers. Clinical Neuropsychiatry: Journal of Treatment Evaluation, 14(1), 34–43.

Von der Heiden, J. M., Braun, B., Müller, K. W., & Egloff, B. (2019). The association between video gaming and psychological functioning. Frontiers in Psychology, 10, 17-31. https://doi.org/10.3389/fpsyg.2019.01731


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