INTRODUCTION:Tobacco waste is a costly, widespread blight and environmental toxicant that is not distributed equally across geographical areas. This investigation reports on the prevalence of noticing tobacco litter and potential inequities in tobacco litter exposure among adolescents in California, USA. METHODS:Data from the 2023 Teens, Nicotine, and Tobacco (TNT) Online Survey (N=4910), a statewide, online cross-sectional survey of California adolescents aged 12-17 years, were analyzed for the self-reported frequency of noticing tobacco product litter. All participants were asked to report how often they notice tobacco product litter (closed-ended response options: almost always, sometimes, once in a while, never). Survey-weighted multivariable regression models were fitted to quantify the odds of noticing tobacco litter 'almost always' according to participant characteristics (age, sex, gender/sexual identity, race/ethnicity, location, family finances, and own and household tobacco use). Data were weighted for geographical and demographic representativeness and response quality. RESULTS:The prevalence of noticing tobacco litter almost always was 44.6% overall and higher among participants who identified as Hispanic/Latino (50.9%) or LGBTQ+ (53.3%), lived in a small town (57.8%), or whose families were financially disadvantaged (52.7%). These inequities persisted in multivariable models, including adjustment for own and household tobacco use. For example, Hispanic/Latino participants had 1.66-times the adjusted odds of almost always noticing tobacco litter (95% CI: 1.32-2.07; reference: non-Hispanic White); the adjusted odds ratio for LGBTQ+ identity was 1.39 (95% CI: 1.04-1.87; reference: non-LGBTQ+). CONCLUSIONS:The pervasive exposure to tobacco litter observed in this study suggests a need for stronger efforts to reduce tobacco waste, with an emphasis on advancing equity.

BACKGROUND:The rising use of e-cigarettes, particularly dual use with cigarettes, necessitates understanding usage patterns and identifying participant and product characteristics that influence behaviors to guide tobacco regulatory decisions. METHODS:Analysis included adults (≥18 years) from the Population Assessment of Tobacco and Health (PATH) study, a nationally representative, longitudinal cohort. Participants were classified into six e-cigarette/cigarette category at each of waves 1-5 (2013-2019). Latent class analysis (LCA) was performed to identify distinct trajectories of cigarette and e-cigarette use patterns over time in Mplus. Random forest was used to examine the importance of baseline participant and product characteristics in predicting the distinct groups of use trajectories. Within each cigarette class, odds ratios and 95% CIs of the top 15 predictors of e-cigarette use group were calculated in multinomial logistic regression controlling for age, race/ethnicity, and education. RESULTS:Four cigarette-use trajectories were identified: "Cigarette never smokers" (31.3%), "Past experimental cigarette smokers" (23.8%), "Current experimental cigarette smokers" (18.8%), and "Current cigarette smokers" (26.0%). E-cigarette-use trajectories included "Never users" (53.6%), "Past progressors" (32.3%), and "Current progressors" (14.3%). Random forest highlighted common and unique predictors across cigarette-use groups. For example, perceptions of e-cigarette harm relative to cigarettes strongly predicted e-cigarette progression among current smokers, whereas younger age and higher social media use were more relevant among never and past smokers. CONCLUSIONS:Distinct cigarette and e-cigarette use trajectories were identified, with predictors varying by cigarette-use group. These findings underscore the importance of targeted regulatory strategies based on subgroup-specific behaviors and characteristics.

IntroductionThe tobacco endgame, policies aiming to end the commercial tobacco epidemic, requires sustained public support, including among youth. We assessed endgame support among California (USA) adolescents, including their reasons and associated participant and policy-specific factors.MethodsTeens, Nicotine and Tobacco Project online surveys (n=4827) and focus groups were conducted in 2021 and 2022 among California residents aged 12-17 years. Cross-sectional survey participants were asked their agreement level with eight policy statements related to tobacco and/or cannabis sales restrictions, use in public places and use in multiunit housing. Ordered logistic regression modelled level of agreement according to respondent characteristics, behaviours and statement content. Qualitative data were collected through focus groups (n=51 participants), which were analysed to provide insight into support for different policies.ResultsMost survey participants agreed or strongly agreed with tobacco product sales restrictions (72%-75%, depending on the policy), bans on use in public spaces (76%-82%) and smoke-free (79%) and vape-free (74%) apartment buildings. Support was stronger among younger, female, Asian and tobacco non-using participants and for policies directed at 'tobacco' (vs 'vapes' or cannabis), at flavoured tobacco (compared with all tobacco), and when statements featured 'should end' (vs 'not allowed'). Focus group participants who were supportive viewed policies as protecting children from harmful products, while those less supportive cited concerns about limiting adults' freedoms and unintended consequences.ConclusionsMost participants supported strong tobacco control policies. Public communication that promotes broader endgame benefits besides protecting youth and accelerates industry denormalisation may counter youth concerns and further bolster their support.

Background For dental professionals, the rapid evolution of tobacco products, particularly newer products, like e-cigarettes and nicotine pouches, directly affects clinical practice and patient oral health. Dental professionals must navigate possible health misinformation associated with such products and counteract misinformation effectively to safeguard patient health.Methods This study analyzed tobacco-related misinformation on Twitter during the COVID-19 pandemic (2020–2022). 7,960 tweets relevant to oral health or newer tobacco products were identified through keyword search. A qualitative coding of 10% of the tweets, grounded in health guidelines from reputable institutions, was used to categorize and understand the nature of the misinformation.Results From the 796 tweets analyzed, 52 were identified as containing misinformation, with 10 directly related to oral health. Tweets containing misinformation included understating the risks of e-cigarette use (colloquially called “vaping”) for oral health, claiming the absolute safety of vaping for oral health, and suggesting that vaping is the best alternative to smoking and superior to nicotine replacement therapy. Misinformation tweeted by vaping advocates often downplayed the risks or exaggerated the benefits of vaping. Tweets overstating e-cigarette risks were not identified in this sample.Conclusion This analysis characterizes types of tobacco-related misinformation on social media. Dental professionals should be aware of typical characteristics of misinformation that can influence patient perceptions and decisions regarding tobacco products.Practical Implications Familiarity with evidence-based guidelines can help dental professionals effectively counteract misinformation and provide accurate, reliable information to their patients.

ntroduction: In December 2022, a California law banned the retail sale of most flavored tobacco products (including e-cigarettes). This investi-gation evaluates adolescents' use of flavored tobacco before and after enactment. Aims and Methods: The Teens Nicotine and Tobacco Project included online surveys of California adolescents (age 12-17) in 2022 (N=5127) and 2023 (N=5015) that assessed past 30-day use of various tobacco products, flavored product use, and perceived access to flavored e-cigarettes. Eight focus groups conducted in 2023 and 2024 (total N=35) queried flavored tobacco experiences and perceptions. Results: Among participants who used specific products, the prevalence of flavored product use declined for cigarettes (2022: 72.0%; 2023: 57.2%), cigars (2022: 87.2%; 2023: 67.4%), and smokeless tobacco (2022: 93.1%; 2023: 83.1%) but not for e-cigarettes (2022: 91.0%; 2023: 90.7%) or hookah (2022: 88.1%; 2023: 85.6%; the flavor law exempted some hookah sales). In 2023, 10.2% of all participants used any flavored tobacco product (2022: 10.0%), primarily flavored e-cigarettes (2022: 8.6%; 2023: 8.8%). In 2023, 22.0% of all participants were aware of the statewide flavor ban, including 44.1% of participants who reported tobacco use. Few focus group participants were aware of the statewide law or perceived difficulties accessing flavored e-cigarettes. Conclusions: Shortly following a statewide flavor ban, adolescent use of flavored cigarettes, cigars, and smokeless tobacco declined, but fla-vored e-cigarette use was unchanged. More time for implementation and enforcement may be needed to see full policy impact. Implications: These findings suggest that a statewide flavored tobacco policy in California was followed shortly by declines in adolescent use of some flavored tobacco products. Additional time for implementation and enforcement, along with potential further actions, such as greater restrictions on online sales, could be necessary to curb youth access to flavored e-cigarettes.

IMPORTANCE Little is known about whether concurrent use of tobacco and cannabis is associated with higher or lower levels of mental health problems than use of either substance alone among youths. OBJECTIVE To examine the association between concurrent use of tobacco and cannabis and mental health problems in a national sample of US youths. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study analyzed publicly available wave 6 data within the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative cohort study of US youths aged 14 to 17 years, collected from March to November 2021. This analysis used wave 6 single-wave weights to obtain statistically valid estimates for cross-sectional analyses generalizable to the wave 4 cohort sample. Data were analyzed from November 15, 2023, to April 20, 2024. EXPOSURE Past 30-day use of any tobacco and cannabis products was self-reported and categorized into 4 exclusive patterns: concurrent, tobacco only, cannabis only, and nonuse. MAIN OUTCOMES AND MEASURES Self-reported past-year internalizing and externalizing mental health problems were measured using the modified version of the Global Appraisal of Individual Needs-Short Screener and separately categorized into 3 levels: low (0-1 symptoms), moderate (2-3 symptoms), and high (>= 4 symptoms). RESULTS A total of 5585 youths were included in the study, with a weighted proportion of 51.3% being male and 72.5% aged 15 to 17 years. In terms of race and ethnicity, 1606 youths (25.7%) were Hispanic, 626 (12.7%) were non-Hispanic Black, 2481 (50.5%) were non-Hispanic White, and 555 (11.0%) were non-Hispanic other. The prevalence of concurrent use (3.4% [95% CI, 2.9%-4.0%]) was comparable to tobacco-only use (3.9% [95% CI, 3.2%-4.6%]), but greater than cannabis-only use (2.5% [95% CI, 2.1%-2.9%]). High levels of internalizing and externalizing problems were most common for the concurrent use group (internalizing: 47.4% [95% CI, 39.2%-55.9%]; externalizing: 61.6% [95% CI, 54.1%-68.7%]), followed by the cannabis-only use group (internalizing: 44.8% [95% CI, 35.7%-54.1%]; externalizing: 48.5% [95% CI, 39.1%-57.9%]), the tobacco-only use group (internalizing: 41.4% [95% CI, 33.7%-49.5%]; externalizing: 46.3% [95% CI, 38.3%-54.5%]), and the nonuse group (internalizing: 22.4% [95% CI, 21.1%-23.8%]; externalizing: 30.4% [95% CI, 28.9%-31.9%]). After controlling for covariates in ordinal logistic regression models, concurrent use of tobacco and cannabis was associated with greater odds of reporting higher levels of externalizing problems compared with tobacco-only use (adjusted odds ratio [AOR], 1.83 [95% CI, 1.15-2.91]) and cannabis-only use (AOR, 1.85 [95% CI, 1.11-3.06]). However, there were no statistically significant differences in the odds of internalizing problems between concurrent use and use of tobacco or cannabis alone. CONCLUSIONS AND RELEVANCE In this cross-sectional study of the PATH Study wave 6 youth data, concurrent use of tobacco and cannabis was linked to higher levels of externalizing mental health problems than use of single substances, indicating a potential need to combine mental health support with tobacco and cannabis cessation interventions for youths.

BACKGROUND:E-cigarettes are the most-used tobacco product among US adolescents and are associated with nicotine addiction. This qualitative investigation aimed to understand adolescents' experiences and perceptions with nicotine addiction, and related influences of addiction, to inform product regulation, health communication, and cessation resource development. METHODS:Between May 2020 and December 2021, in-depth, semi-structured individual interviews were conducted with 47 California (United States) adolescents ages 13-17 who reported recent tobacco use (primarily e-cigarette use). The topic of addiction both arose organically and followed specific interviewer questions. Researchers used thematic analysis techniques to identify unifying themes related to addiction. RESULTS:Adolescents described e-cigarette addiction in ways that reflected a loss of control over their routines and activities and as physical symptoms, including reward and withdrawal. While some viewed addiction risk as a reason not to vape, others perceived it possible to use e-cigarettes and avoid or manage addiction. Specific characteristics of e-cigarette devices, particularly disposable nicotine-salt products, including flavors, "cool" designs, concealable size and odor, low price, and ease-of-use, were seen as enhancing addiction risk. Quit attempts were difficult and usually unsupported by adults or formal cessation aids. CONCLUSIONS:For many adolescents, addiction is a major component of their experience with e-cigarettes, often in ways that disrupt their routines and reduce their quality of life. Tobacco control or regulation could target e-cigarette product characteristics to decrease potential for addiction among adolescents. Needed are youth-targeted public communication about nicotine addiction and adolescent-tailored, evidence-based cessation support.

ABSTRACT BACKGROUND Adolescents' school engagement, mental health, and substance use have been major concerns during the COVID‐19 pandemic, particularly given disruptions to school instruction. We examined how the instructional setting was associated with academic and health‐related outcomes within an adolescent cohort followed during the pandemic. METHODS During 3 semi‐annual follow‐up surveys, adolescents (N = 1066 students; 2242 observations) from 8 California high schools responded to items measuring academic self‐efficacy, school connectedness, internalizing and externalizing problems, and use of substances. Separate generalized estimating equation models predicted outcomes based on the instructional setting. RESULTS Relative to in‐person instruction, students in remote instruction reported lower academic self‐efficacy (Beta: −0.11; 95% confidence interval [CI]: −0.22, −0.01) and school connectedness (Beta: −0.37; 95% CI: −0.48, −0.25), greater odds of past 30‐day internalizing problems (AOR: 1.46; 95% CI: 1.09, 1.95), externalizing problems (AOR: 1.36; 95% CI: 1.02, 1.82), and cigarette, cigar, smokeless tobacco, or hookah use (AOR: 2.50; 95% CI: 1.06, 5.91), but lower odds of past 30‐day e‐cigarette use (AOR: 0.50; 95% CI: 0.30, 0.86). CONCLUSIONS Multiple adverse outcomes related to school engagement, mental health, and substance use were associated with remote instruction. To reduce such impacts under future emergencies, schools should rely sparingly on remote instruction and provide appropriate supportive resources.

BackgroundExposure to tobacco, e-cigarette, or cannabis marketing is associated with adolescent use. Few studies have examined advertising exposure prevalence and patterns across these products concurrently.MethodsThis study assessed past 30-day recalled exposure to promotional messages about tobacco, e-cigarettes ("vapes" on the survey), and cannabis ("marijuana") from various sources among California adolescents (ages 12-17) in the 2022 Teens, Nicotine, and Tobacco Online Survey (N = 2530). Principal components analysis (PCA) was conducted to examine the underlying structure and patterns in advertising exposure sources. Multivariable logistic regression was used to evaluate associations between any advertising exposure and future use expectations (a susceptibility measure) in one year and at age 25 among current never-users.ResultsOverall, 65.9% of participants recently noticed at least one tobacco (52.5%), vape (51.5%), or marijuana (45.6%) advertisement. Gas stations or convenience stores were the most common source for tobacco or vape ads; billboards were for marijuana ads. In PCA, advertising exposure patterns correlated with advertising source, not the type of product. Exposures from tobacco-specific sources and nearer point of sale were associated with current use, older age, LGBTQ + identity, and sensation seeking. Among never-users, advertising exposure was associated with one-year and age-25 use expectations for cigarettes (one-year expectations adjusted odds ratio: 1.7; 95% CI: 1.1, 2.5), vapes (2.3; 1.5, 3.5), and marijuana (2.1; 1.5, 3.0).ConclusionCalifornia adolescents' exposure to tobacco, e-cigarette, and cannabis marketing is common, follows similar patterns, and is associated with use susceptibility. Comprehensive restrictions on marketing accessible to adolescents could help prevent youth use.

IntroductionElectronic cigarettes (also termed e-cigarette or vapes) often contain nicotine, an addictive psychoactive substance, which can have harmful effects during adolescence. Frequent experiences of discrimination are one risk factor shown to increase susceptibility to tobacco use, especially for individuals that identify as a social minority. Applying Intersectionality Theory, this research examined the relationship between youth experiences of discrimination and vape use at the intersection of race/ethnicity and sexual orientation.MethodCross-sectional survey data from 4,747 youth (ages 12-17) that participated in the 2022 Teens, Nicotine, and Tobacco Project (TNT) online survey were used to evaluate the impact of discrimination on vape use for lesbian, gay, bisexual, and/or queer/questioning (LGBQ+) youth of color.ResultsMultivariable regression analyses showed that identifying as both a sexual and racial/ethnic minority was a risk factor for experiencing discrimination. Frequent discrimination and reporting discrimination due to sexual orientation was associated with a greater likelihood of ever and current vaping. Path models supported that discrimination mediated the relationship between intersectional identity and vape use. LGBQ+ youth of color reported more frequent discrimination, which was associated with a greater likelihood of ever/current vape use.ConclusionsIntersectionality Theory aids in understanding how discrimination can exacerbate tobacco-related disparities for youth with multiple minority identities. Findings corroborate the importance of measuring discrimination in public health surveys. Effective tobacco interventions could incorporate strategies to cope with discrimination-related stress.

OBJECTIVES:While physical health status is known to impact social functioning, a growing literature suggests that social well-being may affect oral health. This investigation evaluated whether self-perceived quality of social roles, activities and relationships (social well-being) influences gingival inflammation. METHODS:Data were from the Population Assessment of Tobacco and Health Study, a nationally representative cohort of US adults, biennial waves 4 (2017) to 6 (2021). Social well-being was derived from the validated PROMIS Global-10 survey instrument, categorized for this longitudinal analysis as high, moderate or low. The main outcome was incident self-reported gum bleeding (dichotomous, proxy for gingivitis). Survey-weighted logistic regression modelling adjusted for overall health status, sociodemographic (e.g. age, sex, race/ethnicity), socioeconomic (e.g. income, education) and behavioural (e.g. tobacco, alcohol) confounders and was used to predict marginal mean gum bleeding incidence. RESULTS:Cross-sectionally at wave 4 (N = 23 679), gum bleeding prevalence was higher along a stepwise gradient of decreasing satisfaction with social activities and relationships (extremely satisfied: 20.4%; not at all: 40.1%). Longitudinally, among participants who had never reported gum bleeding through wave 4 (N = 9695), marginal predicted new gum bleeding at wave 6 was greater with each category of lower wave 4-5 social well-being (high: 7.6%; moderate: 8.6%; low: 12.4%). Findings were robust to alternative model specifications. Results should be interpreted considering study limitations (e.g. potential unmeasured confounding; outcome by self-report). CONCLUSIONS:Social functioning may affect physical health. Specifically, social roles, activities and relationships may influence inflammatory oral conditions, like gingivitis. Confirmatory research is warranted, along with policies and interventions that promote social well-being.

Use of electronic cigarette (vaping) devices, whether to inhale nicotine, cannabis, or other substances, may pose health risks to adolescents. Those risks could be heightened when a vaping device is “fake,” a term we use to include inauthentic, knockoff, counterfeit, and/or adulterated devices, an issue exemplified by the Electronic Cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) outbreak of 2019-2020. Methods Investigators completed in-depth, semi-structured interviews in 2020-2021 with 47 California adolescents (ages 13-17) who used nicotine products. Investigators used thematic analysis to examine participants’ perceptions and reactions to fake vaping products, including devices to inhale nicotine or cannabis. Results Participants were familiar with fake vaping devices, which they considered to be low-quality and potentially dangerous, learning about them from peers, their own experience, seeing other young people affected by them, social media, and occasionally from classes in school. Some had heard about health emergencies after using a fake product, but few were specifically familiar with EVALI. Some adolescents were confident that they could detect fake products, although others perceived encountering and using fake devices to be unavoidable. Participants believed that profit motives drove the existence of fake products, especially from informal sellers, and assumed that large companies and government agencies were actively protecting consumers. Conclusions Adolescents are aware of and may encounter fake vaping devices, potentially exposing them to elevated health risks. Effective public messaging and stronger actions to curb the fake product supply would better protect this population.

The GLOBICS—Global Consortium of Oral Health Birth Cohort Studies (OHBCS)—is a long-lasting international collaborative research group among existing OHBCS, established in response to the Lancet Series on Oral Health, which pointed out the need to shift the global oral health agenda. This study aimed to identify priority research questions from OHBCS that can be leveraged to improve children’s global oral health. A 2-phase online Delphi process sought consensus over research priorities for OHBCS. Participants were identified by mapping existing OHBCS. Fourteen research questions were grouped into 4 thematic areas. A 9-point Likert-type scale was applied. Consensus was achieved if the question had (1) at least 51% of participants scoring a research question as “high priority,” (2) an interquartile range of <2.5, and (3) a standard deviation of <1.7 or 75% of responses falling between 2 points above and below the mean score. Forty-four of 114 participants completed the Delphi survey. The 8 research priorities identified included questions about the effect of childhood dental visits on oral health throughout life ( n = 2), questions related to sugar consumption and dental caries in childhood and adolescence ( n = 4), infant growth and dental diseases ( n = 1), and whether socioeconomic inequalities in dental caries are mitigated by fluoride exposure ( n = 1). Guided by expert insight, the priorities identified for future OHBCS research should leverage a life course perspective to address knowledge gaps in children’s oral health and oral health equity.

PURPOSE:To examine adolescents' perspectives regarding external and internal influences of the e-cigarette initiation process. DESIGN:Semi-structured, in-depth qualitative interviews. SETTING:California, remote videoconference. PARTICIPANTS:Adolescents ages 13-17 who currently or previously used e-cigarettes (n = 47). METHOD:Interviews occurred from May 2020-February 2021. Two researchers coded transcripts based on a codebook developed inductively. Coded excerpts were reviewed to identify encompassing themes related to adolescent e-cigarette initiation. RESULTS:Adolescents were often near e-cigarette use by peers, family members, and others, creating ample opportunities to try e-cigarettes in response to curiosity, peer pressure, and desires to cope with stress or belong to a group. Adverse first experiences were common (eg, throat irritation, nausea), but many adolescents vaped again or continued to use regularly in attempts to cement friendships or alleviate symptoms of stress and anxiety. Specific characteristics of e-cigarette devices, including low-cost, concealability, and variety in designs and flavors facilitated initiation, continued use, and nicotine dependence. CONCLUSIONS:Adolescents progress to e-cigarette use via a multistage process, starting where social expectations and opportunity converge. While individual circumstances vary, many continue to vape as a perceived coping tool for emotional issues, to gain social belonging, or influenced by e-cigarette characteristics that contribute to ongoing use and dependence. Efforts to deter use should address the devices themselves and the social forces driving youth interest in them.

ABSTRACTBackground California has a shortage of dentists able and willing to treat children in the Medi-Cal Dental Program. A dental community of practice (DCOP) model was used in Alameda County to increase provider skills and capacity and to support their Medi-Cal program participation. This paper describes the Alameda County DCOP and the experiences of the participating dental providers.Methods Dental providers were invited to join the DCOP and receive program benefits in exchange for accepting children from the Medi-Cal Dental Program in their practice. A mixed-methods study utilizing surveys and focus groups with participating dental providers was conducted, assessing and documenting their experiences, benefits and challenges of participating in the DCOP.Results The DCOP program enrolled 169 dental providers and delivered 14 C.E. courses (49 total C.E. units). Additionally, 132 dental providers completed Wave 1 surveys, and 42 providers completed Wave 2. The majority (68%) felt participating in the DCOP increased their capacity to serve children under age 5 in the Medi-Cal Dental Program. Eight focus groups were conducted with 47 dental providers. Focus groups discussed preferred C.E. topics, serving children in the Medi-Cal Dental Program, community dental care coordinators (CDCCs), family oral health education (FOHE), and the emergent theme of building community among dental providers.Conclusion Dental providers felt participating in the DCOP helped increase their capacity and confidence to serve low-income children. They also felt there was value in uniting with colleagues in a community dedicated to improving children’s oral health.

Having ever used tobacco is a key surveillance metric. Existing tobacco use survey items differ in their inclusion of minimal use language, such as 'even one or two puffs.' This study aimed to quantify how minimal use language affects tobacco ever use prevalence estimated from adolescent surveys. Participants (N = 5127) in the 2022 Teens, Nicotine, and Tobacco Project online panel survey of California adolescents (ages 12-17) were randomized to one of two differently worded ever use survey items (i.e. with or without minimal use language) for eight different tobacco products independently. For seven of the eight products (except hookah), minimal use language resulted in numerically higher ever use prevalence estimates. Averaged across all products, ever use prevalence was 0.7-percentage points higher when items included minimal use language (95% CI: 0.1, 1.4). Findings suggest that minimal use language yields modestly higher tobacco use prevalence, with implications for comparing and interpretating surveillance data.

Evidence connects mental illness to other adverse health conditions, including oral health. However, longitudinal associations between mental and oral health remain understudied. We aimed to examine mental health–oral health associations prospectively in a nationally representative US cohort. Data were from the Population Assessment of Tobacco and Health (PATH) Study. The Global Appraisal of Individual Needs–Short Screener measured 3 types of mental health symptoms: internalizing, externalizing, and substance use problems. Six self-reported oral health conditions related to periodontal disease were evaluated: self-rated oral health, bleeding gums, loose teeth, tooth extraction, gum disease, and bone loss around teeth. Cross-sectional analysis within PATH Study wave 4 (2016 to 2018, n = 30,746) compared the survey-weighted prevalence of the 6 oral health outcomes according to severity of mental health problems. Prospectively, oral health outcomes were assessed 2 y later (wave 5, 2018 to 2019) according to wave 4 (baseline) mental health problems ( n = 26,168). Survey-weighted logistic regression models controlled for confounders (age, sex, tobacco use, etc.) with imputation for missing values. All 6 adverse oral health conditions were greater in prevalence among participants with severe internalizing problems. Multiple conditions were also associated with severe externalizing or substance use problems. Longitudinally associations attenuated, but multiple associations of meaningful magnitude persisted, most with internalizing problems. For example, the adjusted odds ratio was 1.27 (95% CI, 1.08 to 1.50) for bleeding gums and 1.37 (95% CI, 1.12 to 1.68) for tooth extraction when we compared severe versus none/low internalizing problems. Providers should expect higher levels of oral disease among patients with adverse mental health symptoms. Independent of externalizing and substance use problems, symptoms of internalizing problems (related to depression and/or anxiety) are plausible risk factors for future oral disease. Better integration and coordination of mental and oral health treatment and prevention are recommended.