Associations between the Type of Tobacco Products and Suicidal Behaviors: A Nationwide Population-Based Study among Korean Adolescents.

Youn Huh,Hong-Jun Cho

doi:10.3390/ijerph18020367

Abstract

The relationships between multiple tobacco products, such as heated tobacco products (HTPs), electronic cigarettes (ECs), and combustible cigarettes (CCs), and suicide-related behaviors among adolescents have not been extensively researched. This study examined the associations between the type of tobacco products used and suicidal thoughts, plans, and attempts among Korean adolescents. Data from the 2019 Korea Youth Risk Behavior Web-Based Survey were analyzed, and participants included 57,069 individuals aged 13–18 years. A multivariable logistic regression analysis was performed. Of the total participants, 13.0%, 4.0%, and 2.9% reported suicidal thoughts, suicidal plans, and suicidal attempts, respectively. After adjusting for confounding variables, all tobacco product users showed a greater likelihood of having suicidal behavior. However, compared with never users, dual users of CCs and HTPs were not significantly associated with having suicidal thoughts and attempts. Among tobacco product users, dual users of ECs and HTPs and triple users of CCs, ECs, and HTPs showed a greater likelihood of having suicidal behavior. Considering the prevalence of suicide and the increasing trend of using multiple tobacco products among Korean adolescents, tobacco control policies should monitor the effects of different products.

Highlights

Suicide is a leading cause of death among adolescents and young adults worldwide and in South Korea [1,2,3]
Dual users of electronic cigarettes (ECs) and heated tobacco products (HTPs) had a significantly higher likelihood of having suicide-related behaviors (OR, 95% confidence intervals (CIs): 3.91, 2.12–7.24 for suicidal thoughts; 6.21, 3.14–12.31 for suicidal plans; 8.76, 4.11–18.70 for suicidal attempts)
Compared with the adolescents using only combustible cigarettes (CCs), suicidal thoughts, plans, and attempts were significantly higher in triple users of CCs, ECs, and HTPs (OR, 95% CI: 1.73, 1.41–2.12; CI: 2.23, 1.66–3.00; and CI: 2.59, 1.84–3.65, respectively), while suicidal plans and attempts were significantly higher for dual users of ECs and HTPs (OR, 95% CI: 2.89, 1.47–5.66 and CI: 3.00, 1.45–6.23, respectively)

Summary

Introduction

Suicide is a leading cause of death among adolescents and young adults worldwide and in South Korea (hereafter, “Korea”) [1,2,3]. Several epidemiological studies have reported an association between smoking and suicidal behaviors in adolescents [6]. A recent study demonstrated the association of electronic cigarettes (ECs) with depressive mood, mental illnesses, and suicidal behaviors [7,8]. One study found that about 34% of people with suicidal thoughts have plans for suicide, about 72% of people who plan for suicide attempt suicide, and a quarter of the people who have suicidal thoughts attempt suicide impulsively without having a premeditated plan [9]. Suicidal ideation and suicidal behaviors are important mental health issues among adolescents [10]

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Results

Discussion

Conclusion