Association of Cigarette Type Initially Smoked With Suicidal Behaviors Among Adolescents in Korea From 2015 to 2018

Abstract

IMPORTANCE Assessment of whether past electronic cigarette (e-cigarette) use or initiating smoking with e-cigarettes is associated with suicidal behaviors among adolescents is needed to inform future research and public health interventions. OBJECTIVE To evaluate the association between starting smoking with e-cigarettes or conventional cigarettes and suicidal behaviors among Korean adolescents. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study analyzed data on adolescents in grades 7 through 12 who participated in the nationwide Korea Youth Risk Behavior Web-Based Survey between 2015 and 2018. EXPOSURES Type of cigarette initially smoked: electronic or conventional. MAIN OUTCOMES AND MEASURES Multiple logistic regression analysis was performed to examine the association between initial cigarette type and suicidal behaviors, including suicidal ideation and suicide planning and attempts. All participants completed questionnaires about their history of suicidal behavior and were categorized into groups according to the type of cigarette used at initiation of smoking and any subsequent change (or lack of change) in the type of cigarette used. RESULTS A total of 255 887 Korean adolescents (51.2% male; mean (SD) age, 15.0 [1.8] years) were included in the primary analysis. Among 131 094 male adolescents, 3310 boys (2.5%) initially used e-cigarettes and 27 368 boys (20.9%) initially used conventional cigarettes. Among 124 793 female adolescents, 952 girls (0.8%) initially used e-cigarettes and 9296 girls (7.4%) initially used conventional cigarettes. Of those who initially used e-cigarettes, 178 of 3310 boys (5.4%) and 134 of 952 girls (14.1%) attempted suicide. Of those who initially used conventional cigarettes, 946 of 27 368 boys (3.5%) and 911 of 9296 girls (9.8%) attempted suicide. Adolescents who initially used e-cigarettes had a higher risk of suicidal behaviors, including suicide planning (boys: adjusted odds

Association of weekend catch-up sleep ratio and subjective sleep quality with depressive symptoms and suicidal ideation among Korean adolescents

“…Our research is meaningful because we additionally analyzed the balance of sleep duration between weekdays and weekends using a “weekend CUS ratio.” Overall, our findings serve as a warning regarding the risk of depression or suicidal behaviors in adolescents with an imbalance of sleep duration between weekdays and weekends, and this is an important hypothesis to be confirmed in future neurobiological studies. Furthermore, because this cross-sectional study used multiyear national survey data (2015–2019) with 270,619 respondents based on random cluster sampling, our results were sufficiently representative of South Korean adolescents 30 , 49 . Additionally, we considered many covariates to increase the credibility and accuracy of our study.…”

“…When the weekend CUS ratio was < 1.00, male and female adolescents living with relatives or with low perceived stress levels were more likely to experience depressive symptoms and suicidal ideation. Previous studies reported that adolescents living apart from one or both biological parents showed association with suicidality 30 , 42 . However, to the best of our knowledge, no study has investigated the association between mental health and sleep duration, especially weekend CUS, among adolescents living with relatives.…”

“…We performed sub-group analyses considering the effect of family environment on sleep disorders 29 , the relationship between family environment and mental health 30 , and the relationship between perceived stress and sleep duration with metal health 31 . In the stratified analysis, the trend of association was significant, depending on residence type and perception of stress.…”

“…Second, the results of this study were based on anonymous self-reported data. Thus, the weekend CUS ratio and subjective sleep quality might have been underestimated or overestimated, and some survey questions might be subject to recall bias 30 . Third, as the dependent variables, depressive symptoms and suicidal ideation, consist of single-item questions like other population-based studies such as YRBS 50 , 51 , it may have caused measurement problems and misclassification 52 .…”

Association of Household Type and Fast-Food Consumption in Korean Adolescents

“…Despite these limitations, this study identified the effect of both the household type and of the individuals adolescents were living with and where they were living on the frequency of fast-food intake. Furthermore, the multiyear national survey data (2017–2020) were obtained from approximately 186,000 adolescents based on random cluster sampling, ensuring that the results were sufficiently representative of Korean adolescents [ 32 ].…”