Introduction
Cigarette use and smoking intensity increase risk of suicidal ideation. Less is known about e-cigarette use. Here we examine direct influences of cigarette versus e-cigarette use on suicidal ideation among 16-to-23-year-olds in Texas.
Methods
Since 2019 the Texas Adolescent Tobacco and Marketing Surveillance study collected data on suicidal ideation every six months covering the previous two-weeks. Youths answering that they had “thoughts that you would be better off dead, or of hurting yourself” on more than two of 14 days were categorized as having suicidal ideation. Generalized linear mixed-effects logistic regressions examined the influence of ever and past 30-day (P30D) use of cigarettes, e-cigarettes, impulsivity and anxiety on suicidal ideation, controlling for gender, race/ethnicity, SES, and grade in school. Interactions between ever and P30D use of both products and a) impulsivity and b) gender were examined.
Results
Of the 2,329 participants, 29.1% reported ever and 6.5% reported P30D cigarette use, 48.2% reported ever and 11.6% reported P30D e-cigarette use, and 18.5% reported suicidal ideation. Ever cigarette use among females (aOR=1.83; 95% CI: 1.36-2.46), P30D e-cigarette use (aOR=1.30; 95% CI: 1.00-1.68), and P30D cigarette use (aOR=1.47; 95% CI: 1.06-2.05) were independently associated with higher risk for suicidal ideation, after adjusting for covariates. Impulsivity and anxiety directly increased risk for suicidal ideation regardless of product type used. Hispanic youth had higher risk of suicidal ideation than white youth, while higher levels of SES were protective.
Conclusion
Cigarette/e-cigarette use, as well as impulsivity and anxiety, directly increase the risk of suicidal ideation.
IMPLICATIONS
Clinicians should ask young adults with a history of tobacco use, anxiety or impulsive behavior, about suicidal ideation
Nicotine prevention and cessation programs might be more effective if they simultaneously target substance use and mental health
Culturally appropriate support is needed for ethnic and racial minority youth and young adults in school, college and at work
When evaluating and understanding risk, the role of multiple social identities (such as minority status, gender, and SES) is important
