Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.
JAMA Netw Open. 2021 Apr 1;4(4):e218803. doi: 10.1001/jamanetworkopen.2021.8803.
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.
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.
Type of cigarette initially smoked: electronic or conventional.
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.
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 ratio [AOR], 1.63 [95% CI, 1.40-1.89]; P < .001; girls: AOR, 1.55 [95% CI, 1.23-1.95]; P < .001) and suicide attempts (boys: AOR, 1.55 [95% CI, 1.28-1.87]; P < .001; girls, AOR, 1.64 [95% CI, 1.29-2.10]; P < .001) compared with those who initially used conventional cigarettes. Changing from e-cigarettes to conventional cigarettes was associated with a higher risk of suicide attempts among both boys (AOR, 1.89; 95% CI, 1.39-2.57; P < .001) and girls (AOR, 2.36; 95% CI, 1.53-3.64; P < .001) compared with changing from conventional cigarettes to e-cigarettes.
In this study, the initial use of e-cigarettes vs conventional cigarettes was associated with suicidal behaviors among adolescents. In future research on the association of e-cigarette use with adolescent mental health and interventions for suicide prevention, the type of cigarette initially used and changing the cigarette type should be considered.
评估过去使用电子烟或使用电子烟开始吸烟是否与青少年的自杀行为有关，这对于为未来的研究和公共卫生干预措施提供信息是必要的。
评估在韩国青少年中，开始使用电子烟或传统香烟与自杀行为之间的关联。
设计、地点和参与者：本横断面研究分析了参加 2015 年至 2018 年全国韩国青少年风险行为网络调查的 7 至 12 年级青少年的数据。
最初吸烟的香烟类型：电子或传统。
采用多逻辑回归分析，考察了初始香烟类型与自杀行为（包括自杀意念和自杀计划和尝试）之间的关联。所有参与者都完成了关于自杀行为史的问卷，并根据吸烟时使用的香烟类型以及随后（或没有）使用的香烟类型进行了分组。
共纳入 255887 名韩国青少年（51.2%为男性；平均[SD]年龄为 15.0[1.8]岁）进行了主要分析。在 131094 名男性青少年中，3310 名男孩（2.5%）最初使用电子烟，27368 名男孩（20.9%）最初使用传统香烟。在 124793 名女性青少年中，952 名女孩（0.8%）最初使用电子烟，9296 名女孩（7.4%）最初使用传统香烟。在最初使用电子烟的人群中，178 名男孩（5.4%）和 134 名女孩（14.1%）企图自杀。在最初使用传统香烟的人群中，946 名男孩（3.5%）和 911 名女孩（9.8%）企图自杀。最初使用电子烟的青少年自杀行为的风险更高，包括自杀计划（男孩：调整后的优势比[OR]，1.63[95%CI，1.40-1.89]；P<0.001；女孩：OR，1.55[95%CI，1.23-1.95]；P<0.001）和自杀企图（男孩：OR，1.55[95%CI，1.28-1.87]；P<0.001；女孩，OR，1.64[95%CI，1.29-2.10]；P<0.001），与最初使用传统香烟的青少年相比。从电子烟改为传统香烟与男孩（OR，1.89；95%CI，1.39-2.57；P<0.001）和女孩（OR，2.36；95%CI，1.53-3.64；P<0.001）自杀企图的风险增加有关，而不是从传统香烟改为电子烟。
在这项研究中，电子烟与传统香烟的初始使用与青少年的自杀行为有关。在未来关于电子烟使用与青少年心理健康关联的研究和预防自杀的干预措施中，应考虑最初使用的香烟类型和改变香烟类型。
