Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston.
Center for Genomic Medicine, Massachusetts General Hospital, Boston.
JAMA Netw Open. 2024 Feb 5;7(2):e240376. doi: 10.1001/jamanetworkopen.2024.0376.
The use of tobacco products, including e-cigarettes and vaping, has rapidly increased among children. However, despite consistent associations found between smoking cigarettes and suicidal behaviors among adolescents and adults, there are limited data on associations between emerging tobacco products and suicidal behaviors, especially among preadolescent children.
To examine whether the use of tobacco products is associated with nonsuicidal self-injury (NSSI), suicidal ideation (SI), and suicide attempts (SAs) among preadolescent children.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study, conducted from September 1, 2022, to September 5, 2023, included participants in the Adolescent Brain Cognitive Development study, a population-based cohort of 11 868 US children enrolled at 9 and 10 years of age. The cross-sectional investigation focused on 3-year periods starting from the baseline to year 2 of follow-up. Statistical analysis was performed from October 1, 2022, to June 30, 2023.
Children's use of tobacco products was assessed based on youth reports, including lifetime experiences of various nicotine-related products, supplemented with hair toxicologic tests. Main outcomes were children's lifetime experiences of NSSI, SI, and SAs, assessed using the K-SADS-5 (Kiddie Schedule for Affective Disorders and Schizophrenia for the DSM-5). Multivariate logistic regression was conducted to examine the associations of the use of tobacco products with NSSI, SI, and SAs among the study participants. Sociodemographic, familial, and children's behavioral, temperamental, and clinical outcomes were adjusted in the analyses.
Of 8988 unrelated study participants (median age, 9.8 years [range, 8.9-11.0 years]; 4301 girls [47.9%]), 101 children (1.1%) and 151 children (1.7%) acknowledged lifetime use of tobacco products at baseline and at 18-month follow-up, respectively. After accounting for various suicide risk factors and potential confounders, children reporting use of tobacco products were at a 3 to 5 times increased risk of SAs (baseline: n = 153 [adjusted odds ratio (OR), 4.67; 95% CI, 2.35-9.28; false discovery rate (FDR)-corrected P < .001]; year 1: n = 227 [adjusted OR, 4.25; 95% CI, 2.33-7.74; FDR-corrected P < .001]; and year 2: n = 321 [adjusted OR, 2.85; 95% CI, 1.58-5.13; FDR-corrected P = .001]). Of all facets of impulsivity measures that were significant correlates of use of tobacco products, negative urgency was the only independent risk factor for SAs (adjusted OR, 1.52 [95% CI, 1.31-1.78]; FDR-corrected P < .001). In contrast, children's alcohol, cannabis, and prescription drug use were not associated with SAs.
This study of US children suggests that the increased risk of SAs, consistently reported for adolescents and adults who smoke cigarettes, extends to a range of emerging tobacco products and manifests among elementary school-aged children. Further investigations are imperative to clarify the underlying mechanisms and to implement effective preventive policies for children.
包括电子烟和蒸气烟在内的烟草制品在儿童中的使用迅速增加。然而，尽管在青少年和成年人中一致发现吸烟与自杀行为之间存在关联，但关于新兴烟草制品与自杀行为之间的关联，特别是在未成年儿童中，数据有限。
研究烟草制品的使用是否与未成年儿童的非自杀性自我伤害（NSSI）、自杀意念（SI）和自杀企图（SA）有关。
设计、地点和参与者：这项队列研究于 2022 年 9 月 1 日至 2023 年 9 月 5 日进行，参与者为美国青少年大脑认知发展研究中的参与者，这是一个基于人群的队列，由 9 岁和 10 岁的 11868 名美国儿童组成。横断面调查集中在基线至随访第 2 年的 3 年期间。统计分析于 2022 年 10 月 1 日至 2023 年 6 月 30 日进行。
根据青少年报告，包括各种与尼古丁相关产品的终生经历，辅以头发毒理学测试，评估儿童对烟草制品的使用情况。主要结果是儿童的 NSSI、SI 和 SA 的终生经历，使用 K-SADS-5（DSM-5 的儿童情感障碍和精神分裂症时间表）进行评估。多变量逻辑回归用于检查烟草制品使用与研究参与者中 NSSI、SI 和 SA 之间的关联。在分析中调整了社会人口统计学、家庭和儿童行为、气质和临床结果。
在 8988 名无关联的研究参与者中（中位数年龄为 9.8 岁[范围为 8.9-11.0 岁]；4301 名女孩[47.9%]），分别有 101 名儿童（1.1%）和 151 名儿童（1.7%）在基线和 18 个月随访时报告了烟草制品的使用。在考虑了各种自杀风险因素和潜在混杂因素后，报告使用烟草制品的儿童发生自杀企图的风险增加了 3 至 5 倍（基线：n=153[调整后的优势比（OR），4.67；95%置信区间（CI），2.35-9.28；错误发现率（FDR）校正 P<0.001]；第 1 年：n=227[调整后的 OR，4.25；95% CI，2.33-7.74；FDR 校正 P<0.001]；第 2 年：n=321[调整后的 OR，2.85；95% CI，1.58-5.13；FDR 校正 P=0.001]）。在与烟草制品使用相关的所有冲动性测量方面，负性冲动是自杀企图的唯一独立风险因素（调整后的 OR，1.52[95% CI，1.31-1.78]；FDR 校正 P<0.001）。相比之下，儿童的酒精、大麻和处方药物使用与自杀企图无关。
这项对美国儿童的研究表明，持续报告的青少年和成年人吸烟与自杀行为之间的风险增加，扩展到一系列新兴的烟草制品，并在小学年龄的儿童中表现出来。需要进一步调查以澄清潜在机制，并为儿童实施有效的预防政策。
