Chen Manman, Wang Xijie, Tan Din Son, Wang Huan, Guo Jianhui, Li Jing, Zou Zhiyong, Jiang Yu, Liang Wannian
School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Vanke School of Public Health, Tsinghua University, Beijing, China.
BMC Med. 2025 Mar 18;23(1):163. doi: 10.1186/s12916-025-03983-6.
We aimed to evaluate the potential independent and interactive associations of tobacco and alcohol use with suicide ideation, plan, and attempt among adolescents, and the role of legal purchase age restrictions among these associations.
A pooled cross-sectional analysis was conducted with data from the Global School-based Student Health Survey (GSHS) (2013-2019), the US Youth Risk Behavior Surveillance System (YRBSS) (2021), and a Chinese school-based health survey (2017). Self-reported use of tobacco and alcohol during the past 30 days, and suicide ideation, plan, and attempt during the past year, were collected from questionnaires. Country-level purchase age restrictions on tobacco and alcohol products were obtained from official government websites.
Among the 211,022 adolescents from 58 countries, 46.7% were boys. Compared with adolescents who used neither tobacco nor alcohol, those who used both tobacco and alcohol had the highest odds of suicide ideation (boys: 2.42 [95% CI: 2.25-2.61]; girls: 3.19 [95% CI: 2.98-3.40]; P < 0.001), suicide plan (boys: 2.39 [95% CI: 2.21-2.58]; girls: 3.33 [95% CI: 3.11-3.57]; P < 0.001), and suicide attempt (boys: 3.24 [95% CI: 3.00-3.51]; girls: 4.03 [95% CI: 3.75-4.33]; P < 0.001). In countries with higher suicide plan prevalence, boys who use tobacco and who live in countries with tobacco purchase age restrictions had lower odds of suicide plan (1.86 [95% CI: 1.64-2.12]) than those who lived in countries without restrictions (2.81 [95% CI: 2.32-3.42]). Similarly, girls who use tobacco and who live in countries with legal age purchase restrictions displayed lower odds of suicide plan (2.20 [95% CI: 1.98-2.45]) compared to those who live in countries without restrictions (4.61 [95% CI: 3.65-5.83]). However, our study revealed no subgroup differences in whether countries have legal tobacco or alcohol purchase age restrictions in association with suicide ideation, plan, and attempt risk in countries with a lower prevalence of suicide behaviors.
Tobacco and alcohol consumption are strongly associated with the risk of suicide behaviors among adolescents, particularly among girls. Country-level tobacco control strategies may have the potential to reduce risks of suicide behaviors associated with tobacco use among adolescents.
我们旨在评估青少年中烟草和酒精使用与自杀意念、计划及未遂之间潜在的独立关联和交互作用，以及法定购买年龄限制在这些关联中的作用。
对全球学校学生健康调查（GSHS）（2013 - 2019年）、美国青少年风险行为监测系统（YRBSS）（2021年）以及一项中国学校健康调查（2017年）的数据进行汇总横断面分析。通过问卷收集过去30天内自我报告的烟草和酒精使用情况，以及过去一年中的自杀意念、计划和未遂情况。从政府官方网站获取各国关于烟草和酒精产品的购买年龄限制。
在来自58个国家的211,022名青少年中，46.7%为男孩。与既不使用烟草也不使用酒精的青少年相比，同时使用烟草和酒精的青少年出现自杀意念的几率最高（男孩：2.42 [95%置信区间：2.25 - 2.61]；女孩：3.19 [95%置信区间：2.98 - 3.40]；P < 0.001），自杀计划（男孩：2.39 [95%置信区间：2.21 - 2.58]；女孩：3.33 [95%置信区间：3.11 - 3.57]；P < 0.001）以及自杀未遂（男孩：3.24 [95%置信区间：3.00 - 3.51]；女孩：4.03 [95%置信区间：3.75 - 4.33]；P < 0.001）的几率也最高。在自杀计划患病率较高的国家，使用烟草且生活在有烟草购买年龄限制国家的男孩出现自杀计划的几率（1.86 [95%置信区间：1.64 - 2.12]）低于生活在无限制国家的男孩（2.81 [95%置信区间：2.32 - 3.42]）。同样，使用烟草且生活在有法定购买年龄限制国家的女孩出现自杀计划的几率（2.20 [95%置信区间：1.98 - 2.45]）低于生活在无限制国家的女孩（4.61 [95%置信区间：3.65 - 5.83]）。然而，我们的研究表明，在自杀行为患病率较低的国家，各国是否有法定烟草或酒精购买年龄限制与自杀意念、计划及未遂风险之间不存在亚组差异。
烟草和酒精消费与青少年自杀行为风险密切相关，尤其是在女孩中。国家层面的烟草控制策略可能有潜力降低青少年中与烟草使用相关的自杀行为风险。
