Abstract
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. AIMS AND METHODS: Since 2019, the Texas Adolescent Tobacco and Marketing Surveillance Study collected data on suicidal ideation every 6 months covering the previous 2 weeks. Youths answering that they had "thoughts that you would be better off dead, or of hurting yourself" on more than 2 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, socioeconomic status (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 2329 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 to 2.46), P30D e-cigarette use (aOR = 1.30; 95% CI: 1.00 to 1.68), and P30D cigarette use (aOR = 1.47; 95% CI: 1.06 to 2.05) were independently associated with higher risk for suicidal ideation after adjusting for covariates. Impulsivity and anxiety directly increased risk of 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. CONCLUSIONS: 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.