Association of Depression and Suicidality with Electronic and Conventional Cigarette Use in South Korean Adolescents

Background: The prevalence of Korean adolescents with depression was 25.1% in 2017, and the suicide rate among Korean teens increased from 4.2 deaths per 100,000 in 2015 to 4.9 deaths per 100,000 in 2016, suggesting that a high prevalence of depression and suicide among adolescents is a serious social problem in South Korea. Owing to the rapid growth of e-cigarettes in the last several years, it is important for research on smoking and mental health to distinguish different uses of tobacco products. Objectives: To examine the relationship between depression and suicidality among Korean adolescents, classified into nonusers, conventional-cigarette-only users, e-cigarette-only users, and dual users. Methods: Data were examined from the 2017 Korean Youth Risk Behavior Web-based Survey. The study included 62,276 students. A multivariate logistic regression was performed to assess the association of depression and suicidality with electronic and conventional cigarette use. Results: There were significant differences among the users: dual users had a higher prevalence of depression and suicidality for both lifetime and current use; e-cigarette-only users had higher levels of depression and suicidality than nonusers; and among female adolescents, conventional-cigarette-only users, e-cigarette-only users, and dual users had a higher prevalence of depression and suicidality than male adolescents. Conclusions: This is the first study to assess the association of depression and suicidality with conventional and e-cigarette use using a nationally representative Korean adolescent sample. These findings suggest an urgent need for evaluation of and intervention for e-cigarette use by health professionals providing smoking cessation programs for adolescents.