ASSOCIATION OF AGE AT E-CIGARETTE INITIATION WITH SMOKING BEHAVIORS, SUICIDALITY, AND MENTAL HEALTH AMONG KOREAN ADOLESCENTS
Author(s)
Seongmin Yoon, PharmD1, Minseol Jang, PharmD1, Hae Sun Suh, MA, MS, PhD2.
1Department of Regulatory Science, Graduate School, Kyung Hee University, Seoul, Korea, Republic of, 2College of Pharmacy, Kyung Hee University, Seoul, Korea, Republic of.
1Department of Regulatory Science, Graduate School, Kyung Hee University, Seoul, Korea, Republic of, 2College of Pharmacy, Kyung Hee University, Seoul, Korea, Republic of.
OBJECTIVES: The rapid expansion of unmanned e-cigarette retail stores in South Korea has raised concerns regarding increased accessibility of nicotine products among adolescents. This study examined the association between grade at e-cigarette initiation and subsequent smoking behaviors, suicidality, and mental health outcomes among Korean adolescents using nationally representative survey data.
METHODS: We analyzed data from the Korea Youth Risk Behavior Survey (KYRBS) conducted in 2020, 2021, 2024, and 2025. Among 218,619 participants, 14,590 adolescents who reported ever using e-cigarettes and had complete covariate data were included. Grade at first e-cigarette use was categorized into five groups: grade 6 or earlier, grade 7, 8, 9, and grades 10 to 12 (reference). Outcomes included current e-cigarette use, heavy e-cigarette use, vaping frequency, conventional cigarette smoking, suicidality (suicidal ideation, planning, and attempts), perceived stress, and depression. Poisson regression models estimated adjusted prevalence ratios (APRs), while negative binomial regression estimated adjusted rate ratios (ARRs).
RESULTS: Earlier initiation of e-cigarette use was strongly associated with adverse smoking-related and suicidality outcomes. Compared with adolescents who initiated e-cigarette use in grades 10 to 12, those initiating in grade 6 or earlier showed higher prevalence of current e-cigarette use (APR, 1.23; 95% CI, 1.15-1.32), heavy e-cigarette use (APR, 1.72; 95% CI, 1.51-1.96), and higher vaping frequency (ARR, 1.61; 95% CI, 1.42-1.81). Early initiation was also associated with substantially greater suicidality, including suicidal ideation (APR, 1.40; 95% CI, 1.25-1.57), suicidal planning (APR, 2.49; 95% CI, 2.08-2.99), and suicide attempts (APR, 4.11; 95% CI, 3.35-5.03). No significant associations were observed for perceived stress or depression after adjustment.
CONCLUSIONS: Early e-cigarette initiation among Korean adolescents was associated with sustained vaping behaviors and markedly elevated suicidality risks. Strengthened regulatory policies targeting youth access to e-cigarettes, particularly through unmanned retail environments, may be necessary to protect adolescent health and prevent early nicotine exposure.
METHODS: We analyzed data from the Korea Youth Risk Behavior Survey (KYRBS) conducted in 2020, 2021, 2024, and 2025. Among 218,619 participants, 14,590 adolescents who reported ever using e-cigarettes and had complete covariate data were included. Grade at first e-cigarette use was categorized into five groups: grade 6 or earlier, grade 7, 8, 9, and grades 10 to 12 (reference). Outcomes included current e-cigarette use, heavy e-cigarette use, vaping frequency, conventional cigarette smoking, suicidality (suicidal ideation, planning, and attempts), perceived stress, and depression. Poisson regression models estimated adjusted prevalence ratios (APRs), while negative binomial regression estimated adjusted rate ratios (ARRs).
RESULTS: Earlier initiation of e-cigarette use was strongly associated with adverse smoking-related and suicidality outcomes. Compared with adolescents who initiated e-cigarette use in grades 10 to 12, those initiating in grade 6 or earlier showed higher prevalence of current e-cigarette use (APR, 1.23; 95% CI, 1.15-1.32), heavy e-cigarette use (APR, 1.72; 95% CI, 1.51-1.96), and higher vaping frequency (ARR, 1.61; 95% CI, 1.42-1.81). Early initiation was also associated with substantially greater suicidality, including suicidal ideation (APR, 1.40; 95% CI, 1.25-1.57), suicidal planning (APR, 2.49; 95% CI, 2.08-2.99), and suicide attempts (APR, 4.11; 95% CI, 3.35-5.03). No significant associations were observed for perceived stress or depression after adjustment.
CONCLUSIONS: Early e-cigarette initiation among Korean adolescents was associated with sustained vaping behaviors and markedly elevated suicidality risks. Strengthened regulatory policies targeting youth access to e-cigarettes, particularly through unmanned retail environments, may be necessary to protect adolescent health and prevent early nicotine exposure.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
EPH5
Topic
Epidemiology & Public Health
Topic Subcategory
Public Health