ASSOCIATION OF CIGARETTE AND ELECTRONIC VAPOR USE ON MENTAL HEALTH AMONG U.S. AND SOUTH KOREAN ADOLESCENTS
Author(s)
Hyunju Seo, PhD1, Jiyul Park, .2, Hye-Jeong Yang, MS3;
1Chungnam National University College of Nursing, Daejeon, Korea, Republic of, 2Buford High School, Buford, GA, USA, 3Graduate School of Chungnam National University, Daejeon, Korea, Republic of
1Chungnam National University College of Nursing, Daejeon, Korea, Republic of, 2Buford High School, Buford, GA, USA, 3Graduate School of Chungnam National University, Daejeon, Korea, Republic of
OBJECTIVES: Given the high prevalence of adolescent smoking, we examined associations of cigarette, electronic vapor (EV), and dual use with depression, stress, and suicidal ideation and attempts in the US and South Korea.
METHODS: We conducted a cross-sectional study using data from the 2019, 2021, and 2023 Youth Risk Behavior Surveillance System (YRBSS) and the Korea Youth Risk Behavior Survey (KYRBS). High school students in grades 9-12 were classified as non-users, cigarette-only, EV-only, or dual users. Multivariable survey logistic regression models were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs), adjusting for sociodemographic and behavioral factors. Subgroup analyses were conducted by sex, age group, and alcohol use.
RESULTS: A total of 46,446 US and 106,387 Korean students, EV use was predominated in the US (17.5% vs. 0.8%), whereas cigarette-only use was more common in Korea (0.5% vs. 3.7%). Dual use prevalence was similar in both countries (3.8% vs. 3.2%). Depression, stress, and suicidal ideation and attempts were higher among cigarette and EV users than non-users, with the highest prevalences observed among dual users in both the US (depression: 65.8%, poor mental health: 28.8%, ideation: 47.8%; attempts: 30.6%) and Korea (depression: 46.9%, stress: 48.8%, ideation: 27.3%; attempts: 11.1%). In the US, dual use was associated with higher odds of depression (aOR=2.94, 95%CI=2.45-3.51), poor mental health (aOR=1.99, 95%CI=1.61-2.48), suicidal ideation (aOR=3.43, 95%CI=2.89-4.07), and suicide attempts (aOR=3.56, 95%CI=2.96-4.28). In Korea, dual use was similarly associated with elevated odds of depression (aOR=1.72, 95%CI=1.57-1.88), high stress (aOR=1.35, 95%CI=1.24-1.47), suicidal ideation (aOR=2.01, 95%CI=1.80-2.23), and suicide attempts (aOR=2.98, 95%CI=2.50-3.54). Subgroup analyses indicated stronger associations among girls, adolescents aged ≤16 years, and alcohol non-users.
CONCLUSIONS: Cigarette and EV use was associated with increased risk of depression and stress among adolescents. Especially, dual users had two- to threefold higher odds of suicidality, highlighting the need for integrated prevention strategies.
METHODS: We conducted a cross-sectional study using data from the 2019, 2021, and 2023 Youth Risk Behavior Surveillance System (YRBSS) and the Korea Youth Risk Behavior Survey (KYRBS). High school students in grades 9-12 were classified as non-users, cigarette-only, EV-only, or dual users. Multivariable survey logistic regression models were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs), adjusting for sociodemographic and behavioral factors. Subgroup analyses were conducted by sex, age group, and alcohol use.
RESULTS: A total of 46,446 US and 106,387 Korean students, EV use was predominated in the US (17.5% vs. 0.8%), whereas cigarette-only use was more common in Korea (0.5% vs. 3.7%). Dual use prevalence was similar in both countries (3.8% vs. 3.2%). Depression, stress, and suicidal ideation and attempts were higher among cigarette and EV users than non-users, with the highest prevalences observed among dual users in both the US (depression: 65.8%, poor mental health: 28.8%, ideation: 47.8%; attempts: 30.6%) and Korea (depression: 46.9%, stress: 48.8%, ideation: 27.3%; attempts: 11.1%). In the US, dual use was associated with higher odds of depression (aOR=2.94, 95%CI=2.45-3.51), poor mental health (aOR=1.99, 95%CI=1.61-2.48), suicidal ideation (aOR=3.43, 95%CI=2.89-4.07), and suicide attempts (aOR=3.56, 95%CI=2.96-4.28). In Korea, dual use was similarly associated with elevated odds of depression (aOR=1.72, 95%CI=1.57-1.88), high stress (aOR=1.35, 95%CI=1.24-1.47), suicidal ideation (aOR=2.01, 95%CI=1.80-2.23), and suicide attempts (aOR=2.98, 95%CI=2.50-3.54). Subgroup analyses indicated stronger associations among girls, adolescents aged ≤16 years, and alcohol non-users.
CONCLUSIONS: Cigarette and EV use was associated with increased risk of depression and stress among adolescents. Especially, dual users had two- to threefold higher odds of suicidality, highlighting the need for integrated prevention strategies.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EPH16
Topic
Epidemiology & Public Health
Topic Subcategory
Public Health
Disease
No Additional Disease & Conditions/Specialized Treatment Areas