Background Limited research has examined associations between adolescent smokeless tobacco and oral nicotine product use and suicidality. Even less is known about how these associations vary by frequency of use. Objective To examine associations between frequency of smokeless tobacco and oral nicotine product use and suicidality among a nationally representative sample of high school students in the United States. Design Cross-sectional study. Methods Data from the 2023 Youth Risk Behavior Survey (n = 17,807) were analyzed. Multivariable logistic regression assessed associations between frequency of smokeless tobacco and oral nicotine product use (0 days, 1-5 days, 6-19 days, 20-30 days) and four outcomes: persistent sadness or hopelessness, suicidal ideation, suicide planning, and suicide attempt. Models adjusted for sex, race, ethnicity, grade, and alcohol use. Linear trends across frequency categories were tested. Sensitivity analyses adjusted for other tobacco product use. Results Approximately 2% of students reported past 30-day smokeless tobacco and oral nicotine product use. Compared to no use, heavy use was associated with higher odds of all four outcomes (aORs = 2.11-9.64); moderate use was associated with higher odds of sadness or hopelessness, suicide planning, and suicide attempt (aORs = 2.14-4.91); and light use was associated with higher odds of suicide attempt (aORs = 2.92, 95% CI: 1.74-4.88). Positive linear trends were observed for all four outcomes (p <0.001). Sensitivity analyses showed that compared to no use, heavy use was associated with higher odds of suicide planning (aOR = 2.02, 95% CI: 1.23-3.30) and suicide attempt (aOR = 5.63, 95% CI: 2.67-11.88) and light use was associated with higher odds of suicide attempt (aOR = 1.69, 95% CI: 1.03-2.77). Conclusion Frequency of smokeless tobacco and oral nicotine product use was associated with persistent sadness or hopelessness and suicidality. These associations were attenuated after adjusting for other tobacco product use. Longitudinal research is needed to establish temporal ordering.
Background This study examined the prevalence and correlates of lifetime tobacco/nicotine initiation status, defined as having ever initiated or used at least one tobacco/nicotine product among adolescents in South Korea. Methods We analyzed 22,843 adolescent-year observations from the 2019-2023 Korean Youth Health Behaviour Panel Survey. Survey-weighted prevalence estimates and sequential survey-weighted logistic regression models were used to examine associations of lifetime initiation status with socioeconomic indicators, academic performance, peer and household smoking, peer pressure, depressive feelings, access-related factors, and media/commercial exposure. Results Overall, 647 adolescent-year observations (2.8%) were classified as having lifetime tobacco/nicotine initiation status. Weighted prevalence was 0.35% in 2019 and 9.07% in 2023, although the 2023 estimate should be interpreted cautiously because of outcome construction and missingness. In the fully adjusted model, lifetime initiation status was strongly associated with having one, two, or three close friends who smoked (AOR = 6.13, 11.07, and 22.31, respectively). Lower academic performance, depressive feelings, peer pressure to smoke, and male sex were also positively associated. Household economic status showed a non-monotonic pattern in the primary categorical analysis, while pocket money adequacy, access-related factors, and media/commercial exposure showed weaker or less consistent associations after full adjustment. Conclusions These findings highlight peer social context, educational vulnerability, and adolescent mental health as potentially relevant considerations for prevention.
Background Excessive health information seeking on the internet has become commonly known as cyberchondria, and it is accepted that cyberchondria is associated with maladaptive behaviors including tobacco use. This paper examined the relationship between cyberchondria, generalized anxiety and tobacco dependence and evaluated whether anxiety statistically mediates this association among young adults. Methods A cross-sectional survey design was used to survey 380 university students who were recruited through a stratified multi-site approach from the outpatient department of Public Health Dentistry, university dental camps, and targeted classroom outreach. The Cyberchondria and anxiety, and tobacco dependence were measured on the Cyberchondria Severity Scale-12 (CSS-12), Generalized Anxiety Disorder Scale (GAD-7), Fagerstrom Test for Nicotine Dependence (FTND) and Severson Smokeless Tobacco Dependence Scale (S-STDS). The scores of tobacco dependencies were standardized (Z-scores). The analysis of data was performed with respect to Kruskal Wallis H tests, Spearman correlation, multiple linear regression, and bootstrapped-mediation analysis (5,000 samples). Results Participants who used both smoked and smokeless tobacco reported greater level of cyberchondria, anxiety and tobacco dependence as compared to participants who used only one product type. There was a positive correlation between cyberchondria and anxiety, and both of them were linked to tobacco dependence. The regression analysis found out that anxiety and gender were both important predictors of tobacco dependence but cyberchondria was not independent of anxiety. Mediation analysis showed that anxiety statistically accounted for the association between cyberchondria and tobacco dependence (indirect effect B = 0.018, 95% CI = 0.011, 0.026). Conclusion Anxiety emerged as a key psychological correlate linking cyberchondria and tobacco dependence. These findings highlight anxiety as a shared vulnerability and supports integration of anxiety reduction and digital health literacy into tobacco cessation strategies.
Background The study of determinants shaping the process of smoking initiation is essential for developing effective preventive programs, especially in regions experiencing a surge in the number of smokers, as well as shifting in gender norms. This paper, as part of a broader study targeting smoking-related behaviors among the Jordanian population, represents an analysis of factors associated with smoking initiation.This sub-study specifically focuses on smoking initiation-associated factors. Methods An analytical cross sectional surgery-based study was conducted among 1022 Jordanian smokers, assessing social influences, educational level at time of smoking uptake, motivational factors, and tobacco and nicotine products used. Associations between variables and gender were studied and interpreted using Cramer’s V values to estimate effect size. Results The strongest association was reported between educational level at time of initiation and gender (Cramer’s V = 0.345, p < 0.001). While males were more likely to start smoking at lower educational levels and earlier ages, women tended to report smoking uptake during university stages (bachelor’s or postgraduate). Regarding the type of tobacco product used, a strong statistically significant association was identified (Cramer’s V = 0.37, p < 0.001), with younger smokers preferring e-cigarettes. The most prevalent social factor encouraging smoking uptake was peer influence, with 75.5% of responders reporting close friends as smokers at time of starting.Male participants were significantly more likely than females to report that school peers, favorite teachers, and identity-related concerns, such as appearing mature, were motivations for smoking initiation. Conclusion This paper demonstrates that smoking uptake is shaped by a complicated interaction between age, gender norms, educational level, peer influence, and social/cultural motivational factors. Such findings highlight the critical need for educational stage and gender tailored preventive interventions targeting the social environments mostly associated with smoking initiation.
Objective This study leverages three data sources to identify and characterize the top e-cigarette brands among young adults and in the e-cigarette retail market. Methods Data were obtained from two cross-sectional surveys of current e-cigarette users participating in either the Truth Continuous Tracking Online (Truth CTO) or Texas College Tobacco Survey and from NielsenIQ Retail Scanner data, aggregated at the national and state (Texas) levels. Results Eight brands (Esco Bars, Elf Bar, Vuse, JUUL, Puff Bar, SMOK, Geek Bar, and Lost Mary) dominated all sources. Rankings of the top e-cigarette brands in the Truth CTO, Texas College Tobacco Survey, and NielsenIQ Retail Scanner data differed. In 2023, Elf Bar, Esco Bars, and Vuse were the top brands among Texas college students, while the Truth CTO sample showed higher use of JUUL, Puff Bar, and Elf Bar. Brand rankings shifted in 2024, with Esco Bars and Elf Bar declining and Geek Bar emerging in the Texas College sample and Geek Bar and Lost Mary increasing in the Truth CTO sample. Conclusion Results demonstrate how rapid surveillance and retail data can be used to complementarily characterize top e-cigarette brands in the US retail market. There is markedly more variation in the top e-cigarette brands at the state level. Continued monitoring of e-cigarette brands is needed to identify emergent trends and inform strategies to reduce e-cigarette use among young adults at the state, national, and retail market levels.
