RESEARCH PAPER
Associated factors for depression, suicidal ideation and suicide attempt among asthmatic adolescents with experience of electronic cigarette use
 
More details
Hide details
1
Department of Obstetrics and Gynecology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
2
Department of Urology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
3
Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
4
Department of Biostatistics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
CORRESPONDING AUTHOR
Sung Hoon Kim   

Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 158 Paryong-ro, Masanhoewon-gu, Changwon, 51353, Republic of Korea
Publication date: 2020-10-16
 
Tob. Induc. Dis. 2020;18(October):85
 
KEYWORDS
TOPICS
# Contributed equally, co-first authors
ABSTRACT
Introduction:
While electronic cigarette (EC) use is rapidly increasing among asthmatic adolescents, little is known about the links between EC use and depression or suicidality. We assessed associated factors for depression and suicidality in asthmatic adolescents with experience of EC use.

Methods:
We analyzed the data from the 11th to 13th Korea Youth Risk Behavior Web-based Surveys, which were completed from 2015 to 2017. Data were obtained from a stratified, multistage, clustered sample. Students supplied ‘yes or no’ answers to questions about previous asthma diagnosis by a doctor. Associated factors for depression and suicidality were evaluated by logistic regression models after controlling for potential confounding factors. We targeted 203336 adolescents, and 195847 completed the survey.

Results:
The proportion of asthma among the respondents was 8.9%. The rate of experience of EC use was higher among asthmatic respondents than non-asthmatic respondents (10.3% vs 8.6%). Asthmatic respondents with experience of EC use had a much higher proportion of negative mental health states including depression and suicidality than subjects without EC experience. In our adjusted models, perception of stress was most strongly associated with depression (adjusted odds ratio, AOR=4.79; 95% CI: 4.12–5.58), and perception of unhappiness was most strongly associated with suicidal ideation (AOR=5.24; 95% CI: 4.51–6.09) and suicide attempt (AOR=4.37; 95% CI: 3.36–5.69).

Conclusions:
Many Korean asthmatic adolescents with experience of EC use report relatively high depression and suicidal behaviors. A multidisciplinary approach, including psychological help, may be required to prevent suicide among this population, especially those who report associated factors.

ACKNOWLEDGEMENTS
We especially thank all adolescents who participated in the KYRBSs.
CONFLICTS OF INTEREST
The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
FUNDING
There was no source of funding for this research.
AUTHORS' CONTRIBUTIONS
CWK and SCJ equally contributed to this study as first authors by contributing to the data collection, manuscript writing, and critical manuscript revisions. JYK contributed to data collection and initial manuscript writing. JHL and JSL contributed in interpretation of the results and reviewed related articles. SHJ also contributed to data collection and analysis. SHK, who was the study supervisor, conceptualized the study, designed the measures, reviewed and revised the initial manuscript, and approved the final manuscript.
PROVENANCE AND PEER REVIEW
Not commissioned; externally peer reviewed.
 
REFERENCES (40)
1.
Schweitzer RJ, Wills TA, Tam E, Pagano I, Choi K. E-cigarette use and asthma in a multiethnic sample of adolescents. Prev Med. 2017;105:226-231. doi:10.1016/j.ypmed.2017.09.023.
 
2.
Solinas A, Paoletti G, Firinu D, et al. Vaping effects on asthma: results from a web survey and clinical investigation. Intern Emerg Med. 2020;20. doi:10.1007/s11739-019-02247-5.
 
3.
Kim SY, Sim S, Choi HG. Active, passive, and electronic cigarette smoking is associated with asthma in adolescents. Sci Rep. 2017;7(1):17789. doi:10.1038/s41598-017-17958-y.
 
4.
Breland A, Soule E, Lopez A, Ramôa C, El-Hellani A, Eissenberg T. Electronic cigarettes: what are they and what do they do? Ann N Y Acad Sci. 2017;1394(1):5-30. doi:10.1111/nyas.12977.
 
5.
Osibogun O, Bursac Z, Maziak W. E-Cigarette Use and Regular Cigarette Smoking Among Youth: Population Assessment of Tobacco and Health Study (2013-2016). Am J Prev Med. 2020;58(5):657-665. doi:10.1016/j.amepre.2020.01.003.
 
6.
Clapp PW, Jaspers I. Electronic Cigarettes: Their Constituents and Potential Links to Asthma. Curr Allergy Asthma Rep. 2017;17(11):79. doi:10.1007/s11882-017-0747-5.
 
7.
Williams M, Villarreal A, Bozhilov K, Lin S, Talbot P. Metal and silicate particles including nanoparticles are present in electronic cigarette cartomizer fluid and aerosol. PLoS One. 2013;8(3):e57987. doi:10.1371/journal.pone.0057987.
 
8.
Rennie LJ, Bazillier-Bruneau C, Rouëssé J. Harm Reduction or Harm Introduction? Prevalence and Correlates of E-Cigarette Use Among French Adolescents. J Adolesc Health. 2016;58(4):440-445. doi:10.1016/j.jadohealth.2015.12.013.
 
9.
Singh T, Arrazola RA, Corey CG, et al. Tobacco use among middle and high school students: United States, 2011-2015. MMWR Morb Mortal Wkly Rep. 2016;65(14):361-367. doi:10.15585/mmwr.mm6514a1.
 
10.
Soneji S, Barrington-Trimis JL, Wills TA, et al. Association Between Initial Use of e-Cigarettes and Subsequent Cigarette Smoking Among Adolescents and Young Adults: A Systematic Review and Meta-analysis. JAMA Pediatr. 2017;171(1):788-797. doi:10.1001/jamapediatrics.2017.1488.
 
11.
Cho JH, Paik SY. Association between electronic cigarette use and asthma among high school students in South Korea. PLoS One. 2016;11(3):e0151022. doi:10.1371/journal.pone.0151022.
 
12.
Fedele DA, Barnett TE, Dekevich D, Gibson-Young LM, Martinasek M, Jagger MA. Prevalence of and beliefs about electronic cigarettes and hookah among high school students with asthma. Ann Epidemiol. 2016;26(12):865-869. doi:10.1016/j.annepidem.2016.10.004.
 
13.
Choi K, Bernat D. E-cigarette use among Florida youth with and without asthma. Am J Prev Med. 2016;51(4):446-453. doi:10.1016/j.amepre.2016.03.010.
 
14.
National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division, Board on Population Health and Public Health Practice, Committee on the Review of the Health Effects of Electronic Nicotine Delivery Systems. Public Health Consequences of E-Cigarettes. In: Eaton DL, Kwan LY, Stratton K, eds. Washington, DC: National Academies Press (US); 2018.
 
15.
Prochaska JJ. The public health consequences of e-cigarettes: a review by the National Academies of Sciences. A call for more research, a need for regulatory action. Addiction. 2019;114(4):587-589. doi:10.1111/add.14478.
 
16.
Rigotti NA. Balancing the Benefits and Harms of E-Cigarettes: A National Academies of Science, Engineering, and Medicine Report. Ann Intern Med. 2018;168(9):666-667. doi:10.7326/M18-0251.
 
17.
Cooke A, Fergeson J, Bulkhi A, Casale TB. The Electronic Cigarette: The Good, the Bad, and the Ugly. J Allergy Clin Immunol Pract. 2015;3(4):498-505. doi:10.1016/j.jaip.2015.05.022.
 
18.
Wills TA, Pagano I, Williams RJ, Tam EK. E‐cigarette use and respiratory disorder in an adult sample. Drug Alcohol Depend. 2019;194:363‐370. doi:10.1016/j.drugalcdep.2018.10.004.
 
19.
Chung SJ, Kim BK, Oh JH, et al. Novel tobacco products including electronic cigarette and heated tobacco products increase risk of allergic rhinitis and asthma in adolescents: Analysis of Korean youth survey. Allergy. 2020;75(7). doi:10.1111/all.14212.
 
20.
Kim JS, Kim K. Electronic cigarette use and suicidal behaviors among adolescents. J Public Health (Oxf). 2019. doi:10.1093/pubmed/fdz086.
 
21.
Khouja JN, Suddell SF, Peters SE, Taylor AE, Munafò MR. Is e-cigarette use in non-smoking young adults associated with later smoking? A systematic review and meta-analysis. Tob Control. 2020. doi:10.1136/tobaccocontrol-2019-055433.
 
22.
Lee Y, Lee KS. Association of Depression and Suicidality with Electronic and Conventional Cigarette Use in South Korean Adolescents. Subst Use Misuse. 2019;54(6):934-943. doi:10.1080/10826084.2018.1552301.
 
23.
Leventhal AM, Strong DR, Sussman S, et al. Psychiatric comorbidity in adolescent electronic and conventional cigarette use. J Psychiatr Res. 2016;73:71-78. doi:10.1016/j.jpsychires.2015.11.008.
 
24.
Chen VC, Kuo CJ, Wang TN, et al. Suicide and Other-Cause Mortality after Early Exposure to Smoking and Second Hand Smoking: A 12-Year Population-Based Follow-Up Study. PLoS One. 2015;10(7):e0130044. doi:10.1371/journal.pone.0130044.
 
25.
Li D, Yang X, Ge Z, et al. Cigarette smoking and risk of completed suicide: a meta-analysis of prospective cohort studies. J Psychiatr Res. 2012;46(10):1257-1266. doi:10.1016/j.jpsychires.2012.03.013.
 
26.
Zygo M, Pawłowska B, Potembska E, Dreher P, Kapka-Skrzypczak L. Prevalence and selected risk factors of suicidal ideation, suicidal tendencies and suicide attempts in young people aged 13-19 years. Ann Agric Environ Med. 2019;26(2):329-336. doi:10.26444/aaem/93817.
 
27.
Chadi N, Li G, Cerda N, Weitzman ER. Depressive Symptoms and Suicidality in Adolescents Using e-Cigarettes and Marijuana: A Secondary Data Analysis From the Youth Risk Behavior Survey. J Addict Med. 2019;13(5):362-365. doi:10.1097/ADM.0000000000000506.
 
28.
Obisesan OH, Mirbolouk M, Osei AD, et al. Association Between e-Cigarette Use and Depression in the Behavioral Risk Factor Surveillance System, 2016-2017. JAMA Netw Open. 2019;2(12):e1916800. doi:10.1001/jamanetworkopen.2019.16800.
 
29.
Kim Y, Choi S, Chun C, Park S, Khang YH, Oh K. Data Resource Profile: The Korea Youth Risk Behavior Web-based Survey (KYRBS). Int J Epidemiol. 2016;45(4):1076-1076e. doi:10.1093/ije/dyw070.
 
30.
Larsen K, Faulkner GEJ, Boak A, et al. Looking beyond cigarettes: Are Ontario adolescents with asthma less likely to smoke e-cigarettes, marijuana, waterpipes or tobacco cigarettes? Respir Med. 2016;120:10-15. doi:10.1016/j.rmed.2016.09.013.
 
31.
Kwon E, Seo DC, Lin HC, Chen Z. Predictors of youth e-cigarette use susceptibility in a U.S. nationally representative sample. Addict Behav. 2018;82:79-85. doi:10.1016/j.addbeh.2018.02.026.
 
32.
Lee KJ. Current smoking and secondhand smoke exposure and depression among Korean adolescents: analysis of a national cross-sectional survey. BMJ Open. 2014;4:e003734. doi:10.1136/bmjopen-2013-003734.
 
33.
Nock MK, Green JG, Hwang I, et al. Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: results from the National Comorbidity Survey Replication Adolescent Supplement. JAMA Psychiatry. 2013;70(3):300-310. doi:10.1001/2013.jamapsychiatry.55.
 
34.
Riehm KE, Young AS, Feder KA, et al. Mental Health Problems and Initiation of E-cigarette and Combustible Cigarette Use. Pediatrics. 2019;144(1):e20182935. doi:10.1542/peds.2018-2935.
 
35.
Cummins SE, Zhu SH, Tedeschi GJ, Gamst AC, Myers MG. Use of e-cigarettes by individuals with mental health conditions. Tob Control. 2014;23:iii48-iii53. doi:10.1136/tobaccocontrol-2013-051511.
 
36.
Al Rifai M, Mirbolouk M, Obisesan OH, et al. The Association of Electronic Cigarette Use and the Subjective Domains of Physical and Mental Health: The Behavioral Risk Factor Surveillance System Survey. Cureus. 2020;12(2):e7088. doi:10.7759/cureus.7088.
 
37.
Cho HJ, Dutra LM, Glantz SA. Differences in adolescent e-cigarette and cigarette prevalence in two policy environments: South Korea and the United States. Nicotine Tob Res. 2018;20(8):949-953. doi:10.1093/ntr/ntx198.
 
38.
Kong G, Bold KW, Morean ME, et al. Appeal of JUUL among adolescents. Drug Alcohol Depend. 2019;205:107691. doi:10.1016/j.drugalcdep.2019.107691.
 
39.
Patel M, Czaplicki L, Perks SN, et al. Parents' Awareness and Perceptions of JUUL and Other E-Cigarettes. Am J Prev Med. 2019;57(5):695-699. doi:10.1016/j.amepre.2019.06.012.
 
40.
Göney G, Çok İ, Tamer U, Burgaz S, Şengezer T. Urinary cotinine levels of electronic cigarette (e-cigarette) users. Toxicol Mech Methods. 2016;26(6):414-418. doi:10.3109/15376516.2016.1144127.
 
eISSN:1617-9625