BACKGROUND: Adolescents who use multiple tobacco products are at an increased risk of suicidal thoughts, plans, and attempts. However, little is known about the link between poly-tobacco use and suicidal ideation in adults.
METHODS: A survey was conducted with 800 Korean adults aged 19 and older who use tobacco products to assess their tobacco use behaviors and mental health indicators, including anxiety, depression, and suicidal ideation. Poly-tobacco users were categorized into groups: conventional cigarette(CC)+heated tobacco product(HTP), CC + electronic cigarette(EC), HTP+EC and CC+HTP+EC. The survey included measures such as the Fagerström Test for Nicotine Dependence (FTND), electronic FTND (e-FTND), Beck Anxiety Inventory, Patient Health Questionnaire-9, and suicidal ideation assessments. Urinary cotinine tests were conducted on 100 participants to validate the findings.
RESULTS: Among participants, 77.6% were male, and 22.4% were female, with an average age of 43.3 years and 42.5 years respectively. Of the 800 participants, 217 were poly-tobacco users. In the CC+HTP group (123 participants), the first tobacco product used in the morning was CC (52.8%) or HTP (47.2%). In the CC+EC group (32 participants), it was CC (62.5%) or EC (37.5%). For the HTP+EC group (13 participants), it was HTP (30.8%) or EC (69.2%). In the CC+HTP+EC group (49 participants), the distribution was CC (53.1%), HTP (22.0%), and EC (16.9%). Nicotine dependence (FTND or e-FTND) scores were as follows: CC (3.23), HTP (3.23), EC (3.75), CC+HTP (3.67), CC+EC (3.25), HTP+EC (4.50), and CC+HTP+EC (3.78). Poly-tobacco users exhibited poorer scores for suicidal ideation compared to single-product users. Urinary cotinine levels were 1,032 ng/ml for CC users, 2,846 ng/ml for HTP users, 890 ng/ml for EC users, and 2,395 ng/ml for poly-tobacco users.
CONCLUSIONS: Among adult tobacco users, poly-tobacco users demonstrated worse outcomes for suicidal ideation compared to single-product users. Comprehensive screening is necessary to address the mental health needs of poly-tobacco users.