Associations Between Frequency of Smokeless Tobacco and Oral Nicotine Product Use and Suicidality Among High School Students in the United States: A Cross-Sectional Study
Valerie L. Simpson, Shari Esquenazi-Karonika, Kimberly Bird, Dale S. ManteyBackground
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.