Korean J Health Promot KJHP Korean Journal of Health Promotion 2234-2141 2093-5676 Korean Society for Health Promotion and Disease Prevention 10.15384/kjhp.2017.17.4.219 Original Article The Relationship between Smoking and Suicidal Behavior in Korean Adolescents: 12th Korea Youth Risk Behavior Web-based Survey Kim Hye Won Kim Yang Keun Paik Jae Yong Hong Chang Bin Lee Kayoung Park Tae-Jin Kim Jinseung Department of Family Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea. Corresponding author: Jinseung Kim, MD. Department of Family Medicine, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan 47392, Korea. Tel: +82-51-890-6683, Fax: +82-51-894-7554, jinseungkim@inje.ac.kr 12 2017 28 12 2017 17 4 219 233 03 07 2017 17 10 2017 Copyright © 2017 Korean Society for Health Promotion and Disease Prevention 2017 Korean Society for Health Promotion and Disease Prevention This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background

Suicide is the first leading cause of death among teenagers in Korea, and smoking is reported to be one of the risk factors for suicide. The purpose of this study is to investigate the relationship between smoking and smoking amount and suicidal behavior using data from the Korea Youth Risk Behavior Web-based Survey (KYRBS).

 Methods

Using the 12th KYRBS 2016, we surveyed smoking, smoking amount, suicidal ideation, suicidal planning, and suicidal attempt of adolescents. And a total of 65,528 respondents were divided into current smoker, former smokers, and non-smoker, and 4,012 smokers were classified into ≤9 cigarettes/day group, 10–19 cigarettes/day group, and ≥20 cigarettes/day group according to the amount of smokers. We analyzed the relationship between smoking and smoking amount and suicidal ideation, suicidal planning, and suicidal attempt using multivariate logistic regression analysis.

 Results

As a result of adjusting for all confounding variables, the current smoker has an odds ratio of 1.143 (confidence interval 1.020–1.281) with suicidal ideation compared to non-smoker and the odds ratio of suicidal planning and suicidal attempt is also statistically significant, respectively. And the odds ratio of all suicidal behaviors was significantly higher in ≥20 cigarettes/day group than in ≤9 cigarettes/day group, respectively.

 Conclusions

We found that smoking and smoking amount was related to suicidal ideation, suicidal planning, and suicidal attempts in adolescents. Therefore, suicidal prevention strategies considering this relationship should be established.

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Values are presented as number (%) using frequency analysis in complex sample design.

aP values are obtained by F-test.

bPhysical activity for a week is defined as a day in which a total of 60 minutes or more of a day ‘physical activity of the heartbeat is increased or breathed’ during the past 7 days.

 Differences in suicidal ideation according to general characteristics

Values are presented as number (%) using cross tabulation analysis in complex sampling design.

aCalculated by Rao-Scott chi-square test.

 Differences in suicidal planning according to general characteristics

Values are presented as number (%) using cross tabulation analysis in complex sampling design.

aCalculated by Rao-Scott chi-square test.

 Differences in suicidal attempt according to general characteristics

Values are presented as number (%) using cross tabulation analysis in complex sampling design.

aCalculated by Rao-Scott chi-square test.

 Odds ratio for suicidal ideation according to smoking and daily smoking amount by logistic regression

Values are presented as adjusted odds ratio (95% confidence interval). Calculated by multivariate logistic regression analysis using complex sampling design.

aLogistic regression for suicidal ideation with smoking and smoking amount without adjustment.

bLogistic regression for suicidal ideation with smoking and smoking amount after adjustment for school, residence type, and economic status.

cLogistic regression for suicidal ideation with smoking and smoking amount after adjustment for school, residence type, economic status, perceived health, physical activity for a week, alcohol drinking, and drug experience.

dLogistic regression for suicidal ideation with smoking and smoking amount after adjustment for school, residence type, economic status, perceived health, physical activity for a week, alcohol drinking, drug experience, perceived stress, academic performance, perceived happiness, and sadness during the past 12 months.

eP values are obtained by F-test.

 Odds ratio for suicidal planning according to smoking and daily smoking amount by logistic regression

Values are presented as adjusted odds ratio (95% confidence interval). Calculated by multivariate logistic regression analysis using complex sampling design.

aLogistic regression for suicidal planning with smoking and smoking amount without adjustment.

bLogistic regression for suicidal planning with smoking and smoking amount after adjustment for school, residence type, and economic status.

cLogistic regression for suicidal planning with smoking and smoking amount after adjustment for school, residence type, economic status, perceived health, physical activity for a week, alcohol drinking, and drug experience.

dLogistic regression for suicidal planning with smoking and smoking amount after adjustment for school, residence type, economic status, perceived health, physical activity for a week, alcohol drinking, drug experience, perceived stress, academic performance, perceived happiness, and sadness during the past 12 months.

eP values are obtained by F-test.

 Odds ratio for suicidal attempt according to smoking and daily smoking amount by logistic regression

Values are presented as adjusted odds ratio (95% confidence interval). Calculated by multivariate logistic regression analysis using complex sampling design.

aLogistic regression for suicidal attempt with smoking and smoking amount without adjustment.

bLogistic regression for suicidal attempt with smoking and smoking amount after adjustment for school, residence type, and economic status.

cLogistic regression for suicidal attempt with smoking and smoking amount after adjustment for school, residence type, economic status, perceived health, physical activity for a week, alcohol drinking, and drug experience.

dLogistic regression for suicidal attempt with smoking and smoking amount after adjustment for school, residence type, economic status, perceived health, physical activity for a week, alcohol drinking, drug experience, perceived stress, academic performance, perceived happiness, and sadness during the past 12 months.

eP values are obtained by F-test.

 Post-hoc verification of smoking and smoking amount affecting suicidal ideation

Abbreviation: SD, standard deviation.

P-value <0.05.

 Post-hoc verification of smoking and smoking amount affecting suicidal planning

Abbreviation: SD, standard deviation.

P-value <0.05.

 Post-hoc verification of smoking and smoking amount affecting suicidal attempt

Abbreviation: SD, standard deviation.

P-value <0.05.