JMIR Publications

ABSTRACT

Background:

The prosperity of tobacco/conventional cigarette (CC) and electronic cigarette (EC) usage among Chinese youth has become a growing public health concern. This is the first large-scale study to compare the impact of CC and EC on risk for non-suicidal self-injury (NSSI) and suicidality in cis-heterosexual and sexual and gender minority (SGM) youth.

Objective:

This study examined the CC and EC and risks for NSSI and suicidality among Chinese youth and investigated the different extent to which SGM and cis-heterosexual youth’s risk for NSSI and suicidality were influenced by their CC and EC usage, CC and EC dependence.

Methods:

A total of 89,342 Chinese participants completed this cross-sectional self-report survey in 2021. Sociodemographic information, sexual orientations, gender identities, CC and EC usage, CC and EC dependence, and risks for suicidality and NSSI were collected and assessed. The Mann-Whitney U test and the chi-square test were performed for non-normally distributed continuous variables and categorical variables, respectively. The multivariable linear regression model was used to examine both the influence of CC and EC usage, CC and EC dependence on NSSI and suicidality, as well as the interaction effects of CC and EC usage, CC and EC dependence on NSSI and suicidality by group.

Results:

Results show that the prevalence of CC usage and CC dependence was lower in SGM participants compared to its cis-heterosexual counterpart (Ps < .001). However, the prevalence of EC usage and EC dependence were higher in SGM participants (p = .031; p < .001). Results from the multivariable linear regression model underscored that CC dependence and EC dependence have a unique effect on NSSI and suicidality (CCs: B=0.03, p < .001; B=0.12, p < .001; ECs: B=0.04, p < .001; B=0.13, p < .001). More importantly, the interaction effects of 1) CC usage and group type on NSSI and suicidality (B=0.35, p < .03; B=0.24, p < .001) and dual usage and group type on NSSI and suicidality (B=0.54, p < .001; B=0.84, p < .001) were significant; 2) CC dependence and group type on NSSI were significant (B=0.07, p < .001), and 3) EC dependence and group type on NSSI and suicidality were significant (B=0.04, p < .001; B=0.09, p < .001). No significant interaction effect between EC and group type on NSSI and suicidality (B=0.15, p =.12; B=0.33, p =.32), and between CC dependence and group type on suicidality (B=-0.01, p =.72).

Conclusions:

The present study offers evidence of intergroup differences in NSSI and suicidality risks between SGM and cis-heterosexual youth related to CC and EC. These findings contribute to the growing literature on CC and EC in both cis-heterosexual and SGM populations. Concerted efforts are necessary at a societal level to curb the aggressive marketing strategies of the EC industry and media coverage and to maximize the impact of educational campaigns on EC prevention and intervention among the youth population.