Examining the association between tobacco and its substitutes use with psychosocial symptoms among 187,329 adolescents: A comparative analysis across 47 countries with varied universal health coverage index

Abstract

Objective

This study aimed to analyze the association between tobacco and its substitutes use and psychosocial symptoms among adolescents, and to investigate whether these associations varied based on the Universal Health Coverage (UHC) index.

Methods

A pooled cross-sectional analysis was conducted using data from the Global School-based Student Health Survey from 2013 to the most recent available year, covering 47 countries and involving 187,329 adolescents aged 12–17 years. Log-binomial regression models were applied to analyze the association between current tobacco and substitutes use and psychosocial symptoms including suicide ideation, being lonely, and worrying. Further stratified analysis was performed with log-binomial regression models to analyze whether the associations differed under different national UHC index.

Results

The prevalence of psychosocial symptoms, including suicide ideation, being lonely, and worrying, were 14.1 %, 12.8 %, and 10.3 %, respectively. The prevalence of tobacco and its substitutes use was significantly higher among boys (20.9 % vs. 10.7 %; P < 0.001). Tobacco and its substitutes use was associated with greater risk of suicide ideation (boys: OR = 1.89, 95%CI 1.82–1.97; girls: OR = 2.33, 95%CI 2.26–2.40), being lonely (boys: OR = 1.58, 95%CI 1.51–1.64; girls: OR = 1.68, 95%CI 1.63,1.73), and worrying (boys: OR = 1.78, 95%CI 1.70,1.87; girls: OR = 1.82, 95%CI 1.76,1.89). The differences were also significant in all sex-stratified subgroup analyses (P < 0.001). These associations were greater in countries with lower UHC index, particularly tobacco-related risk of suicide ideation among girls.

Conclusion

Tobacco and its substitutes use is associated with increased risks of various psychosocial symptoms, including feelings of suicide ideation, being lonely, and worrying, in adolescents, particularly among girls and in countries with lower UHC index.