Association Between Smoking and Vaping Status with Suicidality Among Malaysian University Students

Abstract

Tobacco smoking and electronic cigarette (vaping) use remain prevalent among young adults, including university students, and have been associated with adverse mental health outcomes such as suicidality. However, limited evidence exists regarding this relationship among Malaysian university students. This study aimed to examine the association between smoking and vaping status and suicidality in this population. A cross-sectional study was conducted among undergraduate students from 31 Malaysian universities. Participants completed a self-administered questionnaire assessing sociodemographic characteristics, current smoking and vaping status, and suicidality using the YATT Suicide Attitude Scale, which measures suicidal ideation and suicide attempts. Simple and multiple regression analyses were performed to determine the associations, adjusting for sex, religion, and monthly household income. Of the 4,514 respondents, 4,030 valid responses were included in the analysis (89.3%). The majority were female (71.8%), 51.3% were Muslims, and 48.8% reported low monthly household income. The mean scores for suicidal ideation and suicide attempts were
4.52±5.11 and 2.37±4.24, respectively. After adjusting for confounders, current smoking and vaping were significantly associated with higher suicidal ideation (smoking: B=1.340, 95% CI 0.375–2.305, p=0.006; vaping: B=1.695, 95% CI 0.970–2.420, p<0.001) and higher
suicide attempt scores (smoking: B=1.596, 95% CI 0.801–2.392, p<0.001; vaping: B=1.776, 95% CI 1.179–2.374, p<0.001). These findings underscore the need to integrate mental health screening and support into tobacco and vaping prevention programs within university settings.