Exploring the Association between Suicidality and Smoking Behavior among School-Based Children in Lao People’s Democratic Republic (PDR)

ABSTRACT

This study examines the relationship between suicidality and smoking behavior. Specifically, it examines how and the degree to which suicide ideation and plan are associated with the probability of being a regular smoker among school-based children. Data come from Lao Student Health Survey (2017), a project funded by the National Research Foundation of Korea. Using primary hierarchically nested data (students clustered in classrooms across schools), we investigate the complex interplay between suicidality and smoking behavior in Lao PDR, a low-income country located in Southeast Asia. Results from fitting two-level random intercept models show that net of controls (e.g., gender, age, parental regulation, self-rated health, household SES), the likelihood of daily smoking is higher among students who have seriously considered committing suicide or have planned a suicide attempt. Controlling for individual-level factors, significant classroom-level contextual effects are also found with respect to peer relations. Finally, we observe a cross-level interaction: the positive association between suicide intent and odds of smoking is weaker in classrooms with better peer relations.

KEYWORDS:

• Smoking behavior
• suicide intent
• suicide plan
• peer relations
• Laos

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. The relationship between smoking and suicide has been an issue of much contention and confusion (for review, see Fluharty et al. 2017). In particular, the endogeneity problem makes it difficult to infer conclusively the direction of causality (Kessler et al. 2007; Li et al. 2012; McGee, Williams, and Nada-Raja 2005; Poorolajal and Davishi 2016). We contribute to the debate by treating smoking as an outcome measure. Our strategy is based on the recognition that there is a shortage of research on smoking behaviors among those with psychological distress, especially in connection with developing effective cessation strategies (Aubin et al. 2012; Catchpole et al. 2017; Le Cook et al. 2014).

2. We do not have access to more objective measures of academic performance, unfortunately. In models not shown, as a robustness check, we included additional variables that capture students’ attitudes toward school, assuming a positive attitude to be equated with better performance. Main results were consistent.

Additional information

Funding

This study was supported by the National Research Foundation of Korea [NRF-2014-2014S1A5A2A03066021] and the Bill & Melinda Gates Foundation.