# A cross-sectional study on the association between secondhand smoke exposure and suicide among adolescents in multicultural families: The mediating role of perceived stress

## TL;DR

Exposure to secondhand smoke increases suicide risk in South Korean adolescents, especially those from multicultural families, with perceived stress playing a partial role.

## Contribution

This study identifies perceived stress as a mediator linking secondhand smoke exposure and suicidality in multicultural adolescents.

## Key findings

- Secondhand smoke exposure is significantly linked to higher odds of suicidal ideation, planning, and attempts in multicultural adolescents.
- Perceived stress partially mediates the relationship between SHS exposure and suicide attempts in this group.
- Multicultural adolescents show stronger associations between SHS exposure and suicidality compared to non-multicultural peers.

## Abstract

Adolescent suicidality poses a serious barrier to healthy growth and development. This study examines the association between secondhand smoke (SHS) exposure and suicidality among adolescents from multicultural families in South Korea, using a secondary analysis of the Korea Youth Risk Behavior Webbased Survey (KYRBS).

This cross-sectional study used pooled secondary data from the 2021 and 2024 waves of the KYRBS, a nationally representative survey of adolescents in South Korea, collected through self-administered questionnaires. This is a secondary dataset analysis of the KYRBS using logit regression models to assess the associations between the duration and setting-specific frequency of SHS exposure and suicidality among adolescents. The mediating role of perceived stress was examined using the Karlson-Holm-Breen (KHB) method.

SHS exposure is significantly associated with increased suicidality likelihood among adolescents, with particularly strong associations observed in those from multicultural families. Among multicultural adolescents, each additional total day of SHS exposure is significantly associated with the likelihood of suicidal ideation (AOR=1.117; 95% CI: 1.084–1.151), suicide planning (AOR=1.095; 95% CI: 1.052–1.139), and suicide attempts (AOR=1.117; 95% CI: 1.069–1.168). SHS exposure showed a stronger association with suicidality in multicultural families versus non-multicultural families. A higher frequency of SHS exposure across multiple settings is significantly associated with elevated odds of suicidal ideation (AOR=1.422; 95% CI: 1.247–1.621), suicide planning (AOR=1.395; 95% CI: 1.153–1.689), and suicide attempts (AOR=1.524; 95% CI: 1.222–1.902). Further analysis reveals that perceived stress partially mediates the association between SHS exposure and suicidality among multicultural adolescents. Perceived stress indirectly mediated 23.19% of the effect of SHS exposure on suicide attempts. It also mediated 30.67% and 34.18% of the effects on suicidal ideation and planning, respectively.

SHS exposure was associated with a higher likelihood of suicidality among adolescents, with this association observed in greater magnitude in adolescents from multicultural families. Moreover, perceived stress partially mediates the association between SHS exposure and suicide attempts among multicultural adolescents.