Importance: The use of tobacco products, including e-cigarettes and vaping, has rapidly increased among children. However, despite consistent associations found between smoking cigarettes and suicidal behaviors among adolescents and adults, there are limited data on associations between emerging tobacco products and suicidal behaviors, especially among preadolescent children.

Question: Is the use of tobacco products associated with an increased risk of self-injurious thoughts and behaviors among children?

Findings: This cohort study of 8988 preadolescent children enrolled in the Adolescent Brain Cognitive Development study found statistically significant associations between children’s use of tobacco products and suicide attempts. These associations were partially related to increased negative urgency and remained significant after accounting for various demographic, socioeconomic, familial, and clinical risk factors of suicide.

Meaning: The findings suggest that smoking tobacco products may be a modifiable risk factor that can be addressed in suicide prevention efforts, especially among children.