for religious reasons,10,12,13 age at initiation of cigarette smoking and sexual intercourse has been conservatively measured in most previous studies (i.e., "regular/daily smoking or smoking a whole cigarette" and "unwanted/forced sexual intercourse").7,8,14 By using such methodologies, previous studies may have overestimated the contribution of early initiation of cigarette smoking and/or sexual intercourse to suicidal behaviors. Furthermore, according to Jessor's Problem Behavior Theory,15 alcohol drinking, cigarette smoking, and sexual intercourse have been highly correlated, even occurring simultaneously in some cases. Kim16 and Schmid, et al.17 reported that concur-rent users of alcohol and cigarettes were at higher risk for developing other problem behaviors (e.g., leaving home, delinquency, violating school rules) and substance use (e.g., stimulants/sleeping pills, marijuana, or butane gas/glue), compared to drinkers who did not smoke, smokers who did not drink, and abstainers (neither drinking nor smoking). However, little is known about the nature and extent of the health effects of early concurrent participation in problem behaviors, particularly in regard to later suicidal ideation and suicide attempts.
