Data were collected through the Global school-based Student Health Survey, a collaborative surveillance project between the World Health Organization, the United Nations, UNICEF, UNESCO, UNAIDS, and the U.S. Centers for Disease Control and Prevention. Suicidal ideation, tobacco smoking, and drug and alcohol use were included in loglinear models to analyze higher order interactions among suicidality and regional and country differences separately for boys and girls. School-aged children who reported suicidal ideation had a higher risk of smoking tobacco even after controlling for drug and alcohol misuse. Furthermore, analyses indicated higher order interactions between suicidal ideation and countries belonging to different regions with different exposure to tobacco smoking among school-aged children. Future studies analyzing the mechanism and sequencing of the relationship among suicidal ideation and tobacco smoking should explore cultural factors. (Published Abstract)