Is smoking tobacco associated with psychotic experiences across racial categories in the United States? Findings from the Collaborative Psychiatric Epidemiological Surveys
Introduction
The prevalence of smoking has reduced significantly in the US over the past few decades, yet the effects of smoking continue to result in cancers, cardiovascular and metabolic diseases, respiratory diseases, and preventable death (see Jha et al. (2013)). The effects of smoking can also profoundly affect the brain (e.g. accelerated cortical thinning, see Karama et al. (2015)), and increase risk for psychopathology. Recently, Gurillo et al. (2015) conducted a meta-analysis that showed smoking tobacco was associated with increased odds for psychosis, and suggested that the association could be causal.
In this context, most studies have examined the relationship between smoking and psychotic disorders (e.g. schizophrenia, see de Leon and Diaz (2005)). However, a growing number of studies have begun to examine the relationship between smoking and sub-threshold psychotic experiences. For example, Koyanagi et al. (2016) analyzed the World Health Survey data from 44 countries and found that current smoking increased the odds of reporting at least one psychotic symptom in the past year by approximately 35% when compared with non-smokers, after adjusting for age and sex. This association was only statistically significant at a conventional level in about a third of the countries, and effect sizes varied between 0.81 (95%CI 0.43–1.52) and 4.97 (95%CI 1.17–14.45), suggesting that context matters.
The current paper builds on these findings by being the first to examine the relationship between smoking status and psychotic experiences (PEs) in the United States, stratifying by race and adjusting for ethnicity in order to assess the extent to which effect sizes vary across subpopulations within the same country. The current paper also builds on previous work by using validated measures to assess the confounding role of cannabis use, as well as anxiety and mood disorders (Morissette et al., 2007; Jane-Llopis et al., 2006; DeVylder et al., 2014; Ksir and Hart, 2016), which are related to both smoking and PEs, but have not been adequately and consistently addressed in prior studies.
We analyzed data from three large surveys of the US general population, and we examined the association between smoking status and lifetime PEs, adjusting for socio-demographics, as well as DSM diagnoses of co-occurring substance use disorder, anxiety disorders, and mood disorders. We hypothesized that current smoking status would be associated with increased odds of reporting PEs, and that controlling for co-occurring disorders would diminish these effects.
Section snippets
Sample
We analyzed three population-level surveys in the US, which are: (1) the National Comorbidity Survey Replication (NCS-R; Kessler et al., 2004), (2) the National Latino and Asian American Study (NLAAS; Alegria et al., 2004) and (3) the National Survey of American Life (NSAL; Jackson et al., 2004), which together composed the Collaborative Psychiatric Epidemiology Surveys (CPES). The surveys were conducted between 2001 and 2003, and used similar methodology and sampling design. All surveys used
Results
Descriptive statistics for main explanatory, confounding, and outcome variables can be found in Table S1 in the Supplemental materials. In the NCS-R, being a current smoker was associated with 92% greater odds of reporting a lifetime PE after adjusting for socio-demographics, but this association diminished and did not retain a conventional level of statistical significance after controlling for co-occurring disorders. Among Latinos in the NLAAS, being a current smoker and former smoker was
Discussion
Across all samples, we found evidence in support of our hypothesis that current smokers had greater odds of reporting a lifetime PE when compared with never smokers after adjusting for socio-demographics. However, the effects did not remain at a conventional level of statistical significance after controlling for co-occurring disorders, except among Asian-Americans in the NLAAS, who have lower prevalence of smoking and psychosis relative to other racial groups in these data. Given the
Funding source
Preparation of this publication was supported by Grant T32AA014125 from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of NIAAA or NIH.
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