Smokin' hot: adolescent smoking and the risk of psychosis

Acta Psychiatr Scand. 2018 Jul;138(1):5-14. doi: 10.1111/acps.12863. Epub 2018 Feb 18.


Objective: Daily smoking has been associated with a greater risk of psychosis. However, we are still lacking studies to adjust for baseline psychotic experiences and other substance use. We examined associations between daily smoking and psychosis risk in a 15-year follow-up while accounting for these covariates in a prospective sample (N = 6081) from the Northern Finland Birth Cohort 1986.

Methods: Self-report questionnaires on psychotic experiences (PROD-screen), tobacco smoking and other substance use were completed when the cohort members were 15-16 years old. Tobacco smoking was categorized into three groups (non-smokers, 1-9 cigarettes and ≥10 cigarettes/day). Psychosis diagnoses were obtained from national registers until the age of 30 years.

Results: Subjects in heaviest smoking category were at increased risk of subsequent psychosis (unadjusted HR = 3.15; 95% CI 1.94-5.13). When adjusted for baseline psychotic experiences the association persisted (HR = 2.87; 1.76-4.68) and remained significant even after adjustments for multiple known risk factors such as cannabis use, frequent alcohol use, other illicit substance use, parental substance abuse, and psychosis. Furthermore, number of smoked cigarettes increased psychosis risk in a dose-response manner (adjusted OR = 1.05; 1.01-1.08).

Conclusion: Heavy tobacco smoking in adolescence was associated with a greater risk for psychosis even after adjustment for confounders.

Keywords: epidemiology; nicotine; psychosis; schizophrenia; tobacco.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adolescent Behavior*
  • Adult
  • Cigarette Smoking / epidemiology*
  • Female
  • Finland / epidemiology
  • Follow-Up Studies
  • Humans
  • Male
  • Psychotic Disorders / epidemiology*