Jones Hannah J, Gage Suzanne H, Heron Jon, Hickman Matthew, Lewis Glyn, Munafò Marcus R, Zammit Stanley
Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
Medical Research Centre, Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom.
JAMA Psychiatry. 2018 Mar 1;75(3):240-246. doi: 10.1001/jamapsychiatry.2017.4271.
There is concern about potentially causal effects of tobacco use on psychosis, but epidemiological studies have been less robust in attempts to minimize effects of confounding than studies of cannabis use have been.
To examine the association of patterns of cigarette and cannabis use with preceding and subsequent psychotic experiences, and to compare effects of confounding across these patterns.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the Avon Longitudinal Study of Parents and Children, which initially consisted of 14 062 children. Data were collected periodically from September 6, 1990, with collection ongoing, and analyzed from August 8, 2016, through June 14, 2017. Cigarette and cannabis use data were summarized using longitudinal latent class analysis to identify longitudinal classes of substance use. Associations between classes and psychotic experiences at age 18 years were assessed.
Depending on the analysis model, exposures were longitudinal classes of substance use or psychotic experiences at age 12 years.
Logistic regression was used to examine the associations between substance use longitudinal classes and subsequent onset of psychotic experiences.
Longitudinal classes were derived using 5300 participants (56.1% female) who had at least 3 measures of cigarette and cannabis use from ages 14 to 19 years. Prior to adjusting for a range of potential confounders, there was strong evdience that early-onset cigarette-only use (4.3%), early-onset cannabis use (3.2%), and late-onset cannabis use (11.9%) (but not later-onset cigarette-only use [14.8%]) latent classes were associated with increased psychotic experiences compared with nonusers (65.9%) (omnibus P < .001). After adjusting for confounders, the association for early-onset cigarette-only use attenuated substantially (unadjusted odds ratio [OR], 3.03; 95% CI, 1.13-8.14; adjusted OR, 1.78; 95% CI, 0.54-5.88), whereas those for early-onset cannabis use (adjusted OR, 3.70; 95% CI, 1.66-8.25) and late-onset cannabis use (adjusted OR, 2.97; 95% CI, 1.63-5.40) remained consistent.
In this study, our findings indicate that while individuals who use cannabis or cigarettes during adolescence have an increased risk of subsequent psychotic experiences, epidemiological evidence is substantively more robust for cannabis use than it is for tobacco use.
人们担心烟草使用对精神病可能存在因果影响，但与大麻使用研究相比，流行病学研究在尽量减少混杂因素影响方面做得不够有力。
研究香烟和大麻使用模式与之前及之后的精神病体验之间的关联，并比较这些模式中混杂因素的影响。
设计、背景和参与者：这项队列研究使用了来自雅芳亲子纵向研究的数据，该研究最初有14062名儿童。数据从1990年9月6日开始定期收集，目前仍在进行收集，并于2016年8月8日至2017年6月14日进行分析。使用纵向潜在类别分析对香烟和大麻使用数据进行汇总，以确定物质使用的纵向类别。评估了这些类别与18岁时精神病体验之间的关联。
根据分析模型，暴露因素为物质使用的纵向类别或12岁时的精神病体验。
使用逻辑回归来研究物质使用纵向类别与随后精神病体验发作之间的关联。
纵向类别是从5300名参与者（56.1%为女性）中得出的，这些参与者在14至19岁期间至少有3次香烟和大麻使用测量数据。在对一系列潜在混杂因素进行调整之前，有强有力的证据表明，与非使用者（65.9%）相比，早期仅使用香烟（4.3%）、早期使用大麻（3.2%）和晚期使用大麻（11.9%）（但不包括晚期仅使用香烟[14.8%]）的潜在类别与精神病体验增加有关（综合P＜0.001）。在对混杂因素进行调整后，早期仅使用香烟的关联大幅减弱（未调整的优势比[OR]为3.03；95%置信区间为1.13 - 8.14；调整后的OR为1.78；95%置信区间为0.54 - 5.88），而早期使用大麻（调整后的OR为3.70；95%置信区间为1.66 - 8.25）和晚期使用大麻（调整后的OR为2.97；95%置信区间为1.63 - 5.40）的关联仍然一致。
在本研究中，我们的发现表明，虽然青少年使用大麻或香烟的个体随后出现精神病体验的风险增加，但大麻使用的流行病学证据比烟草使用的证据实质上更有力。
