Adults With Psychosis Have Higher Nicotine Dependence, Tobacco Use Than Controls

Adults living in the United States with a history of psychosis were found to have a high prevalence of tobacco use and severe nicotine dependence, according to results of a study published in JAMA Network Open.

Investigators from the National Institute on Drug Abuse sourced data for this study from wave 5 of the Population Assessment of Tobacco and Health (PATH) Study which was an ongoing US-based cohort study. Between 2018 and 2019, study participants (N=29,045) were asked about past-month tobacco use, nicotine dependence, and past-year smoking cessation attempts. Trends were compared between the subset of individuals who answered yes to the questions about whether they had ever received a diagnosis of schizophrenia, schizoaffective disorder, psychosis, or psychotic illness (n=1186) along with those who answered no (n=27,859).

Participants with and without lifetime psychosis had mean ages 41.1 (SD, 0.7) and 47.4 (SD, 0.1) years (P <.001), 54.6% and 51.5% were women, 60.5% and 65.0% were White (P <.001), 18.0% and 32.0% had a Bachelor’s degree or above (P <.001), and 11.5% and 35.4% earned $75,000 or more annually (P <.001), respectively.

A lifetime history of psychosis was associated with a greater likelihood of any tobacco use (adjusted risk ratio [aRR], 1.49; 95% CI, 1.36-1.63), cigarette use (aRR, 1.61; 95% CI, 1.44-1.79), e-cigarette use (aRR, 1.51; 95% CI, 1.27-1.74), and any other tobacco product use (aRR, 1.65; 95% CI, 1.40-1.89).

Stratified by subgroups, psychosis associated among all age groups with increased tobacco use (aRR range, 1.29-1.59), cigarette use (aRR range, 1.40-1.86), and other tobacco use (aRR range, 1.51-1.87) whereas only adults aged 25 years and older were associated with higher e-cigarette use (aRR range, 1.44-1.92) compared with controls. Both men and women with psychosis were at higher odds of all tobacco outcomes compared with controls (aRR range, 1.27-1.72). For race and ethnicity, all groups with psychosis were at higher odds of using tobacco products compared with controls, with the exceptions of Black individuals and other tobacco product use, Hispanic individuals and e-cigarette use, and other race or ethnicity and cigarette, e-cigarette, and other tobacco product use.

The individuals with psychosis were also associated with significantly higher nicotine dependence scores (adjusted mean difference [aMD], 5.2; 95% CI, 2.3-8.0 points; P =.001).

Individuals with psychosis had higher nicotine dependence compared with controls among subgroups aged 45 years and older (aMD, 6.9 points; P =.002), women (aMD, 7.1 points; P =.001), Black (aMD, 7.4 points; P =.005), and Hispanic (aMD, 13.8 points; P =.01).

In the past 12-months, the group with psychosis were more likely to have any attempt to quit (aRR, 1.11) and to attempt to quit using counseling or support (aRR, 2.25) or any means (aRR, 1.35) compared with controls.

These findings may be limited by the reliance on self-reporting.

Study authors concluded, “[A] high prevalence of tobacco use, poly-tobacco use, and making a quit attempt and high nicotine dependence severity highlighted the urgent need for tailoring tobacco cessation interventions for persons with psychosis.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Psychiatry Advisor