Cannabis use in adolescence robustly increases the risk of psychotic experiences, tobacco use alone shows no significant association after adjustment.
Summary
ALSPAC cohort (n=5.300, JAMA Psychiatry): Early cannabis use in adolescence (onset <16 years) associated with increased psychosis risk (OR=3,70, 95% CI 1,66–8,25 after adjustment); late-onset use (OR=2,97, 95% CI 1,63–5,40); tobacco effects not robust (OR 1,78, 95% CI 0,54–5,88 after adjustment ns); findings demonstrate stronger epidemiological evidence for cannabis risks in adolescents than for tobacco.
P
PopulationAdolescents from the Avon Longitudinal Study of Parents and Children (ALSPAC), n=5.300, with at least 3 measurements of cigarette and cannabis use at ages 14–19 years
I
InterventionLongitudinal patterns of tobacco and/or cannabis use in adolescence (latent classes: early cigarette-only use, early cannabis use, late cannabis use, late cigarette-only use)
C
ControlNon-users (65,9% of the sample)
O
OutcomeEarly cannabis use (adj. OR 3,70; 95%-CI 1,66–8,25) and late cannabis use (adj. OR 2,97; 95%-CI 1,63–5,40) significantly associated with psychotic experiences; early cigarette-only use no longer significant after confounder adjustment (adj. OR 1,78; 95%-CI 0,54–5,88)
Confidence in the evidence
Very lowLowModerateHigh
Low
The second of four GRADE levels, the effect estimate is of limited reliability.
Quality profile
Sample size★★★★★
Blinding—
Effect sizeMixed
Citations / year★★★★★
Authors
Jones HJ, Gage SH, Heron J, Hickman M, Lewis G, Munafò MR, Zammit S.
<h4>Importance</h4>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.<h4>Objectives</h4>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.<h4>Design, setting, and participants</h4>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.<h4>Exposures</h4>Depending on the analysis model, exposures were longitudinal classes of substance use or psychotic experiences at age 12 years.<h4>Main outcomes and measures</h4>Logistic regression was used to examine the associations between substance use longitudinal classes and subsequent onset of psychotic experiences.<h4>Results</h4>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.<h4>Conclusions and relevance</h4>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.