Predictors of starting to smoke cigarettes in patients with first episode psychosis.
BACKGROUND
Cigarette smoking is common in psychotic disorders and may be initiated in an attempt to control features of illness. However, genetic, obstetric and early life conditions are risks for starting to smoke in the general population but their role in psychotic patients is unclear.


METHODS
Smoking history and the putative predictors of starting to smoke were assessed in a community-wide sample of 115 first episode psychosis patients. The proportion that initiated smoking was compared with that from population surveys and the impact of risk factors was assessed within the patient sample.


RESULTS
Most patients began smoking before illness onset and the proportion who initiated smoking was significantly high by the onset of a functional decline. Gestational tobacco exposure was a risk for smoking and was also associated with low birthweight, poor academic achievement, and obesity. Low familial socioeconomic position but not familial psychiatric problems also predicted smoking initiation.


CONCLUSIONS
In most cases, smoking preceded illness onset and was not a response to early features of illness. General population predictors of starting to smoke were also associated with smoking initiation in psychotic patients. Of these risks, exposure to tobacco during gestation is noteworthy in that it affects brain development and is associated with cognitive, behavioral, psychiatric and general health problems. In addition, nicotine interacts with other substances of abuse. The initiation of smoking before illness onset and the association with developmental problems raises the question of whether cigarette smoking influences some aspects of illness in patients with psychosis.
Smith
Geoffrey N
GN
University of British Columbia, Vancouver, Canada. geoffsm@interchange.ubc.ca
Wong
Hubert
H
MacEwan
G William
GW
Kopala
Lili C
LC
Ehmann
Thomas S
TS
Thornton
Allen E
AE
Lang
Donna J
DJ
Barr
Alasdair M
AM
Procyshyn
Ric
R
Austin
Jehanine C
JC
Flynn
Sean W
SW
Honer
William G
WG
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D004522:Educational Status; D005192:Family Health; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications; D015995:Prevalence; D011618:Psychotic Disorders / Q000523:psychology*; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology*; D012959:Socioeconomic Factors; D055815:Young Adult