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. 2025 Oct 10;15(10):e101066.
doi: 10.1136/bmjopen-2025-101066.

Tobacco-related toxicant exposure among people with and without experience of psychosis: findings from the US Population Assessment of Tobacco and Health study

Eve Taylor  1   2 , Ann McNeill  2 , Harry Tattan-Birch  3 , Tim Marczylo  4 , Katherine East  2   5 , Deborah Robson  2
Affiliations

Tobacco-related toxicant exposure among people with and without experience of psychosis: findings from the US Population Assessment of Tobacco and Health study

Eve Taylor et al. BMJ Open. .

Abstract

Objective: Smoking and vaping are especially prevalent among people with experience of psychosis (EoP), potentially increasing their toxicant exposure. Switching from tobacco smoking to vaping e-cigarettes reduces exposure to tobacco-related toxicants and likely associated diseases. We compared levels of nicotine and tobacco-related toxicant exposure among people with versus without EoP.

Design: Cross-sectional study, secondary data analysis of Wave 5 (2018) of the Population Assessment of Tobacco and Health Study.

Setting: Data collection took place in the USA at the home of participants.

Participants: Data were from 5750 adults (aged >18 years) with and without EoP who smoked, vaped, did both or did neither. EoP was defined as ever being told by a health professional that you have schizophrenia, schizoaffective disorder, psychosis, a psychotic illness or psychotic episode.

Primary outcome: Levels of urinary toxicants: nicotine metabolites, metals, volatile organic compounds (VOCs) and tobacco-specific nitrosamines (TSNAs) among people with and without EoP. Analyses were adjusted for demographics, cannabis use and past 30-day smoking/vaping status, and were repeated after stratifying by smoking /vaping status.

Results: Of the 5750 participants, 6.3% (n=361) reported EoP, and 93.7% reported no EoP. Levels of nicotine and TSNA metabolites, cadmium, uranium and some VOCs were significantly higher among participants with EoP compared with those without. However, when smoking, vaping and cannabis use were taken into account, the associations of EoP with nicotine and TSNA metabolites, and most of the VOCs, were attenuated and no longer significant.

Conclusion: Participants with EoP are exposed to more nicotine and tobacco-related toxicants than those without EoP, likely largely due to the high prevalence of smoking, vaping and cannabis use among this population.

Keywords: Schizophrenia & psychotic disorders; TOXICOLOGY; Tobacco Use.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1. Geometric mean levels of cotinine, NNAL, cadmium and 3-HPMA by EoP and vaping/smoking status. EoP, experience of psychosis; NNAL, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol; 3-HPMA, N-Acetyl-S-(3-hydroxypropyl)-L-cysteine.
See this image and copyright information in PMC

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