SMOKING, SUICIDE AND MENTAL HEALTH: USING POLICY CHANGE TO PROBE CAUSALITY

吸烟和自杀之间的联系已经被反复记录在案，然而， 吸烟直接导致自杀的风险是有争议的，确切的证据仍然难以捉摸。但 越来越多的研究表明，吸烟可能直接增加患精神疾病的风险， 可能会增加自杀风险。 这项提案的全球目标是研究吸烟是否是自杀的一个促成因素， 近端不良心理健康结果。我们将利用国家烟草控制政策的自然变化， 减少吸烟率的实验。我们建议，由于他们的影响， 吸烟，这些政策干预也会影响自杀和心理健康问题的风险，包括 滥用药物我们将研究加强烟草控制政策是否会降低风险 自杀和不良心理健康后果的风险。此外，我们将研究这些协会是否 是吸烟者特有的，正如我们的模型所预测的那样。 我们讨论了我们的概念验证研究，该研究表明，加强国家烟草控制政策 对应于自杀风险的降低。我们提出了一项为期三年的研究，旨在扩大这一发现， 超过100万名调查参与者的数据，包括吸烟测量和前瞻性死亡率随访。 这将使一个更强大的分析设计比我们最初的研究。我们亦会研究 烟草政策变化与精神疾病和其他不良心理健康结果的关联， 包括自杀行为这将使我们能够确定吸烟可能通过的具体渠道， 影响心理健康。我们将利用具有全国代表性的大量流行病学数据， 进行这些分析，并应用复杂的分析技术，减少观察到的作用， 未观察到的混杂因素。 这些研究将对科学产生重大影响，因为它们是一个新兴的工作体系的一部分， 挑战传统的解释，即吸烟与精神健康的联系是由于“自我药疗”。这 这项工作还将对公共卫生和政策产生影响，为以下方面的成本/效益分析提供关键参数： 烟草控制政策。我们的假设的证实可能会导致人们更加认识到 戒烟的精神健康患者，也促使基础研究人员更密切地审查 尼古丁对心理健康相关表型的影响。后一项贡献可能至关重要，因为 新兴的烟草产品越来越受欢迎。

The association between smoking and suicide has been repeatedly documented, yet the proposition that smoking contributes directly to suicide risk is controversial and definitive evidence remains elusive. However, a growing body of research suggests that smoking may directly increase risk for psychiatric disorders, which would likely increase suicide risk. The global aim of this proposal is to examine whether smoking is a contributing cause for suicide and more proximal adverse mental health outcomes. We will leverage state tobacco control policy changes as natural experiments that lead to reduced prevalence of smoking. We propose that, as a result of their influence on smoking, these policy interventions also influence risk for suicide and mental health problems, including substance misuse. We will examine whether strengthening of tobacco control policies results in reduced risk for suicide and for adverse mental health outcomes. Furthermore, we will examine whether these associations are specific to smokers, as predicted by our model. We discuss our proof-of-concept study, which shows that strengthening of state tobacco control policies corresponds to reductions in suicide risk. We propose a three-year study that seeks to extend this finding using data on over one million survey participants with smoking measurements and prospective mortality follow-up. This will enable a much a much stronger analytical design than our initial study. We will also examine the associations of tobacco policy changes with psychiatric disorders and other adverse mental health outcomes, including suicidal behavior. This will enable us to identify specific channels through which smoking might influence mental health. We will take advantage of large, nationally representative epidemiological data to conduct these analyses and apply sophisticated analytic techniques that reduce the role of observed and unobserved confounders. These studies would have substantial impact on science by being a part of an emerging body of work that is challenging the traditional interpretation of the smoking-mental health link being due to “self-medication.” This work will also have impact on public health and policy by providing key parameters to cost/benefit analyses of tobacco control policies. Confirmation of our hypotheses could result in increased awareness of the importance of smoking cessation for mental health patients, and also prompt basic researchers to more closely scrutinize the influence of nicotine on phenotypes relevant to mental health. This latter contribution could be critical as emerging tobacco products grow in popularity.