The individual and joint associations of alcohol use and cigarette smoking in adolescence and early adulthood with psychological distress in midlife - a multicohort study

BackgroundAlcohol and tobacco use are associated with later mental health and psychological well-being, yet the associations of combined use of alcohol and tobacco with psychological well-being throughout the life span remain understudied. The aim of this study is to examine the separate and combined associations of heavy episodic drinking (HED) and daily cigarette smoking in adolescence and early adulthood with midlife psychological distress across four prospective cohort studies from Finland and Sweden. MethodsData for this prospective multicohort study were drawn from four longitudinal studies: the TAM cohort (N=1334), the FinnTwin16 Study (N=4409), and the Northern Finland Birth Cohort 1966 (NFBC1966, N=7147) from Finland, and the Individual Development and Adaptation Study (IDA, N=514) from Sweden. HED was measured as drunkenness or using 60g or more pure alcohol on one occasion, smoking as daily cigarette use, and psychological distress using the 12-item General Health Questionnaire. ResultsNo clear evidence for individual or combined associations of HED or smoking in adolescence or early adulthood with midlife distress were found. The results were overall systematic across all cohorts. ConclusionsIn contrast to prior research based on diagnostic criteria, this multicohort study found no evidence that heavy episodic drinking or daily cigarette smoking in adolescence or early adulthood-- individually or combined--are associated with midlife psychological distress when assessed using subclinical symptom measures. These findings, overall consistent across four longitudinal cohorts, suggest that the relationship between early substance use and later mental health may be weaker than previously assumed when studied using non-diagnostic indicators.