Risk and protective factors for alcohol and tobacco related disorders: An umbrella review of observational studies

Marco Solmi; Serena Civardi; Roberto Corti; John Anil; Jacopo Demurtas; Shannon Lange; Joaquim Radua; Elena Dragioti; Paolo Fusar-Poli; Andre F Carvalho

doi:10.1016/j.neubiorev.2020.11.010

Risk and protective factors for alcohol and tobacco related disorders: An umbrella review of observational studies

Neurosci Biobehav Rev. 2021 Feb:121:20-28. doi: 10.1016/j.neubiorev.2020.11.010. Epub 2020 Nov 25.

Authors

Affiliations

¹ Neuroscience Department, University of Padua, Italy; Padua Neuroscience Center, University of Padua, Italy; Early Psychosis: Interventions and Clinical-detection (EPIC) Laboratory, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. Electronic address: marco.solmi@unipd.it.
² Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
³ North American College of Information Technology, Scarborough, Canada.
⁴ Primary Care Department, Azienda Usl Toscana Sud Est, Grosseto, Italy.
⁵ Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.
⁶ Early Psychosis: Interventions and Clinical-detection (EPIC) Laboratory, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Spain; Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden.
⁷ Pain and Rehabilitation Center and Department of Medicine and Health Sciences (IMH), Faculty of Health Sciences University of Linköping, SE- 581 85 Linköping, Sweden.
⁸ Early Psychosis: Interventions and Clinical-detection (EPIC) Laboratory, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; OASIS Service, South London and Maudsley National Health Service (NHS) Foundation Trust, London, United Kingdom.
⁹ IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia; Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto, ON, Canada.

PMID: 33248149
DOI: 10.1016/j.neubiorev.2020.11.010

Abstract

The credibility of evidence of various environmental risk factors for alcohol and tobacco use disorders (AUD/TUD) needs to be graded to identify groups to target with selective prevention. A systematic umbrella review was conducted (PubMed/PsycINFO), grading credibility of meta-analyses of prospective/retrospective observational cohort studies assessing risk/protective factors for AUD/TUD, applying established quantitative criteria. Sensitivity analyses were conducted. Quality of eligible meta-analyses was assessed with AMSTAR-2. Out of 8464 unique references, 80 full text articles were scrutinized, and 12 meta-analyses, corresponding to 21 individual estimates of 12 putative risk/protective factors (n = 241,300), were included. In main analyses no association had convincing nor highly suggestive evidence for AUD/TUD. Six associations had suggestive evidence for AUD, two for TUD. Among these, in sensitivity analyses without >1000 cases criterion, convincing evidence emerged for parental alcohol supply, and impulsivity traits in college students for AUD, and attention-deficit/hyperactivity disorder for TUD. Other associations were supported by weak evidence/were not nominally significant. Few risk factors identified at-risk groups where selective preventative strategies could be developed to prevent AUD/TUD.

Keywords: Alcohol; Meta-analysis; Prevention; Risk factor; Smoking; Substance use; Systematic review; Tobacco; Umbrella review.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Alcoholism*
Humans
Nicotiana* / adverse effects
Observational Studies as Topic*
Prospective Studies
Protective Factors
Retrospective Studies
Risk Factors
Tobacco Use Disorder*