There has been emerging evidence of an association between tobacco smoking and schizophrenia spectrum disorders (SSD). Two meta-analyses have reported that people who smoke tobacco have an ~2-fold increased risk of incident schizophrenia or psychosis, even after adjusting for confounding factors. This study aimed to critically appraise the research which has examined the association between tobacco smoking and SSD against the Bradford Hill criteria for causality, to determine the strength of the evidence for a causal relationship. Eight longitudinal studies (seven cohort studies and one case control study) were identified which examined tobacco smoking as an exposure and psychosis as an outcome. All seven cohort studies were assessed as being of high quality using the Newcastle-Ottawa Scale. Six of the eight studies found a statistically significant positive association between tobacco smoking and onset of SSD. These studies reported a consistent association with a moderate to large effect size and a dose response relationship. The studies adjusted for multiple potential confounders including age, sex, socioeconomic status, shared genetic risk, prodromal symptoms, and comorbid cannabis and other substance use. The studies did not adjust for exposure to childhood trauma or prenatal tobacco. There was substantial though inconclusive evidence supporting a causal relationship between tobacco smoking and increased risk of SSD. If a causal relationship does exist, nicotine is most likely responsible for this association. This raises serious public health concerns about the increasing use of e-cigarettes and other products, particularly by adolescents whose nicotine use may increase their risk of SSD. Research is urgently needed to examine the association between e-cigarette use and incident psychosis, particularly in adolescents and young adults.

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A commonly suggested strategy for addressing bullying is for victims to seek help from a trusted person. Despite this recommendation, there are a group of adolescent victims who choose not to seek help. This study aimed to identify factors associated with not seeking help among adolescents who experienced bullying victimisation. A sub-sample of youth who self-reported being bullied (N = 652) was drawn from an Australian nationally representative household survey of adolescents aged 11-17 years (N = 2,967). Adolescent participants and their parents completed survey items on demographics, bullying experiences, mental health, school, and family characteristics. Overall, 45.3% of bullied adolescents did not seek help. Neither the type, frequency, nor levels of distress caused by the bullying victimisation were associated with helpseeking. Age was no longer associated with increased odds of not seeking help for bullying victimisation, after controlling for mental health, social, and interpersonal functioning. In a multivariate logistic regression model examining demographic, mental health, social, and interpersonal factors, those with poorer prosocial skills, lower perceived social support, and higher internet use had increased odds of not seeking help for bullying victimisation (