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Low stress resilience in late adolescence and risk of smoking, high alcohol consumption and drug use later in life
  1. Beatrice Kennedy1,2,
  2. Ruoqing Chen1,3,
  3. Fang Fang3,
  4. Unnur Valdimarsdottir3,4,5,
  5. Scott Montgomery1,6,7,
  6. Henrik Larsson1,3,
  7. Katja Fall1,3
  1. 1 Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
  2. 2 Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
  3. 3 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
  4. 4 Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
  5. 5 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  6. 6 Department of Epidemiology and Public Health, University College London, London, UK
  7. 7 Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Dr Beatrice Kennedy, Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro 702 81, Sweden; beatrice.kennedy{at}


Background While compromised stress resilience constitutes a recognised risk factor for somatic and psychiatric disease development in general, the knowledge about how individual variation in vulnerability to stress may specifically influence the long-term risks of disadvantageous health behaviours is limited.

Methods In this Swedish cohort study, we aimed to investigate the association between stress resilience in late adolescence and adult use of addictive substances. We included 9381 men with information on psychological stress resilience measured during military conscription examinations, who later responded to an extensive health survey (mean age 34.0±7.2 years) including detailed information on substance use. We modelled continuous outcomes using linear regression, binary outcomes with logistic regression and other categorical outcomes with multinomial logistic regression.

Results We found that low stress resilience in adolescence conferred increased risks of all studied measures of addictive behaviour. After adjusting for childhood socioeconomic information, low stress resilience was associated with adult current regular smoking (relative risk ratio: 5.85, 95% CI 4.32 to 7.93), higher nicotine dependence scores (beta: 0.76, 95% CI 0.29 to 1.23), hazardous use of alcohol (>14 alcoholic drink-equivalents per week, OR: 1.72, 95% CI 1.37 to 2.16), DSM-IV criteria for alcohol dependence (OR: 1.74, 95% CI 1.35 to 2.25), and drug use (OR: 1.77, 95% CI 1.51 to 2.08). The results remained largely unchanged after further adjustments for adult educational attainment and occupation as well as for additional conscription covariates.

Conclusion Low stress resilience in late adolescence appears to be associated with an increased risk of disadvantageous and addictive health behaviours in adulthood.

  • epidemiology
  • health behaviour
  • psychological stress
  • smoking
  • alcohol

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  • BK and RC contributed equally.

  • Contributors All authors devised the hypothesis and designed the study. KF and HL acquired the data. RC performed the statistical analyses. BK conducted the literature review and wrote the first draft. All authors participated in critical revision of the manuscript. FF and KF are the study supervisors. BK and RC are equal contributors and BK will act as guarantor. All authors have had full access to all of the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding This project was funded by a European Research Council Consolidator Grant (grant number 726413) awarded to UV, by the Swedish Council for Information on Alcohol and Other Drugs (grant number 2017-0095) awarded to KF and by Karolinska Institutet through a Senior Researcher Award as well as a Strategic Research Area in Epidemiology Award, both awarded to FF.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement We do not have ethical approval to share our data, but it originates from Swedish national registers and can be obtained from the relevant authorities for research by others who have ethical permission.