Resumen de Trends in Smoking Among Adults With Mental Illness and Association Between Mental Health Treatment and Smoking Cessation
Benjamin Lê Cook, Geoff Ferris Wayne, E. Nilay Kafali, Zimin Liu, Chang Shu, Michael Flores
Importance Significant progress has been made in reducing the prevalence of tobacco use in the United States. However, tobacco cessation efforts have focused on the general population rather than individuals with mental illness, who demonstrate greater rates of tobacco use and nicotine dependence.
Objectives To assess whether declines in tobacco use have been realized among individuals with mental illness and examine the association between mental health treatment and smoking cessation.
Design, Setting, and Participants Use of nationally representative surveys of noninstitutionalized US residents to compare trends in smoking rates between adults with and without mental illness and across multiple disorders (2004-2011 Medical Expenditure Panel Survey [MEPS]) and to compare rates of smoking cessation among adults with mental illness who did and did not receive mental health treatment (2009-2011 National Survey of Drug Use and Health [NSDUH]).The MEPS sample included 32 156 respondents with mental illness (operationalized as reporting severe psychological distress, probable depression, or receiving treatment for mental illness) and 133 113 without mental illness. The NSDUH sample included 14 057 lifetime smokers with mental illness.
Main Outcomes and Measures Current smoking status (primary analysis; MEPS sample) and smoking cessation, operationalized as a lifetime smoker who did not smoke in the last 30 days (secondary analysis; NSDUH sample).
Results Adjusted smoking rates declined significantly among individuals without mental illness (19.2% [95% CI, 18.7-19.7%] to 16.5% [95% CI, 16.0%-17.0%]; P < .001) but changed only slightly among those with mental illness (25.3% [95% CI, 24.2%-26.3%] to 24.9% [95% CI, 23.8%- 26.0%]; P = .50), a significant difference in difference of 2.3% (95% CI, 0.7%-3.9%) (P = .005). Individuals with mental illness who received mental health treatment within the previous year were more likely to have quit smoking (37.2% [95% CI, 35.1%-39.4%]) than those not receiving treatment (33.1% [95% CI, 31.5%-34.7%]) (P = .005).
Conclusions and Relevance Between 2004 and 2011, the decline in smoking among individuals with mental illness was significantly less than among those without mental illness, although quit rates were greater among those receiving mental health treatment. This suggests that tobacco control policies and cessation interventions targeting the general population have not worked as effectively for persons with mental illness.
Despite significant progress made in reducing tobacco use within the general population, individuals with mental illness smoke at rates approximately twice that of adults without mental disorders1,2 and comprise more than half of nicotine-dependent smokers.2,3 Smoking rates are even higher among individuals with multiple lifetime psychiatric diagnoses,2 schizophrenia,4 and other severe mental illnesses.5 Mental illness is associated with higher levels of nicotine dependence, intensity of smoking, and smoking severity (ie, number of cigarettes/wk)6 and with less success in quitting.2,7 Smoking is believed to account for the majority of excess mortality among individuals with serious mental illness,8 and life expectancy among people with severe mental illness is 25 years less than that among the general population.9 Recent studies suggest that smokers with mental illness are highly motivated to quit10 and may do so without aggravating psychiatric symptoms if provided with appropriate support.11 Evidence-based tobacco cessation modules and interventions that integrate mental health and substance abuse treatment12,13 are now readily available and well suited to be integrated into psychotherapy.14 However, it is rare for behavioral health specialists to incorporate behavioral interventions or pharmacological treatments to reduce patient smoking.15 To our knowledge, there have been no studies that examine smoking trends among persons with mental illness. The role of the mental health system in reducing rates of smoking within this key population is also poorly understood. We therefore compared smoking trends between 2004 and 2011 among individuals with and without mental illness and assessed whether these trends vary by treatment for mental illness and by type of diagnosis.
