Influence of tobacco control policies on smokers with poor mental health

Background: While certain tobacco control policies are effective in reducing smoking rates in the general population, their impact on smokers with poor mental health, a group with high rates of smoking, is largely unknown. We examined the effect of tobacco control policies on adult smoking by mental health status among a nationally representative sample from the 2006 Behavioral Risk Factor Surveillance System.

Methods: Self-reported mental health was measured by the number of days in the previous month respondent's mental health was “not good” and was categorized into three groups: 0, 1-29 and all 30 days. Aggregated state tobacco control indicators (smoke-free air law and cigarette excise tax) were merged into the database. We conducted logistic regression with SUDAAN software to adjust for the complex sample design.

Results: Participants with the poorest mental health had the highest rates of smoking (38.1%), followed by those with some poor mental health days (23.3%) and those with good past month mental health (16.7%). Current smoking for each category of mental health was lower among those in states with more stringent smoke-free air laws compared to those with less stringent laws. Likewise, smoking rates were lower among those in states with higher cigarette excise taxes across all mental health categories. After adjusting for demographic characteristics, the effects of smoke-free air laws and excise taxes were similar across all levels of mental health.

Conclusions: Effective tobacco control policies, such as smoke-free air laws and taxation, similarly influence smokers with poor mental health.