Disparities in cigarette smoking: Smoking behaviors and cessation attempts of persons with lifetime mental illnesses

Smoking is the leading cause of preventable death in the U.S. Previous research suggests persons with mental illnesses are twice as likely to smoke as other persons. Due to the negative health consequences of smoking, it is pertinent to investigate the smoking patterns of persons with mental illnesses. To address this public health concern, we used cross-sectional data from the 2007 National Health Interview Survey (n=23,393) to assess current smoking behaviors (prevalence, frequency and intensity) and cessation attempts among persons with lifetime diagnosed mental illnesses. Weighted and age-adjusted percentages for current smoking were calculated among persons with a lifetime diagnosed mental illness (Bipolar disorder, Schizophrenia, Attention Deficit Disorder (ADD)/Hyperactivity, Dementia, and phobias/fears) and by number of mental illnesses.

Age-adjusted smoking prevalence ranged from 34.3% (phobias/fears) to 64.9% (Schizophrenia) compared to 19.8% of the general population. The majority of persons with mental illnesses reported smoking everyday (>75%). Approximately 43.8% of the general population attempted to quit smoking in the past year; whereas, 55.1% of persons with ADD/Hyperactivity and 39.3% of persons with Schizophrenia reported attempting to quit smoking. Smoking frequency and intensity increased with the number of co-morbid mental illnesses, whereas the number of quit attempts did not change. Consistent with previous research, persons with mental illnesses had higher prevalence of current smoking than the general population, and persons with Schizophrenia reported a smoking prevalence 3.3 times that of the general population. Our findings underscore the importance of recognizing that mental illness and smoking often co-occur when considering cessation efforts.