Trends in smoking and tobacco product use among individuals with mental illness 2005-2010

Significant progress has been made in reducing the prevalence of tobacco use in the United States. However, individuals with mental illness demonstrate greater rates of tobacco use than the general population and comprise between 33% and 50% of remaining smokers. We examine whether declines in tobacco use in the general population have also been realized among individuals with mental illness, assess whether those with and without mental illness differ with regard to product type preferences (e.g. high nicotine, menthol, lower perceived risk) and measure whether these differences vary by race/ethnicity. We use six years (2005-2010) of data from the National Survey on Drug Use and Health (NSDUH). We compare rates of smoking, product preferences and trends using logistic regression models, adjusting for mental illness, time, age, race/ethnicity, gender, and socioeconomic status. Individuals diagnosed with major depressive episode (MDE) or as having severe psychological distress (SPD) increased their rates of nicotine dependence and use of full flavor cigarettes between 2005 and 2010 while the corresponding trends decreased among those without these conditions. Analyses by race/ethnicity of individuals with MDE or SPD demonstrate substantial increases between 2005 and 2010 in full flavor, high nicotine cigarette use among Asians (2.5% to 9.4%) and Latinos (10.8% to 14.7%) whereas white levels remained relatively steady (15.6% to 16.7%) and Black levels decreased but remained troublingly high (26.9% to 23.8%). A growing proportion of current smokers have mental illness and racial/ethnic minorities with mental illness may be particularly vulnerable to increased harm from tobacco use.