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CHA Researchers Find Mentally Ill Make Up a Growing Proportion of U.S. Smoking Population

New study finds significant declines in general population are not seen among mentally ill

Posted Date: 1/7/2014
Somerville, Mass. – Individuals with mental illness are nearly twice as likely to smoke as those without mental illness and make up more than half of nicotine-dependent smokers in the U.S., according to a new study led by a Harvard Medical School researcher. The study, published in the January 8th edition of JAMA, demonstrates that recent declines in smoking rates in the general population have largely bypassed those with mental illness.

“Individuals with severe mental illness have a life expectancy 25 years less than the rest of the population and their high rates of smoking explain a significant amount of this difference,” said lead author Benjamin Cook, PhD, MPH (pictured), an assistant professor of psychiatry at Harvard Medical School and a senior scientist at the Center for Multicultural Mental Health Research at Cambridge Health Alliance. “While the decline in smoking rates in the U.S. is commendable, we have to increase our focus on improving smoking cessation among individuals with mental illness.”

Using a dataset of 165,269 respondents from the Medical Panel Expenditure Survey, the authors identified a 20% decline in smoking rates for those without mental illness, whereas the rates among those with mental illness remained steady. This significant difference in trends persisted even after accounting for differences in income, education, employment, and other important characteristics.

“Policy efforts to reduce the health burden of tobacco use have been a remarkable public health success,” said study co-author Geoffrey Ferris Wayne, a leading tobacco control researcher. “That this success has not been realized among those with mental illness suggests the need for different approaches.”

Additionally, the researchers found that individuals receiving mental health treatment are not only less likely to smoke than those with mental illness who do not receive treatment, but also more likely to quit. “There has been a sense in the field that treating nicotine dependence is secondary or may even interfere with mental health treatment,” said Dr. Cook. “Our findings suggest that smokers do quit and abstain from cigarettes during mental health treatment. It’s a natural place for practitioners to address nicotine dependence because of the overlap between mental health and cessation therapies.”

In the study, the researchers suggest that overcoming barriers to accessing mental health care, increasing the supply of mental health care providers, and training more providers to provide cessation therapies can contribute to increasing smoking cessation among the mentally ill.

An area of concern identified was that individuals receiving treatment in psychiatric hospitals or other inpatient settings were not as likely to quit as those receiving treatment in community mental health centers and other outpatient settings. The authors point to prior studies documenting that clinicians have historically viewed smoking in inpatient settings as normal, and that cigarettes have been provided as a complement to patients in intensive psychiatric treatment.

“Views about smoking are starting to change for the better in mental health treatment settings, and clinicians are realizing that smoking cessation does not have to be an after thought in mental health care. Patients in mental health treatment are excellent candidates for smoking cessation therapies and smoking cessation can be administered so that it does not interfere with improving mental health symptoms,” said Dr. Cook. Additionally, many hospitals across the U.S. have become smoke-free and are beginning to encourage smoking cessation. “Hopefully these policies will come into the mainstream, and we will begin to see greater smoking rate declines among the mentally ill.”

This study was supported by the William F. Milton Fund and the National Institute of Mental Health.

“Trends in smoking among adults with mental illness and association between mental health treatment and smoking cessation.” Benjamin Lê Cook, PhD, MPH, Geoffrey Ferris Wayne, MA, E. Nilay Kafali, PhD, Zimin Liu, MA, Chang Shu, BS, and Michael Flores, MA. JAMA, January 8, 2014.

Cambridge Health Alliance is a vital and innovative community health system that provides essential services to Cambridge, Somerville, and Boston’s metro-north communities. It includes three hospital campuses, a network of primary care and specialty practices, and the Cambridge Public Health Department. CHA is a Harvard Medical School teaching affiliate and is also affiliated with Harvard School of Public Health, Harvard School of Dental Medicine, and Tufts University School of Medicine.