Smoking Rates Remain High Among Those With Mental Health Conditions

man smoking cigarette
man smoking cigarette
Nationwide initiatives to decrease cigarette smoking prevalence have not accommodated individuals with mental health or substance use disorders.

Study results published in the Journal of Clinical Psychiatry suggest an increase in nondaily cigarette smoking among individuals with common mental health disorders or substance use problems during the last several years.

Researchers extracted data from the National Survey on Drug Use and Health for the 2005 to 2014 interval. Data captured sociodemographic characteristics, along with tobacco use and any mental health or substance use problems (MHSUP) among participants. Logistic regression analyses were performed to describe the associations between these variables.

During the study period, current cigarette smoking use declined across all participants. In 2014, 38.45% of individuals with MHSUP and 15.36% of individuals without MHSUP reported current cigarette smoking compared with 43.22% and 38.45%, respectively, in 2005 (P <.001). Rates of daily smoking declined in both study groups across the study period (P <.001), although rates of daily smoking among the MHSUP group were twice that of the non-MHSUP group (24.21% vs 10.21%; P <.001). Although overall smoking prevalence declined during the study period, nondaily cigarette smoking increased significantly among individuals with MHSUP (P =.001) from 2005 to 2014.

Specifically, nondaily smoking rates increased among individuals with substance use disorders only (adjusted OR [aOR], 1.02; 95% CI, 1.01-1.02), individuals with mental health disorders only (aOR, 1.01; 95% CI, 1.00-1.02), and individuals with MHSUP (aOR, 1.03; 95% CI, 1.01-1.05). Individuals without any MHSUP experienced a decline in nondaily smoking (aOR, 0.99; 95% CI, 0.98-0.99). The rate of increase in nondaily smoking during the study period was most rapid among those with MHSUP, followed by those with substance abuse disorders alone and then those with mental health disorders alone. The rate of decline in nondaily smoking among individuals without MHSUP was much less rapid than any rates of change associated with MHSUP individuals (P <.001).

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These data highlight the vulnerabilities of individuals with MHSUP and suggest that nationwide initiatives to decrease cigarette smoking prevalence have not accommodated individuals with mental health or substance use disorders. From a policy perspective, these results support the development of a tobacco control initiative that directly addresses mental health and substance abuse issues among communities. For clinicians, this data may be useful for recognizing the specific needs of patients with MHSUP and developing appropriate intervention strategies.


Weinberger AH, Streck JM, Pacek LR, Goodwin RD. Nondaily cigarette smoking is increasing among people with common mental health and substance use problems in the United States: data from representative samples of US adults, 2005-2014. J Clin Psychiatry. 2018;79(5):17m11945.