An online survey of tobacco use, intentions to quit, and cessation strategies among people living with bipolar disorder

Abstract

Objectives Tobacco use is prevalent among people living with bipolar disorder. We examined tobacco use, quit attempts, and tobacco-related attitudes and intentions among 685 individuals with bipolar disorder who smoked ≥ 100 cigarettes in their lifetime. Methods Data were collected online through the website of the Depression and Bipolar Support Alliance a mood disorder peer-support network. Results The sample was 67% female, 67% aged 26 to 50, and 89% Caucasian; 87% were current smokers; 92% of current smokers smoked daily, averaging 19 cigarettes/day (SD=11). The sample began smoking at a mean age of 17 years (SD=6) and smoked a median of 7 years prior to bipolar disorder diagnosis. Among current smokers, 74% expressed a desire to quit; intent to quit smoking was unrelated to current mental health symptoms, χ2(3)= 5.50, p=.139. Only 33% were advised to quit smoking by a mental health provider, 48% reported smoking to treat their mental illness, and 96% believed being mentally healthy was important for quitting. Ex-smokers (13% of sample) had been quit a median of 2.7 years; 48% quit “cold turkey.” Most ex-smokers (64%) were in poor or fair mental health when they quit smoking. At the time of the survey, however, more ex-smokers described their mental health as in recovery than current smokers (57% vs. 40%, χ2(3)=11.12, p=.011). Conclusions Most smokers living with bipolar disorder are interested in quitting. The Internet may be a useful cessation tool for recruiting and potentially treating smokers with bipolar disorder who face special challenges when trying to quit and rarely receive cessation treatment from their mental health providers.

A mixed-method systematic review and meta-analysis of mental health professionals' attitudes toward smoking and smoking cessation among people with mental illnesses

“…Indeed, UK clinical guidelines on smoking cessation in secondary care advise that all health and social care practitioners in in‐patient and community‐based mental health services identify smokers and offer advice and assistance to quit 11. However, smokers with mental illness are less likely to be offered advice and support to quit than those without 12, 13.…”

Correlates of Current Smoking Among Adults Served by the Public Mental Health System

“…They also have a higher smoking prevalence, greater level of nicotine dependence, lower smoking cessation rates, and disproportionate health and financial burdens from smoking (Williams, Steinberg, Griffith, & Cooperman, 2013). Considerable evidence suggests that adults with mental illnesses are seldom offered smoking cessation treatment by service providers (Himelhoch & Daumit, 2003;Prochaska et al, 2011; Substance Abuse and Mental Health Services Administration, 2014a) and remain unaware that effective, evidence-based interventions are available (Christiansen et al, 2016). Coupled with this, little is known about the factors associated with current smoking in this population that impede efforts to design smoking cessation interventions that address its special needs and circumstances.…”

Smokers with serious mental illness and requests for nicotine replacement therapy post-hospitalisation

“…11 Several studies have reported equal interest in quitting among smokers with SMI relative to the general population, [12][13][14] and a few studies have examined interest in or use of cessation medications. In an online survey, 78% of 685 smokers with bipolar disorder expressed a desire to use cessation pharmacotherapy to quit smoking, 15 and in two treatment studies with psychiatric outpatients interested in quitting, over 80% of participants randomised to intervention used study-provided 16 and clinic-provided 17 NRT. In a treatment study in which desire to quit was not required to enrol, 34% of depressed outpatients entered cessation treatment that included a behavioural component plus NRT.…”