Gender-specific profiles of tobacco use among non-institutionalized people with serious mental illness

Abstract

BackgroundIn many countries, smoking remains the leading preventable cause of death. In North America, reductions in population smoking levels are stabilising and, in recent years, those involved in tobacco control programming have turned their attention to particular segments of society that are at greatest risk for tobacco use. One such group is people with mental illness. A picture of tobacco use patterns among those with mental illness is beginning to emerge; however, there are several unanswered questions. In particular, most studies have been limited to particular in-patient groups. In addition, while it is recognised that men and women differ in relation to their reasons for smoking, levels of addiction to nicotine, and difficulties with cessation, these sex and gender differences have not been fully explored in psychiatric populations.MethodsCommunity residents with serious mental illness were surveyed to describe their patterns of tobacco use and to develop a gender-specific profile of their smoking status and its predictors.ResultsOf 729 respondents, almost one half (46.8%) were current tobacco users with high nicotine dependence levels. They spent a majority of their income on tobacco, and reported using smoking to cope with their psychiatric symptoms. Current smokers, compared with non-smokers, were more likely to be: diagnosed with a schizophrenia spectrum disorder (rather than a mood disorder); male; relatively young; not a member of a racialised group (e.g., Aboriginal, Asian, South Asian, Black); poorly educated; separated or divorced; housed in a residential facility, shelter, or on the street; receiving social assistance; and reporting co-morbid substance use. There is evidence of a gender interaction with these factors; in the gender-specific multivariate logistic regression models, schizophrenia spectrum disorder versus mood disorder was not predictive of women's smoking, nor was education, marital status or cocaine use. Women, and not men, however, were more likely to be smokers if they were young and living in a residential facility.ConclusionFor men only, the presence of schizophrenia spectrum disorder is a risk factor for tobacco use. Other factors, of a social nature, contribute to the risk of smoking for both men and women with serious mental illness. The findings suggest that important social determinants of smoking are "gendered" in this population, thus tobacco control and smoking cessation programming should be gender sensitive.

Cigarette smoking among psychiatric patients in Brazil

“…In addition, the relatively high price of cigarettes in Brazil, considered the highest in the world, may also have contributed to this reduction 30 . Our results are corroborated by the findings of studies in high income countries that observed a higher rate of current smoking prevalence among patients with mental illnesses than in the general population 5,6,7 . However, it is important to note that the psychiatric patients from our sample did not start smoking earlier (mean age = 16 years) than the general population (13 to 15 years of age) 29 .…”

“…As in other studies, an association was found between current smoking and several sociodemographic characteristics, including being male, older age, low education level 6,11,13,14,16 , and history of homelessness 40,41 , while a negative association was found between smoking and practicing a religion 42,43 . A low level of education may be considered a marker for low access to knowledge and understanding of the harmful effects of tobacco 16 .…”

“…Several studies have found an association between smoking and the level of severity of mental illness 5,6,7,8,19 . Although no independent association was observed between smoking and more severe psychiatric diagnoses (psychoses and bipolar disorders), we found a strong independent association between smoking and substance use disorders.…”

“…The prevalence of current smoking among people with mental illness is higher than in the general population in the USA (34.8% and 28.5%, respectively) 5 , Canada (46.8% and 14%, respectively) 6 , and Australia (31.2% and 18.7%, respectively) 7 . In Australia, a study showed that prevalence is higher among patients with severe mental illness than in people with general mental illness (51.2% and 26.4%, respectively) 7 , while in Canada smoking prevalence was 51.8% in patients with schizophrenia compared to 39.2% among those with mood disorder or anxiety 6 . A more recent study of a nationally representative probability sample of 9,282 people in the USA showed that adults affected by a mental disorder in the past 12 months smoked almost twice as much as adults without mental disorders 8 .…”

“…On the other hand, female and younger smokers had higher rates of mental disorders than male or older smokers, respectively 8 . Behavioral correlates of smoking, including alcohol and illicit drug use, are also more common among psychiatric patients 6,12,13,14,15,16 .…”