Mental health and smoking cessation—a population survey in England

Abstract

Background: To reduce inequalities between individuals with and without mental health problems, a better understanding is required of triggers and success of quit attempts among the third of smokers with mental health problems. The aim was to assess whether there are differences by mental health status in (i) triggers for quit attempts, (ii) use of evidence-based support (iii) and quit success. Methods: Monthly cross-sectional household surveys of representative samples of the adult population in England. In 2016/2017, 40,831 adults were surveyed; 1956 who had attempted to stop smoking cigarettes in the past year were included. Logistic regressions assessed associations between mental health (ever diagnosis, past-year treatment, past-month distress), triggers, support used and quit success, adjusting for sociodemographic and smoking characteristics. Results: Concern about future health, current health problems and expense of smoking were the most common triggers overall. For respondents with an ever diagnosis, past-year treatment or serious past-month distress, quit attempts were more frequently triggered by current health problems. Non-evidence-based support and e-cigarettes were used most often, and this did not differ by mental health status. Respondents with an ever diagnosis and moderate or serious distress were less likely to have used non-prescription nicotine replacement therapy (NRT). Respondents with past-year treatment or serious distress were more likely to have used prescription medication/ behavioural support. Quit success did not differ by mental health status. Compared with non-evidence-based support, non-prescription NRT conferred no benefit. There was some evidence that prescription medication/ behavioural support was beneficial (depending on outcome and adjustment, ORs ranged from 1.46, 95% CI 0.92-2.31, to 1.69, 1.01-2.86). E-cigarettes were associated with higher success rates after adjustment for different indicators of mental health (ORs ranged from 2.21, 1.64-2.98, to 2.25, 1.59-3.18). Conclusions: Smokers with mental health problems were more likely to have attempted to quit because of health problems and were more likely to have used gold standard support (medication and behavioural support) than other smokers. E-cigarettes were strongly associated with increased success and were used similarly by those with and without mental health problems, indicating that improved uptake of e-cigarettes for smoking cessation among smokers with mental health problems could help address inequalities.

Mental health, smoking, harm reduction and quit attempts – a population survey in England

“…Specific challenges such as higher dependence on tobacco need to be addressed by making effective support available. A combination of behavioural support and medication is most effective in the wider population of smokers and has been shown to be effective for smokers with severe mental illness [14,15] and for smokers with and without mental health problems making quit attempts [40]. In quit attempts and accompanied by behavioural support, e-cigarettes have been shown to be more effective than NRT [41].…”

“…In quit attempts and accompanied by behavioural support, e-cigarettes have been shown to be more effective than NRT [41]. In the Smoking Toolkit Study, they were also associated with increased success rates for smokers with and without mental health problems [40]. Additionally, smaller studies in smokers with severe mental illness who were not interested in quitting found that substantial proportions reduced their smoking by at least 50% when supplied with e-cigarettes [42,43].…”

Re-examining the Association Between E-Cigarette Use and Myocardial Infarction: A Cautionary Tale

“…-cigarettes have been heralded as effective tools for smoking cessation. 1 Cross-sectional analyses 2 and RCTs 3 show that e-cigarettes both are associated with and lead to superior smoking-cessation outcomes. That said, public health organizations and policymakers vary in whether they have embraced or resisted these products, due, in part, to uncertainties about the consequences of prolonged use.…”

Mental health, smoking, harm reduction and quit attempts – a population survey in England

“…Speci c challenges such as higher dependence on tobacco need to be addressed by making effective support available. A combination of behavioural support and medication is most effective in the wider population of smokers and has been shown to be effective for smokers with severe mental illness (14,15) and for smokers with and without mental health problems making quit attempts (40). In quit attempts and accompanied by behavioural support, e-cigarettes have been shown to be more effective than NRT (41).…”