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

Abstract

Background: Tobacco control strategies have engendered overall declines in smoking; however, a large gap remains between people with and without mental health problems, causing substantial health inequalities. Population-level information on barriers and opportunities for improvements is scarce. We aimed to assess mental health status of cigarette smokers and recent ex-smokers (‘past-year smokers’) in England, and smoking and harm reduction behaviour and quit attempts by mental health status.Methods: Data were collected from 5,637 current and 434 recent ex-smokers in 2016/17 in household surveys of representative samples of adults. We calculated weighted prevalence of different indicators of mental health problem: a) ever diagnosis, b) none, moderate, serious past-month distress, c) past-year treatment. We compared weighted smoking status, cigarette type, dependence, motivation to stop smoking, cutting down, use of nicotine replacement therapy or e-cigarettes, short-term abstinence, and quit attempts according to mental health status. Results: Among past-year smokers: 35.9% ever had a diagnosis; 24.3% had experienced moderate, an additional 9.7% serious, past-month distress; 21.9% had had past-year treatment. Those with an indication of a mental health problem were more highly dependent and more likely to smoke roll-your-own cigarettes but also more likely to be motivated to stop smoking, to cut down, use nicotine replacement therapy or e-cigarettes and to have attempted to quit in the past year.Conclusions: About a third of cigarette smokers in England have mental health problems. Interventions should address their increased dependence and leverage higher prevalence of harm reduction behaviours, motivation to stop and attempts to stop smoking.

Smoking, distress and COVID-19 in England: Cross-sectional population surveys from 2016 to 2020

“…Older smokers were less likely to report psychological distress compared with younger groups ( Brose et al, 2020 ). These findings re-emphasise the need to address higher prevalence of poor mental health among younger smokers ( Pierce et al, 2020 , Pedersen and Von Soest, 2009 , Schmidt et al, 2019 ).…”

“…Our previous research has highlighted an age gradient in psychological distress among smokers, with younger groups reporting higher levels of distress compared with older age groups ( Brose et al, 2020 ). However, considering the sharp positive age gradient in the risk of death from COVID-19 ( Verity et al, 2020 ), deterioration in mental health during the pandemic may be more pronounced among older age groups.…”

“…Between 2016/2017 in England, 24.3% and 9.7% of past-year smokers indicated moderate and serious psychological distress in the past month, respectively ( Brose et al, 2020 ). Also, those with an indication of a mental health problem were more dependent on cigarettes but more likely to be motivated and have recently attempted to quit.…”