Smoking, Mental Illness, and Public Health

Abstract

Tobacco use remains the leading preventable cause of death worldwide. In particular, people with mental illness are disproportionately affected with high smoking prevalence; they account for more than 200,000 of the 520,000 tobacco-attributable deaths in the United States annually and die on average 25 years prematurely. Our review aims to provide an update on smoking in the mentally ill. We review the determinants of tobacco use among smokers with mental illness, presented with regard to the public health HAVE framework of “the host” (e.g., tobacco user characteristics), the “agent” (e.g., nicotine product characteristics), the “vector” (e.g., tobacco industry), and the “environment” (e.g., smoking policies). Furthermore, we identify the significant health harms incurred and opportunities for prevention and intervention within a health care systems and larger health policy perspective. A comprehensive effort is warranted to achieve equity toward the 2025 Healthy People goal of reducing US adult tobacco use to 12%, with attention to all subgroups, including smokers with mental illness.

A retrospective analysis of the comparative effectiveness of smoking cessation medication among individuals with mental illness in community‐based mental health and addictions treatment settings

“…Overall, individuals with a current psychiatric condition have three times the odds of smoking, and with each additional psychiatric diagnosis, the odds of smoking increases by 67% (Smith, Mazure, & McKee, 2014). Thus, treating tobacco use among individuals with mental illnesses is crucial given that tobacco control efforts in the general population are not effectively reaching them (Prochaska, Das, & Young-Wolff, 2017;Schroeder & Morris, 2010).…”

Smoking, psychiatric illness and the brain

“…1 Rates of smoking are markedly higher among people with psychiatric illness than in the general population, estimated at being 2-5 times higher in patients with several disorders, including schizophrenia, mood disorders, anxiety disorders, attentiondeficit/hyperactivity disorder (ADHD), binge eating disorder, bulimia and substance use disorders. [2][3][4][5] The aim of this editorial is to emphasize the importance of smoking as a factor that should regularly be considered as a potential confound in neurobiological studies of psychiatric illnesses. Smoking can be regarded as playing at least several roles in relation to psychiatric illness -as a causal factor contributing to psychiatric disorders, as an agent causing brain changes on its own that may interact with psychiatric pathophysiology, or as a modulator of effects of psychotropic medications.…”

“…It has been estimated that approximately 40% of premature deaths in the United States caused by smoking occur in individuals with a mental illness. 2 In addition to effects on general health, smoking cessation may positively impact psychiatric symptomatology. For example, a recent metaanalysis found reductions in measures of anxiety and depression after smoking cessation, with an effect size at least as great as that for antidepressant treatments and a similar effect size in both the general population and populations with psychi atric disorders.…”

The Convention on the Rights of Persons with Disabilities as a tobacco control tool in the mental health setting

“…Smoke-free laws, especially in indoor areas, are essential for protecting the health of others. While over 1.3 billion people are already protected by comprehensive smoke-free laws,27 many of these laws do not cover mental health institutions 49. This is detrimental to the health of patients, their visitors and staff, and normalises smoking in the institutional mental health setting and makes it more difficult for patients to give up smoking.…”