Trends in Prevalence of Cigarette Smoking Among US Adults With Major Depression or Substance Use Disorders, 2006-2019

Abstract

IMPORTANCE Tobacco use is highly concentrated in persons with mental illness.OBJECTIVES To assess trends in past-month prevalence of cigarette smoking among adults with vs without past-year depression, substance use disorders (SUDs), or both, using nationally representative data. DESIGN, SETTING, AND PARTICIPANTS Exploratory, serial, cross-sectional study based on data from 558 960 individuals aged 18 years or older who participated in the 2006-2019 US National Surveys on Drug Use and Health. EXPOSURE Past-year major depressive episode (MDE) and SUD using Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) criteria. MAIN OUTCOMES AND MEASURES Past-month self-reported cigarette use, adjusted for sociodemographic characteristics. RESULTSOf the sampled 558 960 adults, 41.4% (unweighted) were aged 18 to 25 years, 29.8% (unweighted) were aged 26 to 49 years, and 53.4% (unweighted) were women. From 2006 to 2019, the past-month self-reported cigarette smoking prevalence declined significantly among adults with MDE from 37.3% to 24.2% for an average annual percent change of −3.2 (95% CI, −3.5 to −2.8; P < .001), adults with SUD from 46.5% to 35.8% for an average annual percent change of −1.7 (95% CI, −2.8 to −0.6; P = .002), and adults with co-occurring MDE and SUD from 50.7% to 37.0% for an annual average annual percent change of −2.1 (95% CI, −3.1 to −1.2; P < .001). The prevalence declined significantly for each examined age, sex, and racial and ethnic subgroup with MDE and with SUD (all P < .05), except for no significant changes in American Indian or Alaska Native adults with MDE (P = .98) or with SUD (P = .46). Differences in prevalence of cigarette smoking between adults with vs without MDE declined significantly for adults overall from 11.5% to 6.6%, for an average annual percent change of −3.4 (95% CI, −4.1 to −2.7; P < .001); significant average annual percent change declines were also seen for men (−5.1 [95% CI, −7.2 to −2.9]; P < .001); for women (−2.7 [95% CI, −3.9 to −1.5]; P < .001); for those aged 18 through 25 years (−5.2 [95% CI, −7.6 to −2.8]; P < .001); for those aged 50 years or older (−4.7 [95% CI, −8.0 to −1.2]; P = .01); for Hispanic individuals (−4.4 [95% CI, −8.0 to −0.5]; P = .03), and for White individuals (−3.6 [95% CI, −4.5 to −2.7]; P < .001). For American Indian or Alaska Native adults, prevalence did not significantly differ between those with vs without MDE during 2006-2012 but was significantly higher for those with MDE during 2013-2019 (difference, 11.3%; 95% CI, 0.9 to 21.7; P = .04). Differences among those with vs without SUD declined for women for an average annual percent change of −1.8 (95% CI, −2.8 to −0.9; P = .001). CONCLUSIONS AND RELEVANCEIn this exploratory, serial, cross-sectional study, there were significant reductions in the prevalence of self-reported cigarette smoking among US adults with major depressive episode, substance use disorder, or both, between 2006 and 2019. However, continued efforts are needed to reduce the prevalence fur...

Trends in cigarette use and health insurance coverage among US adults with mental health and substance use disorders

“…The prevalence of smoking in the United States has fallen dramatically over the past 50 years, from 42 to 14% of the adult population [1]. Meanwhile, prevalence among individuals with mental health and substance use disorders (MH/SUD) has shown more limited reduction [2–4]. Risk ratios for smoking are 2.1 for any current psychiatric diagnosis; between 2 and 3 for many common individual diagnoses including depression, anxiety and alcohol use disorder; and greater than 3 for dual disorders and drug use disorders [5–7].…”

“…These findings are consistent with the potential role of health insurance expansion in improving tobacco‐related health outcomes among underserved populations, including lower income adults and those with MH/SUD. Although nationally representative trends in smoking for adults with MH/SUD have declined since the passage of the ACA [4], little has been reported about how insurance coverage changes have been associated with changes in smoking rates among adults with MH/SUD.…”

Incorrect Reference

“…From 2006 to 2019, the difference in past-month prevalence of cigarette smoking between individuals with and without MDE declined significantly from 11.5% to 6.6%. 1 Prior studies [2][3][4] have not demonstrated declines in pastmonth prevalence of cigarette smoking in individuals with SUD and other mental illnesses, highlighting the novelty of our findings. 1 Furthermore, among adults with MDE and/or SUD, our results showed that the lifetime prevalence of cigarette smoking did not decline as much as past-month prevalence, indicating that the reductions in past-month smoking were due to quitting at some time after onset of smoking.…”

“…Thus, tobacco cessation explains the relative improvements in pastmonth prevalence of cigarette smoking. 1 Our study 1 demonstrates that progress has been made by public health tobacco control measures and prevention intervention efforts for adults in the US, including those with MDE or SUD. However, higher past-month prevalence of smoking persists among adults with MDE or SUD, highlighting the ongoing need for smoking cessation efforts that target these individuals.…”

“…Incorrect Reference: In the US Preventive Services Task Force review titled "Screening for Impaired Visual Acuity in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force," 1…”