Mentally Ill Smoke 30% of All Cigarettes

Federal survey results indicate that smoking intensities as well as smoking rates are dramatically higher in the mentally ill compared with other Americans, officials said Tuesday.

A joint "Vital Signs" report from the CDC and the Substance Abuse and Mental Health Services Administration (SAMHSA) indicated that, among adults who reported symptoms consistent with a recognized mental illness, 36.1% were current smokers, compared with 21.4% of the rest of the population.

The report, based on data from the 2009-2011 National Survey on Drug Use and Health, also found that 30.9% of all cigarettes consumed in the U.S. were smoked by the mentally ill. In part, this disproportion reflects heavier smoking in the mentally ill, with an average of 331 cigarettes per month compared with 310 in the rest of the smoking population.

Individuals classified as mentally ill in the study represented 19.9% of the sample surveyed after weighing to reflect the general population's demographics.

Excluded from smoking analyses were individuals in institutions and those considered to have alcohol and substance use disorders.

During a telephone briefing for reporters, Douglas Tipperman, MSW, a tobacco prevention specialist at SAMHSA, said the higher smoking incidence among the mentally ill is an outgrowth of lower quit rates.

More than half of the non-mentally ill population who has ever smoked has since quit. But among the mentally ill, only about 34% of ever-smokers have succeeded in quitting, Tipperman said.

Several barriers help prevent mentally ill smokers from quitting, said Tipperman and CDC Director Thomas Frieden, MD, MPH, who also spoke at the briefing.

These include the symptom relief that some mentally ill people experience with smoking, marketing efforts by tobacco companies directed at the mentally ill, and mistaken beliefs by healthcare providers that smoking cessation may worsen patients' mental illness.

Frieden cited his own experience, noting that his first job was as an aide at a psychiatric hospital. There, he witnessed cigarettes being handed out to patients as rewards for good behavior, he said.

The point was echoed in the Vital Signs report, which cited two recent reviews indicating that mental health facilities have used smoking privileges as rewards.

Asserting that "about a thousand Americans are killed every day by tobacco," Frieden said that smoking is more dangerous to the mentally ill in most cases than their mental illnesses.

Both he and Tipperman said that clinicians, policymakers, and patients themselves should increase their efforts to curb smoking in what the report called this "uniquely vulnerable population."

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By John Gever, Senior Editor, MedPage Today