People with mental illness are 70 percent more likely to smoke cigarettes than people without mental illness, two federal health agencies reported Tuesday.
Data of the Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration show 1 of every 3 adults with mental illness smokes, compared with 1 in 5 adults without mental illness.
Adults with mental illness smoke about a third of all the cigarettes in the United States, and they smoke more cigarettes per month and are significantly less likely to quit than people without mental illness, the report said. There are nearly 46 million adults with mental illness in the United States, about a fifth of the population.
“Many people with mental illness are at greater risk of dying early from smoking than of dying from their mental-health conditions,” said Dr. Thomas Frieden, director of the CDC.
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The report is based on information from the National Survey on Drug Use and Health, which interviewed 138,000 adults in their homes from 2009 to 2011. People were asked 14 questions to assess psychological distress and disability, and were deemed to have mental illness if their responses indicated they had a mental, behavioral or emotional disorder in the past 12 months. Those with substance abuse or developmental disorders were not considered people with mental illness. The report did not include patients in psychiatric hospitals or individuals serving in the military.
People who reported smoking all or part of a cigarette in the previous 30 days were counted as smokers.
The study found that smoking rates for people with mental illness were generally higher in states where overall smoking rates were high. Utah had the lowest rate of smoking among people with mental illness — 18.1 percent — while West Virginia had the highest rate, at 48.7 percent. Smoking among people with mental illness was higher among the poor and less educated, and among American Indians and Alaska Natives, although every ethnic group had significant percentages of smokers.
The study noted possible reasons that smoking among the mentally ill has been and remains high, including marketing by the tobacco industry and the historical use of cigarettes as an incentive to improve behavior in psychiatric hospitals.
“There are some effects of nicotine which can mask some of the negative effects of mental illness,” Frieden said. The study said that smoking also can make some medications less effective, which may lead the person with mental illness to smoke more to quell symptoms.
It said people with mental illness, many of whom struggle to be financially and socially stable, may be less able to cope with withdrawal from quitting cigarettes.
While the study did not compare trends in smoking among people with mental illness over time, Frieden and Douglas Tipperman, lead public-health adviser on tobacco prevention for the Substance Abuse and Mental Health Services Administration, cited indications that smoking rates for this population have not declined nearly as quickly as smoking in the general population.
Frieden called the situation “a very serious health issue that needs more attention.”