Mentally Ill Americans Represent 30% Of US Smoking Population

Due to sustained efforts by the government and introduction of multiple awareness programs, the prevalence of cigarette smoking has reduced considerably all over the United States. However, in certain specific sub-populations, like persons with mental illness, the prevalence of cigarette smoking still remains pretty high. This has been revealed in the recent issue of Vital Signs, a weekly published by the Centers of Disease Control and Prevention.

Tobacco is one of the leading causes of mortality and morbidity in the U.S.

It accounts for 443,000 premature deaths annually. Apart from the deaths, it can cause multiple diseases like diseases of the cardiovascular system, cancers, lung diseases, affliction of the mother and her fetus during pregnancy and exacerbation of pre-existing chronic illnesses.

Tobacco related diseases are a huge drain on the state exchequer too

Treating such ailments costs America $96 billion in direct medical expenses every year. It also costs $97 billion as lost productivity annually. Keeping in mind these factors, the state has formulated the “healthy people 2020 target” of reducing the prevalence of cigarette smoking in adults to ≤12%.

But the latest report, compiled by the 2009-2011 National Survey on Drug Use and Health (NSDUH) has found that

It was seen that almost 19.9% of American adults (45.7 million) above the age of 18 suffered from some kind of mental ailment. Of all the cigarettes smoked by adults aged ≥18 years, 30.9% were smoked by adults with a mental illness. When the population of current smokers was considered, it was seen that adults who did not suffer from mental illness smoked 310 cigarettes in the preceding month compared to 331 cigarettes by people who had any mental illness. Even when comparing the rates of quitting, people with mental illness lagged behind. The quit ratio among adults without mental illness was found to be as high as 53.4% compared to 34.7% in people with mental illness.

Among people with mental illness, the prevalence was higher in men (39.6%) compared to women (33.8%). It was highest in men in the age group of 18 to 24 (41.6%) compared to men above the age of 65 (13.0%). When ethnicity was taken into account it was seen that the prevalence of cigarette smoking was the lowest in Asian men (20.6%) and the highest in whites (37.7%). But Asian men with mental illness were twice as likely to be smokers compared to Asian men without mental illness. In Asian women, this difference was three times. It was also noticed that the prevalence of smoking was higher in adults living below the federal poverty levels (47.9%). When adults with any mental illness above the age of 25 were considered, the prevalence of cigarette smoking was the lowest among college graduates (18.7%).

The lowest prevalence of smoking was noticed in the West and the Northeast. States with lowest rate of prevalence of smoking did so by implementation of comprehensive tobacco control programs and several population based interventions. Certain states promoted Medicaid coverage to cessation treatments in order to remove the cost barriers.

Why Is The Prevalence Of Smoking Higher In Mentally Ill Patients?

Researchers tried to analyze the reasons behind the high rate of cigarette smoking and low levels of quitting in the mentally ill population and have come up with several explanations. According to them, this is most likely because of the following factors:

• Nicotine stimulates the central nervous system and can elevate the mood. People suffering from any mental illness are usually depressed and nicotine present in cigarettes can temporarily mask these negative symptoms.

• Certain constituents of tobacco smoke accelerate the metabolism of some medicines used in the treatment of mental illnesses. As these medicines are removed from the blood stream faster, there is an increased compensatory intake of nicotine.
• It has been seen that 80% of the smokers start smoking in their youth. Mentally ill youth who are depressed because of their illness are more receptive to cigarette advertisements and may start smoking.
• People from tobacco industry regularly fund studies which show that nicotine consumption helps in alleviation of mood in mentally ill patients. They provide free or cheap cigarettes to institutions taking care of the mentally ill, and support efforts which try to block actions to make psychiatric facilities smoke-free.
• Persons suffering from mental illnesses often live in stressful conditions and do not have access to means to help them deal with withdrawal symptoms. They may also be ignorant about the deleterious effects of smoking on health.

Researchers have found that psychiatric facilities are also to be blamed for the high rate of prevalence of smoking amongst the mentally ill. They found that:

• Many health care providers felt that withdrawing nicotine would interfere with the treatment of the mentally ill patients.
• Health care providers feel that mentally ill patients who smoke would not like to give it up. They also feel that it would be difficult them to wean these patients off cigarettes.
• Many psychiatric facilities use cigarettes as rewards. The patients are handed out cigarettes as reward for putting up good behavior.

However, researchers say that mentally ill patients are just as inclined to give up smoking as their normal counterparts. The only problem is that helping them quit smoking is a more intensive and long process.

The experts have pointed out that it is our duty to prevent the sub-population of mentally ill from the disastrous consequences of smoking. What is required is a strong will power, sustained efforts to raise awareness, and more collaboration between tobacco control programs and facilities for mentally ill patients at national, state and local levels. Proper integration of tobacco dependence treatment in psychiatric facilities and making policies to make such facilities as smoke free zones would go a long way in helping mentally ill smokers to quit smoking. Continued surveillance to monitor the implementation of these programs and their progress is necessary to make such interventions successful.