Smoking and Mental Illness

Tobacco use continues to be the leading cause of preventable death in the United States.^1,2 Despite increased evidence provided in the 2010 Surgeon General's report that cigarette smoking causes disease and that no level of cigarette use is safe,³ rates of cigarette use among certain groups of Americans remain high. One group with cigarette use that has garnered both increased attention and concern over the past decade is persons with mental illness. Previous research has shown that rates of cigarette use among persons with mental illness have been significantly higher than rates among persons who do not have mental illness.^4,5 This report uses data from the 2009 to 2011 National Surveys on Drug Use and Health (NSDUH) to provide up-to-date information on the relationship between smoking and mental illness.

NSDUH asks persons aged 18 or older if they ever smoked part or all of a cigarette. Respondents who had smoked are asked if they smoked in the past 30 days, the average number of cigarettes they used on days they smoked in the past 30 days, and if they ever had smoked daily. NSDUH also asks adult respondents questions about past year psychological symptoms in order to determine if they had any mental illness (AMI) in the past year. AMI among adults aged 18 or older is defined as having had a diagnosable mental, behavioral, or emotional disorder (excluding developmental and substance use disorders) of sufficient duration to meet diagnostic criteria specified within the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) during the year prior to the survey interview.⁶ An estimated 19.9 percent of adults had AMI.

This issue of The NSDUH Report compares past month cigarette use among adults with past year AMI to use among those with no past year mental illness. The report also includes a comparison of the prevalence of smoking cessation among adults with past year AMI with those with no past year mental illness. All findings presented in this report are annual averages based on combined 2009 to 2011 NSDUH data.

About 1 in 4 adults aged 18 or older (24.3 percent; 55.9 million persons) smoked cigarettes in the month prior to the survey. However, adults with past year AMI were more likely to have smoked than those without mental illness (36.1 vs. 21.4 percent) (Table 1). The association between cigarette use and mental illness was found among both genders and among age groups (Table 1), as well as among age groups within both genders (Figure 1). For example, 45.6 percent of males aged 18 to 25 with AMI smoked in the past month, compared with 36.8 percent of males aged 18 to 25 without mental illness. Among females in this age group, 39.2 percent of those with AMI smoked in the past month, compared with 25.1 percent of those with no mental illness.

Rates of past month cigarette use among those who had smoked daily at some time in their lives (hereafter referred to as "lifetime daily smokers") indicate how smoking cessation has varied across population groups. High rates of past month cigarette use among lifetime daily smokers in specific population groups indicate that few people in those groups have quit smoking.

Two thirds (66.0 percent) of lifetime daily smokers with past year AMI smoked in the past month, compared with less than half (47.4 percent) of lifetime daily smokers without mental illness (Table 1). The association between past month cigarette use among lifetime daily smokers and mental illness was found among both genders and among age groups. With one exception, this pattern was also found among both age groups within both genders (Figure 2). For example, 73.6 percent of male lifetime daily smokers aged 26 to 49 with AMI smoked in the past month, compared with 60.9 percent of same-aged male lifetime daily smokers without mental illness. Among females in this age group, 71.2 percent of those with AMI smoked in the past month, compared with 59.4 percent of those with no mental illness. The single exception to this pattern was found among males aged 18 to 25; in this age group, male lifetime smokers with and without AMI were equally likely to have smoked in the past month.

Overall, the average number of cigarettes smoked in the past month was higher among adults aged 18 or older with past year AMI than among those who did not have AMI (331 vs. 310 cigarettes). For both genders and age groups, the number of cigarettes smoked was greater among those with AMI than among those without (Table 1). This pattern was also generally seen for age groups within both genders (Figure 3). For example, male smokers aged 18 to 25 with AMI smoked a greater number of cigarettes in the past month than those without mental illness (218 vs. 181 cigarettes). In the same age group, female smokers with AMI smoked an average of 190 cigarettes per month, whereas those without mental illness smoked an average of 167 cigarettes per month. The single exception to this pattern was among males aged 50 or older; for this group, the average number of cigarettes smoked was similar for current smokers with and without AMI.

National, State, and local smoking cessation campaigns have resulted in a significant reduction in the number of Americans who smoke. Although smoking has decreased, certain groups, such as persons with mental illness, have higher rates of smoking than the general population. The data from NSDUH indicate that adults with past year mental illness are more likely to be current smokers and less likely to have stopped smoking than adults who did not experience mental illness in the past year. Likewise, current smokers with past year mental illness smoke more cigarettes, on average, than do those without past year mental illness. Policymakers, mental health practitioners, and public health service providers can use this information to better understand and address the needs of this group to make progress in lowering the rates of smoking among persons with mental illness.

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