Cited by 519Smoking Behavior and CessationSubstance Abuse Treatment and OutcomesMental Health Treatment and Access

The DOI matches its Crossref record; 47 of the 47 references it cites were found in a registry or an index.

Trends in Smoking Among Adults With Mental Illness and Association Between Mental Health Treatment and Smoking Cessation

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Cook, Benjamin Lê, Wayne, Geoff Ferris, Kafali, E. Nilay, Liu, Zimin, Shu, Chang, Flores, Michael·2014·JAMA

DOI 10.1001/jama.2013.284985PMC PMC5555156

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Abstract

IMPORTANCE: Significant progress has been made in reducing the prevalence of tobacco use in the United States. However, tobacco cessation efforts have focused on the general population rather than individuals with mental illness, who demonstrate greater rates of tobacco use and nicotine dependence. OBJECTIVES: To assess whether declines in tobacco use have been realized among individuals with mental illness and examine the association between mental health treatment and smoking cessation. DESIGN, SETTING, AND PARTICIPANTS: Use of nationally representative surveys of noninstitutionalized US residents to compare trends in smoking rates between adults with and without mental illness and across multiple disorders (2004-2011 Medical Expenditure Panel Survey [MEPS]) and to compare rates of smoking cessation among adults with mental illness who did and did not receive mental health treatment (2009-2011 National Survey of Drug Use and Health [NSDUH]).The MEPS sample included 32,156 respondents with mental illness (operationalized as reporting severe psychological distress, probable depression, or receiving treatment for mental illness) and 133,113 without mental illness. The NSDUH sample included 14,057 lifetime smokers with mental illness. MAIN OUTCOMES AND MEASURES: Current smoking status (primary analysis; MEPS sample) and smoking cessation, operationalized as a lifetime smoker who did not smoke in the last 30 days (secondary analysis; NSDUH sample). RESULTS: Adjusted smoking rates declined significantly among individuals without mental illness (19.2% [95% CI, 18.7-19.7%] to 16.5% [95% CI, 16.0%-17.0%]; P < .001) but changed only slightly among those with mental illness (25.3% [95% CI, 24.2%-26.3%] to 24.9% [95% CI, 23.8%- 26.0%]; P = .50), a significant difference in difference of 2.3% (95% CI, 0.7%-3.9%) (P = .005). Individuals with mental illness who received mental health treatment within the previous year were more likely to have quit smoking (37.2% [95% CI, 35.1%-39.4%]) than those not receiving treatment (33.1% [95% CI, 31.5%-34.7%]) (P = .005). CONCLUSIONS AND RELEVANCE: Between 2004 and 2011, the decline in smoking among individuals with mental illness was significantly less than among those without mental illness, although quit rates were greater among those receiving mental health treatment. This suggests that tobacco control policies and cessation interventions targeting the general population have not worked as effectively for persons with mental illness.

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BackgroundInfluential
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Background
Prevalence and Epidemiological Profile of Smokers in the Psychiatric Population and General Population
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BackgroundResultInfluential
A pilot study of wellness coaching for smoking cessation among individuals with mental illnesses
Gao, N., Solomon, P., Clay, Z., & Swarbrick, P. (2021) · Journal of Mental Health · doi:10.1080/09638237.2021.1922630 · Cited by 4
“To further compound the negative effects of smoking in this population, people with mental illnesses continue to have limited access to tobacco use screening and tobacco cessation programs (Gilbody et al., 2015; Lê Cook et al., 2014; Ruther et al., 2014; Swarbrick et al., 2017).”
Background
Comparison of Smoking Cessation Program Registration, Participation, Smoking Cessation Medication Utilization, and Abstinence Rates Between Smokers With and Without Schizophrenia, Schizo-affective Disorder, or Bipolar Disorder
Kertes, J., Stein-Reisner, O., Grunhaus, L. J., Nezry, R., Alcalay, T., Azuri, J., & Neumark, Y. D. (2021) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntab202 · Cited by 4
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“[5] There are several explanations for the high rates of smoking among persons with any mental illness, SMI in particular.”
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Background
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“2% compared to 31% decline between 2005 and 2015) [2, 3, 12].”
Background
A retrospective cohort study of the prevalence of anxiety and agitation in schizophrenic smokers and the unmet needs of smoking cessation programs
Hassanzadah, M., Bitar, A. H., Khanfar, N. M., Khasawneh, F. T., Lutfy, K., & Shankar, G. S. (2019) · Medicine · doi:10.1097/md.0000000000017375 · Cited by 4
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Background
Exploring the Association between Suicidality and Smoking Behavior among School-Based Children in Lao People’s Democratic Republic (PDR)
Kim, H. H., Kim, E. M., & Kim, E. M. (2019) · Journal of Psychoactive Drugs · doi:10.1080/02791072.2019.1707914 · Cited by 4
“Our strategy is based on the recognition that there is a shortage of research on smoking behaviors among those with psychological distress, especially in connection with developing effective cessation strategies (Aubin et al. 2012; Catchpole et al. 2017; Le Cook et al. 2014).”
Background
Feasibility of a Consumer Centred Tobacco Management intervention in Community Mental Health Services in Australia
Johnson, S. E., Mitrou, F., Lawrence, D. M., Zubrick, S. R., Wolstencroft, K., Ennals, P., Hall, C., & McNaught, E. (2020) · Community Mental Health Journal · doi:10.1007/s10597-020-00573-z · Cited by 4
“Compared to a steady decline over past decades in the general population, smoking rates have remained relatively high among people with mental illness and high distress (Cook et al. 2014; Cooper et al. 2012; Lawrence and Williams 2016; Prochaska et al. 2017; Szatkowski and McNeill 2015).”
Background
Proactive tobacco treatment for veterans with posttraumatic stress disorder.
Hammett, P. J., Japuntich, S. J., Sherman, S. E., Rogers, E., Danan, E. R., Noorbaloochi, S., Shahawy, O. E., Burgess, D. J., & Fu, S. S. (2020) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000613 · Cited by 4
“…of mental health treatment engagement observed among those with PTSD, which in itself is associated with a lower probability of quitting smoking (Cook et al., 2014), is also an indication that this group may be less likely to engage in cessation counseling or coaching compared to those without…”
Result
Trends in smoking among adults with serious psychological distress during comprehensive tobacco control in New York City, 2003–2012: Table 1
Jasek, J. P., Williams, J. M., Mandel-Ricci, J., & Johns, M. (2014) · Tobacco Control · doi:10.1136/tobaccocontrol-2014-052024 · Cited by 4
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Examining service participation and outcomes from a population-level telephone-coaching service supporting changes to healthy eating, physical activity and weight: A comparison of participants with and without a mental health condition
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The PSY-SIM Model: Using Real-World Data to Inform Health Care Policy for Individuals With Chronic Psychotic Disorders
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Associations of the density and proximity of the outlets of tobacco and other nicotine-containing products with increased levels of depression, anxiety and stress among the population of 3 Russian regions
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Reducing excess mortality in severe mental illness - a narrative review
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“Smoking prevalence is alarmingly high among persons with mental and/or substance use disorders (Kalman, Morissette, & George, 2005), and has not followed the decline observed in the general U.S. population in recent years (Cook et al., 2014; Secades-Villa et al., 2013).”
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The Psychometric Properties of the Minnesota Tobacco Withdrawal Scale Among Patients With Mental Illness
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“At the same time, the rates of smoking among people with SMI remain high, leading to an increasing gap in smoking prevalence between people with and without SMI in the general population (Lê Cook et al., 2014).”
Background
Variation in characteristics of people with mental disorders across smoking status in the Canadian general population
Dahal, R., Bhattarai, A., & Adhikari, K. (2020) · Tobacco Prevention & Cessation · doi:10.18332/tpc/127523 · Cited by 3
Moderating effect of loneliness on the relationship of housing instability and food insecurity with smoking behavior
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“Smoking is worsening global epidemics such as tuberculosis, HIV infection, alcohol abuse, and mental health (Calvo et al., 2015; Cook et al., 2014; Leung et al., 2015).”
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Association between Low-Dose Computed Tomography Results and 1-Year Smoking Cessation in a Residential Smoking Cessation Program
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An Exploration of Smoking Patterns Among People with Serious Mental Illness Attending an Outpatient Clinic in Qatar
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“Moreover, smokers with psychiatric illnesses tend to be heavier smokers, are considered more nicotine-dependent, and have been reported to suffer from more significant withdrawal symptoms upon smoking cessation.(10,11) There is also evidence that nicotine interferes with antipsychotic medications by increasing the met…”
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Physical health of individuals with psychosis – a mixed method study
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“Additionally, smoking rates among people with SMIs are higher than in the general population (Lê Cook et al., 2014), and are not following the downward trend seen over the past few decades in the general population (Szatkowski & McNeill, 2015).”
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Mortality in Qatari individuals with mental illness: a retrospective cohort study
Ouanes, S., Hashem, L. A., Makki, I., Khan, F., Mahgoub, O., Wafer, A., Dulaimy, O., Amro, R., & Ghuloum, S. (2024) · Annals of General Psychiatry · doi:10.1186/s12991-024-00499-w · Cited by 3
“While smoking is often reported to be more common in people with mental illness in Western countries than in people without, with this gap widening over time [27], this does not seem to be necessarily the case in the Qatari population.”
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Nicotine’s Effects on Schizophrenia-like Symptoms in a Mice Model: Time Matters
Dutra-Tavares, A. C., Couto, L. A., de Souza, T. P., Bandeira-Martins, A., Silva, J. O., Filgueiras, C. C., Ribeiro‐Carvalho, A., Manhães, A. C., & Abreu‐Villaça, Y. (2024) · Brain Sciences · doi:10.3390/brainsci14090855 · Cited by 3
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Broughan, J., McCombe, G., Lim, J., O’Keeffe, D., Brown, K., Clarke, M., Corcoran, C., Hanlon, D., Kelly, N., Lyne, J., et al. (2021) · Early Intervention in Psychiatry · doi:10.1111/eip.13234 · Cited by 3
“…and health risk behaviours including substance use, poor nutrition and sedentariness (Aubin et al., 2012; Auther et al., 2012; Dutta et al., 2012; Gurillo et al., 2015; Krishnadas et al., 2012; Lê Cook et al., 2014; McCreadie, 2003; Saddichha et al., 2008; Shiers et al., 2009; Stubbs et al., 2018).”
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Consumers With Serious Mental Illness Perspectives on Care Integration: Preparation for Integration
Fisher, K. M., Weissinger, G., O’Rorke, R., Edwards, E., & Diamond, G. S. (2022) · Journal of the American Psychiatric Nurses Association · doi:10.1177/10783903221091974 · Cited by 3
“Primary and preventive care, which is associated with decreased healthcare costs (Friedberg et al., 2010), is significantly underutilized by people with SMI, while emergency services are overutilized (Lê Cook et al., 2014; Niedzwiecki et al., 2018).”
Background
Implications of Rural Residence and Single Mother Status for Maternal Smoking Behaviors
Talbot, J. A., Szlosek, D. A., & Ziller, E. C. (2015) · Cited by 3
An audit of the management of nicotine withdrawal in an Australian inpatient unit: are we there yet?
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Offer and Use of Smoking-Cessation Support by Depression/Anxiety Status: A Cross-Sectional Survey
McGowan, J., Brown, J., West, R., Brose, L. S., & Shahab, L. (2018) · The Journal of Smoking Cessation · doi:10.1017/jsc.2018.1 · Cited by 3
Self-perceived Mental Health and Population-level Tobacco Use Disparities
Miller, M. E., Tidey, J. W., Bunn, J. Y., Gaalema, D. E., Scott‐Sheldon, L. A. J., Pericot‐Valverde, I., & Japuntich, S. J. (2018) · Tobacco Regulatory Science · doi:10.18001/trs.4.4.1 · Cited by 3
“We created 3 use categories: (1) current use (every day or some days); (2) former use (ever use but no current use); and (3) non-use (no history of use).”
BackgroundMethod
Extended Nicotine Patch Treatment Among Smokers With and Without Comorbid Psychopathology
Carroll, A. J., Mathew, A. R., Leone, F. T., Wileyto, E. P., Miele, A., Schnoll, R. A., & Hitsman, B. L. (2018) · Nicotine & Tobacco Research · doi:10.1093/ntr/nty191 · Cited by 3
“Following an intention-to-treat model, participants were classified as nonabstinent if they (1) reported smoking a cigarette, even just a puff, in the past 7 days; (2) provided a carbon monoxide reading at least 10 ppm; or (3) could not be reached or were not able to provide a carbon monoxide sample.”
Method
Characterizing e-cigarette use in veteran smokers with mental health conditions
Wang, J., Rogers, E., Fu, S. S., Gravely, A. A., Noorbaloochi, S., & Sherman, S. E. (2019) · The Journal of Smoking Cessation · doi:10.1017/jsc.2019.16 · Cited by 3
The role of key workers in improving physical health in first episode psychosis: A scoping review
Lim, J., McCombe, G., Harrold, Á., Brown, K., Clarke, M., Hanlon, D., Hennessy, L., O’Brien, S., Lyne, J., Corcoran, C., et al. (2020) · Early Intervention in Psychiatry · doi:10.1111/eip.12937 · Cited by 3
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Self- Evaluation Tool to Support Implementation of Treatment for Tobacco Use Disorder in Behavioral Health Programs
Covell, N. H., Foster, F. P., Lipton, N., Kingman, E., Tse, J., Aquila, A., & Williams, J. M. (2021) · Community Mental Health Journal · doi:10.1007/s10597-021-00890-x · Cited by 3
The Association Between Tobacco Retailer Outlet Density and Prevalence of Cigarette Smoking in Virginia
Lin, S.-Y., Zhou, W., Koch, J. R., Barnes, A. J., Yang, R., & Xue, H. (2022) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntac154 · Cited by 3
Examining trends in health care access measures among low-income adult smokers in Ohio: 2012–2019
Teferra, A. A., Wing, J. J., Lü, B., Xu, W., Roberts, M. E., & Ferketich, A. K. (2023) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2022.102106 · Cited by 4
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Oral health inequality in people with severe mental illness: a cross-sectional study using National Health and Nutrition Examination Survey 1999-2016Preprint
Kang, J. X., Wu, J., Aggarwal, V. R., Shiers, D., Doran, T., & Palmier‐Claus, J. E. (2021) · medRxiv · doi:10.1101/2021.03.17.21253840 · Cited by 3
The Effect of Safety Net Generosity on Maternal Mental Health and Risky Health BehaviorsPreprint
Schmidt, L., Shore-Sheppard, L. D., & Watson, T. E. (2021) · SSRN Electronic Journal · doi:10.2139/ssrn.3926939 · Cited by 3
Tobacco Prevention and Cessation
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The Problem of Dual Diagnosis
Bennett, M. E., Peer, J. E., & Muralidharan, A. (2018) · Wiley eBooks · doi:10.1002/9781394258970.ch3 · Cited by 3
Impact of Polysubstance Use on Major Depression, Serious Psychological Distress, and Mental Illness among US Adults
Khan, M. T. F., Mazumder, S., Rana, M. S., & Rahman, M. M. (2025) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-025-01520-3 · Cited by 2
“Some studies (Cook et al., 2014; Stanton et al., 2016) showed a significant positive association between nicotine addiction and psychotic disorders.”
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“Individuals with MDD tend to smoke more heavily and suffer worse health outcomes than those without MDD (Lê Cook et al., 2014), and smoking itself is linked to a higher risk of developing MDD (Fluharty, Taylor, Grabski, & Munafò, 2017).”
Efficacy of Varenicline for Smoking Cessation in Bipolar Disorder
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“In addition, psychiatric patients use a higher number of cigarettes and exhibit less success in SC compared to those without PDs (Cook et al., 2014), dying an average of 5 years earlier from causes associated with tobacco use, such as cardiovascular, respiratory, and oncologic diseases (Centers for…”
Background
Innovations in Care Delivery for Patients With Serious Mental Illness Among Accountable Care Organizations
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Risk prevalence, readiness and confidence to change lifestyle risk factors among clients of community mental health services
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Result
Exercise and Smoking Cessation
Garey, L., Thai, J. M., Zvolensky, M. J., & Smits, J. A. J. (2024) · Current topics in behavioral neurosciences · doi:10.1007/7854_2024_497 · Cited by 2
The Overlooked Risk of Venous Thromboembolism in Psychiatric Patients: Epidemiology, Pathophysiology, and Implications for Clinical Care
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Smoking cessation and exercise: perspectives from smokers with and without mental health problems
Schöttl, S. E., Scheibner, L., Frühauf, A., Kopp-Wilfling, P., Edlinger, M., Holzner, B., & Kopp, M. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1589719 · Cited by 3
“Efforts to support people to quit smoking are primarily aimed at the general public, as people with MHP are a hard-to-reach group for health interventions and differ in some aspects from the general population (35, 36).”

Authors: Cook, B. L., Wayne, G. F., Kafali, E. N., Liu, Z., Shu, C., & Flores, M.
Affiliations: Cambridge Health Alliance (US)
Harvard Medical School/Cambridge Health Alliance, Department of Psychiatry, Cambridge, Massachusetts
Southwest University (CN)
Harvard University (US)
Brown University (US)
ORCID: Cook, Benjamin Lê
Kafali, E. Nilay
Liu, Zimin
Shu, Chang
Flores, Michael
Venue: JAMA
Publisher: American Medical Association (AMA)
Published: 2014-01-08
Volume: 311
Issue: 2
Pages: 172
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.2013.284985
PMC: PMC5555156
OpenAlex: W2028087632
Cited by: 519
References: 46
Citations by year: 2026: 17 · 2025: 32 · 2024: 21 · 2023: 38 · 2022: 59 · 2021: 46 · 2020: 54 · 2019: 59 · 2018: 47 · 2017: 46 · 2016: 44 · 2015: 35 · 2014: 18
FWCI: 31.69
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: JAMA (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health (5r01mh091042-02)
National Institute on Aging (T32AG023482)
National Institute of Mental Health (R01-MH091042)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Keywords: smoking, tobacco use, mental illness, smoking cessation, psychotherapy, nicotine dependence, tobacco use trends, depression, psychological distress, tobacco cessation interventions, tobacco control, adults with mental illness, tobacco harm reduction
MeSH terms: Adolescent, Adult, Aged, Mental Disorders, Female, Health Surveys, Humans, Male, Mental Health, Middle Aged, Smoking, Social Control, Formal, Tobacco Use Disorder, United States, Prevalence, Smoking Cessation, Young Adult

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Trends in Smoking Among Adults With Mental Illness and Association Between Mental Health Treatment and Smoking Cessation

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