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

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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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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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“A previous study has shown that patients receiving treatment for mental illness have higher quit rates than those who have mental illness but are not in psychiatric treatment [42].”
Background
Efficacy of Varenicline for Smoking Cessation between Smokers with and without Psychiatric Disorders: A 12-week Observational Study
Wei, H. T., Lin, W. C., Chen, Y. S., Lee, Y. C., Li, C., Huang, K., & Bai, Y. M. (2017) · Neuropsychiatry · doi:10.4172/neuropsychiatry.1000237
“While remarkable progress has also been made in reducing the prevalence of tobacco use in the general population from 2004 to 2011, the decline in smoking among individuals with mental illness has become much less [27].”
Background
Prevalência e perfil epidemiológico do uso de tabaco da população psiquiátrica dos níveis secundário e terciário de atenção comparados à população geral da rede básica de saúde
de Oliveira, R. M. (2017) · Digital Library of Theses and Dissertations (Universidade de São Paulo) · doi:10.11606/t.22.2017.tde-24012017-161236
Conceptual and theoretical foundations of health promotion education of student youth in conditions of postindustrial society
Madzhuga, A. G., Abdullina, L. B., SAMORODOV, D. P., & Malyarchuk, N. N. (2017) · Science for Education Today · doi:10.15293/2226-3365.1705.09
Tobacco Use in Adults With Mental Illness: An Overview of One State-Wide Tobacco Cessation Program
Sarfraz, N., Fils-Aime, Y., Brand, M. W., Vesely, S. K., & Beebe, L. A. (2018) · The Journal of Smoking Cessation · doi:10.1017/jsc.2018.27
Integrative Approach to Nicotine Use Disorder
Martarano, D. (2018) · doi:10.1093/med/9780190275334.003.0009
Psychological Health and Smoking in Young Adulthood: Smoking Trajectories and Responsiveness to State Cigarette Excise Taxes
Schmidt, A. M. (2019) · Carolina Digital Repository (University of North Carolina at Chapel Hill) · doi:10.17615/ef4w-5738
The Bad and Good News About Tobacco Treatment for People With Comorbid Conditions in the US Health Care System
Tidey, J. W. (2019) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntz150
Electronic cigarettes for smokers with schizophrenia spectrum disorders
Caponnetto, P. (2019) · Stirling Online Research Repository (University of Stirling)
Perfil pregresso e atual do uso de tabaco pela população psiquiátrica e a população geral
de Oliveira, R. M., Santos, J. L. F., & Furegato, A. R. F. (2019) · Revista de Salud Pública · doi:10.15446/rsap.v21n4.67831
“Esse resultado divergiu de pesquisas que mostram que embora os portadores de transtornos mentais almejem parar de fumar tanto quanto os demais fumantes, obtém menos sucesso em suas tentativas (29-33).”
Background
Effect of A Group Tobacco Cessation Behavioural Intervention Among Patients with Mental Illness in Kenya: Results from a Controlled Clinical TrialPreprint
Olando, Y. A., Mathai, M. A., Kuria, M. W., Njiri, F. J., & Huffman, M. D. (2020) · Research Square · doi:10.21203/rs.3.rs-112872/v1
“After adjusting for covariates that potentially confound the relationship between the group allocation and tobacco cessation [19], the direction and magnitude of effect were similar (HR 14.”
Method
Regional Cerebral Blood Flow and Blood-oxygen-level-dependent Smoking-cue Reactivity Responses to Abstinence, Satiety, and Nicotine Replacement Therapy in Treatment-seeking Smokers: A Functional Magnetic Resonance Imaging Study
Wannas, P. A. (2020) · TSpace (University of Toronto)
Smoking cessation and serious mental illness
Cope, G. F. (2021) · Independent Nurse · doi:10.12968/indn.2021.5.11
US Smoking Trends Among Young Adults with Serious Psychological Distress: 1997–2018
Friedman, A. S., Tam, J., & Busch, S. H. (2021) · Journal of General Internal Medicine · doi:10.1007/s11606-021-07013-y
Depression and tobacco smoking (analytical review). Part 2
Savin, S. Z., & Solodkaya, E. V. (2021) · Terapevt (General Physician) · doi:10.33920/med-12-2110-06
The development and evaluation of a web-based well-being intervention, for inclusion within an existing health promotion programme, to support and encourage health related lifestyle behaviour change
Brown, M. (2021) · Cronfa (Swansea University) · doi:10.23889/suthesis.59036
Service-user experiences of an integrated psychological intervention for depression or anxiety and tobacco smoking in IAPT: A qualitative investigation into mechanisms of change in quitting smokingPreprint
Stein, K. F., Sawyer, K., Daryan, S., Allen, J. L., & Taylor, G. M. J. (2022) · medRxiv · doi:10.1101/2022.03.23.22272703
“Results: Five themes were identified: (1) acquiring an increased awareness of smoking patterns, (2) developing individualised strategies, (3) practitioner style as “supportive but not lecture-y” (4) importance of regular sessions, and (5) having the opportunity to access intervention at “the right time”.”
Background
Provider Education with or Without Community Health Worker Support for Tobacco Cessation in Adults with Serious Mental Illness: A Cluster Randomized Clinical TrialPreprint
Evins, A. E., Cather, C., Maravić, M. C., Reyering, S., Pachas, G. N., Thorndike, A. N., Levy, D. E., Fung, V., Fischer, M. A., Schnitzer, K., et al. (2022) · SSRN Electronic Journal · doi:10.2139/ssrn.4047139
Mental Illness and Tobacco Usage
Asharani, P. V., & Subramaniam, M. (2022) · Springer eBooks · doi:10.1007/978-3-030-67928-6_41-1
Differences in Negative Affect Among Current and Former Smokers with and without a Cancer DiagnosisPreprint
Pebley, K., Krukowski, R. A., & Murphy, J. G. (2022) · Research Square · doi:10.21203/rs.3.rs-1670867/v1
Promoting Evidence-Based Tobacco Cessation Treatment in Community Mental Health Clinics: Protocol for a Pilot Study (Preprint)Preprint
Dickerson, F., Goldsholl, S., Yuan, C. T., Dalcin, A., Eidman, B., Minahan, E., Gennusa, J. V., Mace, E., Cullen, B., Evins, A. E., et al. (2022) · doi:10.2196/preprints.44787
Childhood Trauma Related to Tobacco Smoking Mediated by Cognitive Control and Impulsiveness in Severe Mental DisordersPreprint
Lunding, S. H., Ueland, T., Aas, M., Høegh, M. C., Werner, M. C. F., Rødevand, L. N., Johansen, I. T., Hjell, G., Ormerod, M. B. E. G., Ringen, P. A., et al. (2022) · SSRN Electronic Journal · doi:10.2139/ssrn.4113866
Perceptions and attitudes of people with severe mental disorders towards smoking in Greece
Papadosifaki, G., Psarra, V., Touloumis, C., Tzavara, C. K., Farsalinos, K. E., Sakellari, Ε., Lagiou, A., & Barbouni, A. (2023) · Psychiatriki · doi:10.22365/jpsych.2023.022
“2,3 Cook et al. 4 studied the proportion of self-reported smokers among those with and without mental disorders between 2004 and 2011.”
Background
Changes in substance use and engagement in gaming/gambling in persons with severe mental illness during the COVID-19 pandemic and earthquakes: a community study in two points
Medved, S., Palavra, I. R., Gerlach, J., Levaj, S., Shields‐Zeeman, L., Bolinski, F., Bradaš, Z., Madžarac, Z., Filipčić, I., & Kuzman, M. R. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1264875
“This finding is noteworthy considering that effective treatments for smoking cessation are currently available (59), and efforts to raise awareness about cessation strategies during the pandemic have been initiated (60).”
Background
Vaping in mental health inpatient units: A qualitative study of consumer and staff views on electronic nicotine delivery systems
Naylor, H., Howie, A., & Every‐Palmer, S. (2024) · Australasian Psychiatry · doi:10.1177/10398562241236634
Tobacco, Alcohol, and Drug Use Among Young Adults with Serious Mental Illness
Ferron, J. C., Brunette, M. F., Aschbrenner, K. A., ElSayed, M., & Pratt, S. I. (2024) · Community Mental Health Journal · doi:10.1007/s10597-024-01246-x
Persistent High Smoking Prevalence in a Swiss Psychiatric Hospital between 2001 and 2020 despite Smoking Bans and Perspectives for Further Necessary Interventions
Keizer, I., Eytan, A., Khan, A. N., & Papachristou, C. (2024) · Psychology · doi:10.4236/psych.2024.152015
“Many studies concluded that the trends to de-I crease smoking in general populations were not observed for patients with psychiatric diagnoses (Steinberg et al., 2015; Cook et al., 2014).”
Background
Why Mental Health Nurses Should Care About Oral Health: A Commentary
Kerry, E., Velemis, K., Palmier‐Claus, J. E., Shiers, D., Aggarwal, V. R., Morris, A. S., Dawber, A., Lodge, C., & Griffiths, R. (2025) · Issues in Mental Health Nursing · doi:10.1080/01612840.2024.2433496
“People with SMI are more likely to engage in higher risk behaviours, such as smoking (Cook et al., 2014), - which increases the likelihood of tooth loss (Kang et al., 2024) - and eating sugary foods (Teasdale et al., 2019).”
Self-reported dyspnea and interest in a respiratory muscle training program among callers to the New York State Quitline
Ray, A. D., Carl, E. M., Hyland, A. J., Reid, M. E., Mahoney, M. C., & Sheffer, C. E. (2025) · Tobacco Induced Diseases · doi:10.18332/tid/196755
“A K6 score ≥ 5 and 13 is indicative of moderate psychological distress 19-21 and ≥ 13 is indicative of severe psychological distress 21 .”
Brief computer MI to motivate sustained tobacco cessation following psychiatric hospital discharge: Study protocol for a randomized controlled trial
Brown, R. A., Winskowicz, A., Johnson, D. H., Hecht, J., Shumake, J., Carpenter, K., Farrington, J., & Smits, J. A. J. (2025) · Contemporary Clinical Trials · doi:10.1016/j.cct.2025.107841
Principles and standards for medication management of individuals with serious mental illness
Smith, T. E., & Hendrick, D. C. (2025) · Oxford University Press eBooks · doi:10.1093/med/9780198898818.003.0015
Managing co-occurring physical disorders in mental health care
Hendrick, D. C., & Drake, R. E. (2025) · Oxford University Press eBooks · doi:10.1093/med/9780198898818.003.0022
Implementation strategies to increase tobacco treatment in mental health settings: a systematic review
Kacmarek, C. N., Vivino, A. A., Smith, H. C., & Kreyenbuhl, J. A. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-07248-7
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Tobacco dependency treatment services for people with severe mental illness: A mixed methods rapid evaluation
Phillips, W., Dawney, J., Spitters, S., & Newbould, J. (2025) · NIHR Open Research · doi:10.3310/nihropenres.14003.1
Achieving cardiovascular health equity in community mental health: study protocol for a cluster-randomized hybrid Type 3 effectiveness-implementation trial
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The Role of Virtual Care on Access to Mental Health Counseling or Therapy to Reduce Health Inequities in the United States: Considerations on Age, Race, and Education
Vázquez‐Otero, C., & Lee, J. (2025) · Telemedicine Reports · doi:10.1177/26924366251382425
Staff experiences of tobacco dependency services for people with severe mental illness: an evaluation of community-based early-implementer sites
Westbrook, J., Barnett, P., Taylor, C. J., Luna, E., Cheeseman, H., Agrawal, S., Dunne, A., Corte, P. C. L., Keerthikumar, H., & Pilling, S. (2025) · British Journal of Healthcare Management · doi:10.12968/bjhc.2024.0108
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Sirbu, L., Sisti, J. S., & Cone, J. E. (2025) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2025.113010

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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