Smoking and mental illness in the US population
Open accessAbstract
OBJECTIVES: Those with any psychiatric diagnosis have substantially greater rates of smoking and are less likely to quit smoking than those with no diagnosis. Using nationally representative data, we sought to provide estimates of smoking and longitudinal cessation rates by specific psychiatric diagnoses and mental health service use. DESIGN AND PARTICIPANTS: Data were analysed from a two-wave cohort survey of a U.S. nationally representative sample (non-institutionalised adults): the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; 2001-2002, n=43,093; 2004-2005, n=34,653). MAIN OUTCOME MEASURES: We examined smoking rates (lifetime, past year and past year heavy) and cross-sectional quit rates among those with any lifetime or past year psychiatric diagnosis (DSM-IV). Importantly, we examined longitudinal quit rates and conducted analyses by gender and age categories. RESULTS: Those with any current psychiatric diagnosis had 3.23 (95% CI 3.11 to 3.35) times greater odds of currently smoking than those with no diagnosis, and were 25% less likely to have quit by follow-up (95% CI 20% to 30%). Prevalence varied by specific diagnoses (32.4% to 66.7%) as did cessation rates (10.3% to 17.9%). Comorbid disorders were associated with higher proportions of heavy smoking. Treatment use was associated with greater prevalence of smoking and lower likelihood of cessation. CONCLUSIONS: Those with psychiatric diagnoses remained much more likely to smoke and less likely to quit, with rates varying by specific diagnosis. Our findings highlight the need to improve our ability to address smoking and psychiatric comorbidity both within and outside of healthcare settings. Such advancements will be vital to reducing mental illness-related disparities in smoking and continuing to decrease tobacco use globally.
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- Finding
Adults with current psychiatric diagnoses were substantially more likely to be current smokers than adults with no diagnosis.
“Those with a current diagnosis had 3.23 times greater odds of being a current smoker than those with no diagnosis (OR = 3.23, 95% CI = 3.11, 3.35)”
Quote in the paperNot yet classified - Finding
The authors conclude that psychiatric diagnoses are linked to greater smoking and lower quitting, especially for people with comorbid disorders.
“those with psychiatric diagnoses were substantially more likely to smoke cigarettes, and among those who smoked, were less likely to stop using tobacco compared to those with no disorders. This was particularly true for those with co-morbid lifetime disorders”
Quote in the paperNot yet classified - Finding
Mental health treatment utilization was associated with greater smoking prevalence and lower likelihood of cessation.
“Treatment utilization was associated with greater prevalence of smoking and lower likelihood of cessation.”
Quote in the paperNot yet classified - Finding
Smoking prevalence and cessation rates differed by specific psychiatric diagnosis.
“Prevalence varied by specific diagnoses (32.4% to 66.7%) as did cessation rates (10.3% to 17.9%).”
Quote in the paperNot yet classified - Finding
People who had ever sought mental health help were less likely to quit smoking by Wave 2 than those who had not sought help.
“Lifetime smokers who ever sought help were less likely to have quit smoking by Wave 1 (33.0% vs. 38.9%; OR = 0.85, 95% CI = 0.82, 0.87) or by Wave 2 (16.3% vs. 19.7%; RR = 0.83, 95% CI = 0.76, 0.90).”
Quote in the paperNot yet classified
- Finding
Current smokers with a psychiatric diagnosis at Wave 1 were less likely to stop using tobacco by Wave 2 than smokers without a diagnosis.
“current smokers with a diagnosis at Wave 1 were 25% less likely to stop using tobacco by Wave 2 (RR = 0.75, 95% CI = 0.70, 0.80)”
Quote in the paperNot yet classified - Finding
People who had ever sought mental health help had higher lifetime smoking prevalence than those who had never sought help.
“Among those who ever sought help, there was a lifetime smoking prevalence of 60.2%, compared to 54.1% among those who had never sought help (OR = 1.29, 95% CI = 1.24, 1.34).”
Quote in the paperNot yet classified - Finding
Psychiatric diagnoses were associated with higher smoking prevalence and lower quit rates than no diagnosis.
“Smoking prevalence (both lifetime and current) was significantly higher for those with each lifetime disorder than for those with no diagnosis (p < 0.001), and cross-sectionally and longitudinally assessed quit rates were significantly lower (p < 0.001) (Table 3).”
Quote in the paperNot yet classified - Finding
Co-morbid disorders were associated with higher proportions of heavy smoking.
“Co-morbid disorders were associated with higher proportions of heavy smoking.”
Quote in the paperNot yet classified - Method
The authors measured lifetime, past-year, and heavy smoking, plus cross-sectional and longitudinal quit rates.
“We examined smoking rates (lifetime, past year, and past year heavy) and cross-sectional quit rates among those with any lifetime or past-year psychiatric diagnosis (DSM-IV). Importantly, we examined longitudinal quit rates and conducted analyses by gender and age categories.”
Quote in the paperNot yet classified - Method
The investigators assessed psychiatric diagnoses with the AUDADIS-IV interview.
“Axis I and Axis II diagnoses were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule, DSM-IV version (AUDADIS-IV).”
Quote in the paperNot yet classified0 of 2 sources checked- cites [9]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [10]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Method
Lifetime smoking was defined as having smoked 100 or more cigarettes, and current smoking required smoking during the past year.
“lifetime smokers reported having ever smoked 100 or more cigarettes; current smokers further reported having smoked during the past year, based on Wave 1 data.”
Quote in the paperNot yet classified0 of 2 sources checked- cites [2]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [7]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Method
Cessation was defined as at least one year of abstinence from all measured forms of tobacco.
“We defined cessation as long-term (at least one year) abstinence from all measured forms of tobacco (cigarettes, cigars, pipe, snuff, and chewing tobacco).”
Quote in the paperNot yet classified0 of 1 sources checked- cites [12]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Method
The study used data from the NESARC two-wave cohort survey of U.S. non-institutionalized adults.
“Data were analyzed from a two-wave cohort survey of a U.S. nationally representative sample (non-institutionalized adults): the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; 2001-2002, n = 43,093; 2004-2005, n = 34,653).”
Quote in the paperNot yet classified
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the US, individuals with mental health disorders are nearly twice as likely to report cigarette smoking compared to those without mental health disorders (28.2% vs. 15.8% for past-month cigarette smoking).
“In fact, in the US, individuals with mental health disorders are nearly twice as likely to report cigarette smoking when compared to those without mental health disorders (28.2% vs. 15.8% for past-month cigarette smoking) [4, 5].”
From Can an Acceptance and Commitment Therapy-Based Smartphone App Help Individuals with Mental Health Disorders Quit Smoking? (2024) · cites this paper as [5]
The Results section (page unavailable) supports the general association: smoking prevalence was higher among people with psychiatric diagnoses. It reports 39.0% for those with a past-year diagnosis versus 15.5% for those with no diagnosis, not 28.2% versus 15.8%. The Methods section defines current smoking as smoking during the past year, not the past month. (LLM, conf=0.90)
Experimental — accuracy not yet measuredA substantial proportion of all smokers have a history of depression.
“A substantial proportion of all smokers have a history of depression”
From Depression and smoking cessation: evidence from a smoking cessation clinic with 1-year follow-up (2017) · cites this paper as [2]
Among people with depression, smoking prevalence is about twice as high as in the general population.
“Smoking is more prevalent among people with depression.”
From Depression and smoking cessation: evidence from a smoking cessation clinic with 1-year follow-up (2017) · cites this paper as [2]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Prevalence range for specific diagnoses conflicts with Discussion
MinorThe Results section says smoking prevalence across specific diagnoses ranged from 32.4% to 66.7%, but the Discussion says the range was 23.4% to 66.7%. The lower bound cannot be both 32.4% and 23.4% for the same summary.
“Prevalence varied by specific diagnoses (32.4% to 66.7%) as did cessation rates (10.3% to 17.9%).”
“Prevalence was higher and quit rates were lower among those who had ever sought help for their disorder. Prevalence varied widely across specific disorders (23.4% to 66.7%), while there was somewhat less variation in quit rates (10.3% to 17.9%).”
Wave 1 quit-rate comparison runs opposite to its description
MinorThe stated comparison puts the quit rate for those who sought help first. At 29.0% versus 27.6%, that rate is higher, not lower, despite the sentence describing them as less likely to quit.
“Lifetime smokers with a past year diagnosis who ever sought help were slightly less likely to quit smoking by Wave 1”
“(29.0% vs. 27.6%; OR = 0.95, 95% CI = 0.91, 1.00)”
Current-smoking comparison labels both groups as treatment seekers
MinorThe sentence assigns different current-smoking prevalences to people who sought help and people who ever sought help. Unlike the preceding lifetime-smoking comparison, it does not identify a group that did not seek help.
“those who sought help had a prevalence of 38.7%”
“compared to 30.5% among those who ever sought help”
Reported lower bound for diagnosis-specific smoking prevalence changes
MinorThe abstract and discussion give different lower bounds for smoking prevalence across specific diagnoses while sharing the same upper bound: 32.4% and 23.4%, respectively.
“Prevalence varied by specific diagnoses (32.4% to 66.7%)”
“Prevalence varied widely across specific disorders (23.4% to 66.7%)”
Discussion claims adjustment for variables absent from the described models
MinorThe discussion says the differences remained significant after accounting for the sociodemographic variables it lists, including income and race/ethnicity. The methods describe adjustment for age, gender, and education only.
“These differences in smoking prevalence and cessation rates between those with and without diagnoses were consistent across sociodemographic sub-groups (e.g., income, education, and race/ethnicity), and remained significant after accounting for these sociodemographic variables as covariates.”
“We used logistic regression to estimate associations between psychiatric diagnoses and lifetime smoking, current smoking, and cross-sectional quit rates, adjusting for age, gender, and education.”
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- Authors
- Smith, P. H., Mazure, C. M., & McKee, S. A.
- Affiliations
- Yale University (US)
- Corresponding author
- McKee, Sherry A
- Venue
- Tobacco Control
- Publisher
- BMJ
- Published
- 2014-04-12
- Volume
- 23
- Issue
- e2
- Pages
- e147-e153
- ISSN
- 0964-4563 (ISSN-L)
- 1468-3318
- PMC
- PMC4201650
- OpenAlex
- W2141831357
- Cited by
- 323
- References
- 21
- Citations by year
- 2026: 13 · 2025: 18 · 2024: 23 · 2023: 29 · 2022: 30 · 2021: 34 · 2020: 30 · 2019: 29 · 2018: 36 · 2017: 36 · 2016: 23 · 2015: 14 · 2014: 6 · 2013: 1
- FWCI
- 17.56
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Tobacco Control (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- National Institute of Mental Health (T32MH014235)
- National Institute on Drug Abuse (P50DA033945)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- smoking, mental illness, smoking cessation, tobacco use, psychiatric comorbidity, mental health service utilization, heavy smoking, tobacco use disparities, gender differences, age differences
- MeSH terms
- Adolescent, Adult, Mental Disorders, Cross-Sectional Studies, Female, Humans, Longitudinal Studies, Male, Mental Health Services, Middle Aged, Smoking, Socioeconomic Factors, Tobacco Use Disorder, Prevalence, Smoking Cessation, Diagnostic and Statistical Manual of Mental Disorders, Health Status Disparities, Young Adult
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