Cited by 503Smoking Behavior and CessationSubstance Abuse Treatment and OutcomesGlobal Public Health Policies and Epidemiology

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Smoking, Mental Illness, and Public Health

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Prochaska, Judith J., Das, Smita, Young-Wolff, Kelly C.·2017·Annual Review of Public Health

DOI 10.1146/annurev-publhealth-031816-044618PMC PMC5788573

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Abstract

Tobacco use remains the leading preventable cause of death worldwide. In particular, people with mental illness are disproportionately affected with high smoking prevalence; they account for more than 200,000 of the 520,000 tobacco-attributable deaths in the United States annually and die on average 25 years prematurely. Our review aims to provide an update on smoking in the mentally ill. We review the determinants of tobacco use among smokers with mental illness, presented with regard to the public health HAVE framework of “the host” (e.g., tobacco user characteristics), the “agent” (e.g., nicotine product characteristics), the “vector” (e.g., tobacco industry), and the “environment” (e.g., smoking policies). Furthermore, we identify the significant health harms incurred and opportunities for prevention and intervention within a health care systems and larger health policy perspective. A comprehensive effort is warranted to achieve equity toward the 2025 Healthy People goal of reducing US adult tobacco use to 12%, with attention to all subgroups, including smokers with mental illness.

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Bidirectional influence between benign prostatic hyperplasia, prostate cancer, and prostatitis and mental disorders: two-sample and multivariate mendelian randomization analyses
Chen, X., Ren, C., Wang, Q., & Liu, X. (2024) · The Aging Male · doi:10.1080/13685538.2024.2419853 · Cited by 4
“Smoking is a changeable habit; timely cessation does not worsen mood and may improve it [67,68].”
Effects of E-Cigarette Warning Labels About Mental Health Consequences of Nicotine Addiction Among Young Adults in the USA: Results From a Randomized Controlled Experiment
Marynak, K., Cohen, J. E., Thrul, J., Kennedy, R. D., Limaye, R. J., & Moran, M. B. (2024) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntae298 · Cited by 4
A retrospective analysis of the comparative effectiveness of smoking cessation medication among individuals with mental illness in community‐based mental health and addictions treatment settings
Okoli, C. T. C., Wiggins, A. T., Fallin‐Bennett, A., & Rayens, M. K. (2017) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12408 · Cited by 4
Acute nicotine reinforcement requires ability to discriminate the stimulus effects of nicotine.
Perkins, K. A. (2020) · Experimental and Clinical Psychopharmacology · doi:10.1037/pha0000433 · Cited by 4
Non-pharmacological interventions for smoking in persons with schizophrenia spectrum disorders – A systematic review
Rajalu, B. M., Jayarajan, D., Muliyala, K. P., Sharma, P., Gandhi, S., Chand, P., Thirthalli, J., & Murthy, P. (2021) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2020.102530 · Cited by 4
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
“Smoking or tobacco use continues to be a major health concern among persons with mental illnesses (Curkendall et al., 2004; Prochaska et al., 2017; Tam et al., 2016).”
Background
Developing Competency-Based Nursing Treatment for Persons With Tobacco Use Disorder
Essenmacher, C. A., Baird, C. A., Houfek, J. F., Spielmann, M., & Adams, S. B. (2021) · Journal of the American Psychiatric Nurses Association · doi:10.1177/10783903211058785 · Cited by 4
“Inconsistencies in TUD education and training of mental health professionals and lack of high-level evidence continues to perpetuate tobacco-related treatment disparities (Prochaska et al., 2017).”
Background
Drug Abuse in the Middle East
Abazid, H. (2021) · Springer eBooks · doi:10.1007/978-3-030-67928-6_140-1 · Cited by 4
Prevalance and course of tobacco use among individuals receiving coordinated specialty care for first‐episode psychosis
Rogers, R. T., Marino, L. A., Scodes, J. M., Wall, M. M., Nossel, I. R., & Dixon, L. B. (2022) · Early Intervention in Psychiatry · doi:10.1111/eip.13320 · Cited by 4
“Tobacco-related illness is the leading cause of death among individuals with severe mental illness (Prochaska et al., 2017).”
Background
Stress Increases the Association between Cigarette Smoking and Mental Disorders, as Measured by the COVID-19-Related Worry Scale, in the Miami Adult Studies on HIV (MASH) Cohort during the Pandemic
Diaz‐Martinez, J., Delgado‐Enciso, I., Campa, A. L., Tamargo, J. A., Martin, H. R., Johnson, A., Siminski, S. M., Gorbach, P. M., & Baum, M. K. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19138207 · Cited by 4
“Our findings agree with previous studies, showing that smoking is highly prevalent among adults with mental disorder(s); they are less likely to quit smoking than adults without a mental disorder [21,22].”
Result
Psychological distress, structural barriers, and health services utilization among U.S. adults: National Health interview survey, 2011–2017
Chaudhry, M. M., Banta, J. E., McCleary, K., Mataya, R. H., & Banta, J. M. (2022) · International Journal of Mental Health · doi:10.1080/00207411.2022.2123694 · Cited by 7
“Furthermore, adults with mental illness have higher rates of all-cause mortality (Olfson et al., 2015), with suspected reasons being higher rates of chronic physical illness (Dar (cid:1) e et al., 2019) and unhealthy behaviors, such as smoking (Prochaska et al., 2017).”
Background
Tobacco Use and Tobacco Dependence Management
Galiatsatos, P., Kaplan, B., Lansey, D. G., & Ellison-Barnes, A. (2023) · Clinics in Chest Medicine · doi:10.1016/j.ccm.2023.03.004 · Cited by 4
Texas tobacco quitline knowledge, attitudes, and practices within healthcare agencies serving individuals with behavioral health needs: A multimethod study
Britton, M., Rogova, A., Chen, T. A., Leal, I. M., Kyburz, B., Williams, T., Patel, M., & Reitzel, L. R. (2023) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2023.102256 · Cited by 4
“However, the proportion of people who use combustible cigarettes and other tobacco products is significantly higher within some population subgroups, including people with mental health conditions (MHCs) and non-nicotine substance use disorders (SUDs) (Drope et al., 2018; Prochaska et al., 2017).”
Background
A real-world study of the association between cardiovascular risk factors and depression symptom trajectory in individuals with mental illness
Dhingra, R., He, F., Saunders, E. F. H., Waschbusch, D. A., Bixler, E. O., Greaney, J. L., Swigart, A. R., Al‐Shaar, L., Chinchilli, V. M., Yanosky, J. D., et al. (2023) · Psychiatry Research Communications · doi:10.1016/j.psycom.2023.100139 · Cited by 4
Quitline nurses' experiences in providing telephone‐based smoking cessation help to mental health patients: A mixed methods study
Silva, N., Feliu, A., Ballbè, M., Alaustre, L., Vilalta, E., Torres, N., Nieva, G., Pla, M., Pinet, C., Raich, A., et al. (2024) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.13012 · Cited by 4
The Convention on the Rights of Persons with Disabilities as a tobacco control tool in the mental health setting
van der Eijk, Y. (2017) · Tobacco Control · doi:10.1136/tobaccocontrol-2017-053954 · Cited by 4
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
Cigarette smoking in subjects maintained with methadone or buprenorphine: The role of psychiatric symptoms and psychological distress
Cosci, F., Mansueto, G., Zamboni, L., & Lugoboni, F. (2019) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2019.04.009 · Cited by 4
Reducing Nicotine in Cigarettes to Minimally Addictive Levels
Hatsukami, D. K. (2018) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2018.1829 · Cited by 4
Risk factors for depression in asthmatic individuals: Findings from NHANES (2005–2018)
Yang, H., Lin, P., & Liang, Z. (2023) · PLoS ONE · doi:10.1371/journal.pone.0287336 · Cited by 3
“There was increasing evidence to suggest that smoking was associated with an increased risk of mental illnesses such as depression and anxiety [16].”
Background
Association between marijuana and depression: Exploring the mediating role of environmental pollutants
Zhou, J.-X., Liu, X.-B., Zheng, Z.-Y., Ji, M.-X., & Wei, K. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.119607 · Cited by 3
The PADRIS-PRESTO cohort: A comprehensive population-based study on mental health in Catalonia
Prisco, M. D., Oliva, V., Fico, G., Mas, A., Valenzuela‐Pascual, C., Montejo, L., Bort, M., Sommerhoff, C., Bortolozzi, A. A., Miquel-Rio, L., et al. (2025) · European Psychiatry · doi:10.1192/j.eurpsy.2025.10103 · Cited by 3
The Psychometric Properties of the Minnesota Tobacco Withdrawal Scale Among Patients With Mental Illness
Al‐Mrayat, Y. D., Okoli, C. T. C., Studts, C. R., Rayens, M. K., & Hahn, E. J. (2019) · Biological Research For Nursing · doi:10.1177/1099800419895573 · Cited by 3
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
Smoking and the Association with Mental Health
Isse, A. M. (2022) · IntechOpen eBooks · doi:10.5772/intechopen.104233 · Cited by 3
The Impact of a Nurse-Led Service on Tobacco Treatment Provision Within a Psychiatric Hospital: A Time Series Study
Abufarsakh, B., Otachi, J. K., Wang, T., Al‐Mrayat, Y. D., & Okoli, C. T. C. (2022) · Journal of the American Psychiatric Nurses Association · doi:10.1177/10783903221093582 · Cited by 3
“As compared to people without mental illnesses (MI), those with MI have a higher premature mortality rate from tobacco use (Prochaska et al., 2017).”
Background
TOBACCO USE DISORDER AND DUAL DISORDERS Joint statement by the Spanish Psychiatry Society and the Spanish Dual Disorders Society.
Szerman, N., Carlos, P., Pinet, C., Martínez-Raga, J., Basurte, I., & Sáiz, P. A. (2022) · Actas Españolas de Psiquiatría · Cited by 4
Nurses’ Perspectives on Smoking Policies, Safety and Cessation Support in Psychiatric Wards: A Cross-Sectional Survey
Chawłowska, E., Karasiewicz, M., Marcinkowska, K., Giernaś, B., Jóźwiak, P., & Lipiak, A. (2022) · Healthcare · doi:10.3390/healthcare10091735 · Cited by 3
“Hence, it would be advisable to provide relevant training and develop their competencies, as Prochaska et al. (2017) recommended [2].”
Background
Secondhand smoke
Garg, S., & Sharma, A. D. (2022) · Indian Journal of Community and Family Medicine · doi:10.4103/ijcfm.ijcfm_64_22 · Cited by 3
Addressing Health Inequities in People with Serious Mental Illness
Cabassa, L. J. (2023) · doi:10.1093/oso/9780190937300.001.0001 · Cited by 3
Emotional distress and risk of dental caries: Evaluating effect modification by chronic conditions among low-income African American caregivers in Detroit, Michigan
Lim, S., Téllez, M., & Ismail, A. I. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1050511 · Cited by 3
“Along with poor oral hygiene practices, individuals with mental illness may be more likely to consume a higher amount of sugars with higher frequencies or smoke as a coping mechanism (4, 5), which are positively linked to dental caries risk.”
Background
Differences in smoking behaviors and readiness to change for patients with COPD and differing categories of depressive symptoms: a descriptive cross-sectional design
Floyd, J., Mallow, J. A., Wang, K., Davis, S. M., Carpenter, R. D., & Theeke, L. A. (2023) · BMC Pulmonary Medicine · doi:10.1186/s12890-023-02621-2 · Cited by 3
“Being a smoker doubles an individual’s risk for developing depression, and in heavy smokers, that risk quadruples [3].”
Background
Unrestricted public coverage is needed for smoking cessation pharmacotherapies
Kleinman, R. A., & Selby, P. (2024) · Canadian Medical Association Journal · doi:10.1503/cmaj.231333 · Cited by 3
Exploring Retrospective Parenting Styles and Parent-Child Relationship Quality as Correlates of Chinese Adults’ Current Psychological Distress: Influence of Family-of-Origin?
Yu, Y., Cui, T., Barnhart, W. R., Liu, Y., Wang, Q., & He, J. (2024) · Journal of Child and Family Studies · doi:10.1007/s10826-024-02859-2 · Cited by 4
“…complex and vary between individuals, including biological (Brandon & Sawa, 2011; Isgut et al., 2017; Uher, 2014), psychological (Oliver et al., 2019; Turner, 2016), environmental (Grubaugh et al., 2011; Prochaska et al., 2017; Uher, 2014), and social factors (Compton & Shim, 2015; Layte, 2012).”
State Leadership Academies to reduce cigarette smoking among people with behavioral health conditions in the United States
Vijayaraghavan, M., Bonniot, C., Satterfield, J., Clark, B., Xia, F., Cheng, C., Safier, J., Pamatmat, M., & Schroeder, S. A. (2024) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2024.102896 · Cited by 3
Salivary biochemical assessments to determine smoking cessation under smoking cessation program
Daood, U., Bijle, M. N., Mahdi, S. S., Omar, H., & Bilal, S. (2021) · Vibrational Spectroscopy · doi:10.1016/j.vibspec.2021.103235 · Cited by 3
Higher Levels of Nicotine Dependence in Adolescence are Associated with Younger Onset Age of Violent Criminality: A Follow-Up Study of Former Adolescent Psychiatric Inpatients.
Lantto, J., Hakko, H. H., Riala, K., & Riipinen, P. K. (2021) · Europe PMC (PubMed Central) · Cited by 3
Tobacco smoking cessation in mental health services during the COVID-19 pandemic
Seiler, N., Swamy, R., Xiao, J., & Yun, Y. (2020) · Journal of Addictive Diseases · doi:10.1080/10550887.2020.1791379 · Cited by 3
Mental illness: South Africa’s blind spot
Robertson, L. J. (2021) · South African Medical Journal · doi:10.7196/samj.2021.v111i2.15463 · Cited by 3
Personalized chat‐based support for smoking cessation among smokers with mental health symptoms in the workplace: A randomized controlled trial.
Yao, Y., Luk, T. T., Lau, O. S., Wu, Y. S., Weng, X., Ng, C. H., Cheung, Y. T. D., Lam, T. H., & Wang, M. P. (2025) · Addiction · doi:10.1111/add.70013 · Cited by 3
Deficits in peripheric and central olfactory measurements in smokers: evaluated by cranial MRI
Sarıkaya, P. Z. B., Muluk, N. B., Baser, S., Özdemır, A., & YILMAZSOY, Y. (2022) · European Archives of Oto-Rhino-Laryngology · doi:10.1007/s00405-022-07700-4 · Cited by 2
“It is a preventable habit that disrupts life comfort and increases morbidity and mortality, including causing respiratory problems, cardiovascular diseases, fetal diseases and death, and cancer [1].”
Background
Determinants of persistent smoking among breast cancer survivors
Gali, K., Aryal, S., Bokemeyer, F., Behrens, S., Seibold, P., Obi, N., Becher, H., & Chang-Claude, J. C. (2024) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2024.102913 · Cited by 2
The impact of temperature changes on the health vulnerability of migrant workers: an empirical study based on the China family panel studies
Liang, T. B., Ai, Z., Zhong, H., Xiao, M., Xie, M., Liang, X., & Li, L. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1519982 · Cited by 2
Clinical predictors of mortality in dual diagnosis patients receiving integrated in‐patient treatment—A cohort study with 21 years follow‐up
Düring, S. W., Jobe, L. B., Balleby, M. R., & Mårtensson, S. (2025) · Addiction · doi:10.1111/add.70125 · Cited by 2
Cluster analysis of anxiety sensitivity among adults who smoke
Zvolensky, M. J., Olthuis, J. V., Bakhshaie, J., Jo, D., Schmidt, N. B., Heggeness, L. F., Redmond, B. Y., Thai, J. M., & Jones, A. A. (2025) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2025.2551770 · Cited by 2
“…implications given that psychological and physical health concerns frequently co-occur with smoking, are linked with greater smoking rate, and serve as major obstacles to quitting (Conway et al., 2025; LaRowe & Ditre, 2020; Minichino et al., 2013; Prochaska et al., 2017; G. Taylor et al., 2014).”
The Association Between Adolescent Mental Health Symptoms and Characteristics of Cigarette and E-Cigarette Use
Hackworth, E. E., Vidaña-Pérez, D., O’Neal, R., Kim, M., Fillo, J., Hammond, D. G., & Thrasher, J. F. (2025) · Substance Use & Misuse · doi:10.1080/10826084.2025.2584705 · Cited by 2
“…associated with adverse cardiovascular and respiratory effects (Gotts et al., 2019), with additional evidence that nicotine adversely affects brain development (Tobore, 2019) and that mental health can be worsened by both e-cigarette (Becker et al., 2021) and cigarette use (Prochaska et al., 2017).”
Testing a mobile peer support intervention for persons with serious mental illness (DigiPer) in community mental health services: a feasibility study protocol
Wang, B., Mundal, I. P., Fortuna, K. L., Grønvik, C. K. ., Eines, T. F., Mužný, M., Skjærpe, J. N., & Storm, M. (2026) · BMJ Open · doi:10.1136/bmjopen-2025-111869 · Cited by 2
Examining the Sustained Impact of California’s Tobacco Free for Recovery Initiative: Qualitative Perspectives from Program Directors
McCuistian, C. L., Le, J. T., Samayoa, E., CAMPBELL, B. K., Bonniot, C., & Pagano, A. (2026) · Substance Use & Misuse · doi:10.1080/10826084.2026.2710339 · Cited by 2
Transtorno afetivo bipolar: determinantes sociais de saúde, adesão ao tratamento e distribuição espacial [Bipolar affective disorder: health social determinants, adherence to treatment and space distribution] [Trastorno afectivo bipolar: determinantes sociales de la salud, adherencia al tratamiento y distribución del espacio]
Elias, A. F. D., Fagueiro, C. D. O., da Silveira, E. A. A., Pinto, J. A. F., Júnior, J. A. D. A., & Machado, R. M. (2019) · Revista Enfermagem UERJ · doi:10.12957/reuerj.2019.43934 · Cited by 2

Authors: Prochaska, J. J., Das, S., & Young-Wolff, K. C.
Affiliations: Stanford Medicine (US)
Stanford University (US)
Division of Research, Kaiser Permanente Northern California, Oakland, California 94612;
ORCID: Prochaska, Judith J.
Das, Smita
Venue: Annual Review of Public Health
Publisher: Annual Reviews
Published: 2017-03-20
Volume: 38
Issue: 1
Pages: 165-185
ISSN: 0163-7525 (ISSN-L)
1545-2093
DOI: 10.1146/annurev-publhealth-031816-044618
PMC: PMC5788573
OpenAlex: W2520553955
Cited by: 503
References: 135
Citations by year: 2026: 34 · 2025: 51 · 2024: 61 · 2023: 74 · 2022: 70 · 2021: 92 · 2020: 51 · 2019: 36 · 2018: 21 · 2017: 13
FWCI: 2.74
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by-sa
creativecommons.org/licenses/by-sa/4.0/ (vor)
Locations: Annual Review of Public Health (publishedVersion, cc-by-sa)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion, cc-by-sa)
PubMed Central (acceptedVersion, cc-by-sa)
eScholarship (California Digital Library) (submittedVersion)
Funders: National Heart, Lung, and Blood Institute (R01HL117736)
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 › Public Health, Environmental and Occupational Health › Global Public Health Policies and Epidemiology
Keywords: tobacco use, mental illness, smoking prevalence, premature mortality, determinants of tobacco use, nicotine products, tobacco industry, smoking policy, smoking prevention, smoking cessation interventions, health equity, tobacco use reduction
MeSH terms: Mental Disorders, Health Policy, Humans, Public Health, Smoking, United States, Comorbidity, Smoking Cessation, Persons with Psychiatric Disorders

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