Tobacco use among individuals with schizophrenia: what role has the tobacco industry played?

Abstract

Rates of tobacco use among individuals diagnosed with schizophrenia have been estimated as high as 80%. A variety of hypotheses have been proposed to explain the high rate of tobacco use among this vulnerable group. This study examined the tobacco industry's efforts to establish and promulgate beliefs about schizophrenic individuals' need to smoke and the hazards of quitting. The current study analyzed previously secret tobacco industry documents. The initial search was conducted during January-July 2005 in the Legacy Tobacco Documents Library. The search yielded 280 records dating from 1955 to 2004. Documents indicate the tobacco industry monitored or directly funded research supporting the idea that individuals with schizophrenia were less susceptible to the harms of tobacco and that they needed tobacco as self-medication. The tobacco industry promoted smoking in psychiatric settings by providing cigarettes and supporting efforts to block hospital smoking bans. The tobacco industry engaged in a variety of direct and indirect efforts that likely contributed to the slowed decline in smoking prevalence in schizophrenia via slowing nicotine dependence treatment development for this population and slowing the rate of policy implementation vis-à-vis smoking bans on psychiatric units.

Fig. 1.

A 1986 Advertisement for Philip Morris’ Merit Cigarettes Suggests Evidence of Direct Marketing of Tobacco Products to Individuals with Schizophrenia. The ad shows a double image of a pack of Merit cigarettes and reads, “Schizophrenic … For New Merit, having two sides is just normal behavior.”

Fig. 2.

An Example of Campaign Materials from the Alliance for the Mentally Ill (AMI) and Friends and Advocates of the Mentally Ill (FAMI) in Opposition to the Mandate to Make all Hospitals, Including Psychiatric Units, Smoke Free.