Smoking cessation behaviors among persons with psychiatric diagnoses: results from a population-level state survey

Drug Alcohol Depend. 2014 Mar 1;136:63-8. doi: 10.1016/j.drugalcdep.2013.12.010. Epub 2013 Dec 27.


Background: Persons with psychiatric illnesses are disproportionally affected by tobacco use, smoking at rates at least twice that of other adults. Intentions to quit are known to be high in this population, but population-level cessation behaviors and attitudes by mental health (MH) diagnosis are not well known.

Methods: A population-level survey was conducted in 2008 to examine state-level tobacco attitudes and behaviors in Colorado. Respondents were eligible for the study if they had non-missing values for smoking status (n=14,118). Weighted descriptive and multivariate analyses were conducted of smoking prevalence, cessation behaviors, and attitudes toward cessation by MH status and specific diagnosis.

Results: Among respondents with MH diagnoses, smoking was twice as prevalent as among respondents without an MH diagnosis, adjusted for demographic characteristics (adjusted odds ratio 2.2, 95% confidence interval 1.6-3.1). Compared to smokers without an MH diagnosis, those with MH diagnoses were more likely to attempt quitting (58.7% vs. 44.4%, p<0.05), use nicotine replacement therapy more often, and succeed in quitting at similar rates. Smokers with anxiety/PTSD were less likely to quit successfully compared those with other MH diagnoses (0.7% vs. 11.9%, p=0.03).

Conclusions: This population-level analysis found that smokers with mental illness are more likely than those without mental illness to attempt quitting and to use cessation treatment at similar rates, but those with anxiety are less likely to achieve short-term abstinence. Additional approaches are needed for smokers with mental illness in order to reach and sustain long-term abstinence from smoking.

Keywords: Disparities; Epidemiology; Mental health; Smoking cessation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anxiety Disorders / psychology
  • Attitude
  • Colorado / epidemiology
  • Depressive Disorder / psychology
  • Ethnicity
  • Female
  • Health Surveys
  • Humans
  • Male
  • Mental Disorders / psychology*
  • Middle Aged
  • Population
  • Poverty
  • Prevalence
  • Smoking / psychology
  • Smoking Cessation / psychology*
  • Socioeconomic Factors
  • Stress Disorders, Post-Traumatic / psychology
  • Tobacco Use Disorder / psychology
  • Young Adult