Mental health facility ownership and smoking cessation services: a facility-level analysis across the United States

Abstract

Background: In the U.S., tobacco use affects 19.8% of adults (49.2 million) as of 2022, with rates highest among those with mental health conditions. Mental health facilities offering cessation counseling present critical opportunities to support these vulnerable populations. This study aims to examine how ownership structure influences smoking cessation counseling provision in U.S. outpatient mental health facilities.

Method: This cross-sectional study derived data on 9,645 outpatient (OPD) mental facilities from the 2019 N-MHSS-a census of all public and private mental health treatment facilities in the United States. We used multiple logistic regressions to examine how facility ownership would be associated with smoking cessation counseling provision, controlling for other facility characteristics. Models adjusted for state-level clustering for correlated random variances in service provisions across facilities in the same state.

Result: Of the outpatient facilities surveyed, 41.72% of OPD provided smoking cessation counseling. Compared to public facilities, private for-profit facilities were 30% less likely to provide smoking cessation counseling [odds ratio (OR) = 0.70, 95% confidence interval (CI) = 0.59-0.82; p < 0.05]. Private non-profit facilities were 27% less likely to provide smoking cessation counseling (OR = 0.73, CI = 0.64-0.83; p < 0.05), while controlling for other confounders.

Conclusion: Publicly-owned facilities demonstrate higher rates of smoking cessation counseling provision compared to both private non-profit and for-profit counterparts. This disparity in service availability raises concerns for tobacco control efforts, particularly as privatization in mental healthcare continues to expand. The observed pattern suggests potential misalignment between public health priorities and service delivery in private settings. Future policy initiatives should address these gaps and investigate underlying factors driving ownership-based differences in cessation services for patients with mental illness.

Keywords: facility ownership; healthcare disparities and economics; mental health facilities; service accessibility; smoking cessation.