Annals of Epidemiology 24 (2014) 776e780
Contents lists available at ScienceDirect
Annals of Epidemiology journal homepage: www.annalsofepidemiology.org
Brief communication
Cigarette smoking behaviors among adults with serious mental illness in a nationally representative sample Cristie Glasheen PhD, MPH a, Sarra L. Hedden PhD b, Valerie L. Forman-Hoffman PhD, MPH a, Lisa J. Colpe PhD, MPH c, * a b c
Behavioral Health Epidemiology Program, RTI International, Research Triangle Park, NC Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, Rockville, MD National Institute of Mental Health, Division of Services and Intervention Research, Bethesda, MD
a r t i c l e i n f o
a b s t r a c t
Article history: Received 11 April 2014 Accepted 19 July 2014 Available online 30 July 2014
Purpose: This study updates nationally representative information on cigarette smoking behaviors among adults with mental illness, particularly serious mental illness (SMI), to serve as a new benchmark for smoking cessation initiatives. Methods: Data are from the 2008e2012 National Surveys on Drug Use and Health. Prevalence estimates for past month daily smoking, heavy smoking, mean cigarettes consumed per day, nicotine dependence, past month quit ratio, and proportion of cigarettes consumed are presented by mental illness status. Results: Adults with SMI were more likely than adults with any mental illness (AMI) but not SMI and adults without mental illness to engage in smoking behaviors. Adults with AMI but not SMI were more likely to engage in all smoking behaviors compared with adults without mental illness. The past month quit ratio was significantly lower among adults with SMI and among adults with AMI but not SMI than among adults without mental illness. Adults with SMI comprised 6.9% of past month smokers but consumed 8.7% of all cigarettes. Conclusions: Adults with mental illness engage in more smoking behaviors and are less likely to quit than adults without mental illness. In this high-risk population, continued efforts to promote smoking cessation are needed. Published by Elsevier Inc.
Keywords: Smoking Tobacco use disorder Mental health Mental disorders Mentally ill persons
Introduction With the arrival of the 50th anniversary of the Surgeon General’s 1964 report on smoking, significant progress has been made in reducing smoking-related morbidity and mortality in the United States [1]. However, data suggest that this degree of progress has not been seen among those with mental illness [2] who are at higher risk of developing smoking-related morbidity and mortality [3,4] and consume a disproportionate share of cigarettes compared with those without mental illness [5,6]. Through a series of recent initiatives, the National Institute of Mental Health has prioritized improving health and longevity among persons with serious mental illness (SMI). This brief communication provides updated information characterizing smoking behaviors among adults with * Corresponding author. National Institute of Mental Health, Division of Services and Intervention Research, 6001 Executive Boulevard, Bethesda, MD 20892-9663. E-mail address: [email protected] (L.J. Colpe). 1047-2797/$ e see front matter Published by Elsevier Inc. http://dx.doi.org/10.1016/j.annepidem.2014.07.009
mental illness, particularly SMI, by important characteristics to serve as a benchmark to monitor future changes.
Methods Study design and sample description This secondary data analysis uses data from the 2008e2012 National Surveys on Drug Use and Health (NSDUHs). NSDUH is an annual cross-sectional survey of the civilian, noninstitutionalized US population aged 12 years or older. NSDUH sampling uses an independent multistage area probability sample within each state and the District of Columbia. Respondents include residents of households and noninstitutional group quarters, and civilians living on military bases. The survey is administered in the respondent’s residence using face-to-face and audio computer-assisted self-interviewing methods. NSDUH is sponsored by the Substance Abuse and
(0.90) (1.39) (1.50) (1.08) (0.85) (1.81) (1.46) 10.8 29.7b,d 40.1 12.6 6.8b,d 19.8 59.5b,d N/A (0.68) (0.98) (1.00) (0.67) (0.47) (0.01) (1.01) 11.7 34.5 38.8 11.0 4.0 10.5 53.8 N/A (0.36) (0.54) (0.57) (0.40) (0.25) (0.01) (0.58) 10.8 34.8 39.8 10.6 4.0 10.5 54.4 N/A (0.30) (0.44) (0.47) (0.33) (0.21) (0.01) (0.48) 11.0 34.3 39.6 10.9 4.3 10.5 54.7 N/A
c,d
a,b
N/A ¼ not applicable. Difference compared with no mental illness estimate is statistically significant at the .05 level (a) or .01 level (b). Difference compared with AMI but not SMI estimate is statistically significant at the .05 level (c) or .01 level (d). * Low precision; no estimate reported. y Statistical comparisons of median differences were not conducted. SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2008e2010 (revised March 2012) and 2011e2012.
(3.43) (3.48) (2.51) (0.34) (*) (0.18) (2.52) (1.49) 41.1 45.0 13.3 0.6 * 2.1 13.9 66.8b (2.26) (2.30) (1.47) (0.49) (0.25) (0.15) (1.55) (0.81) 42.1 45.2 10.9a 1.4 0.5 1.7 12.7a 68.2b (1.00) (0.99) (0.75) (0.20) (0.13) (0.15) (0.77) (0.35) 39.9 43.5 14.9 1.3 0.4 1.8 16.6 74.2 (0.89) (0.89) (0.66) (0.17) (0.11) (0.11) (0.68) (0.32) 40.3 43.8 14.3 1.3 0.4 1.7 16.0 73.1 14.7b 31.6b,d 36.7a 11.0b 5.9b,d 10.4 53.7b,d 29.6b,d (0.38) (0.48) (0.48) (0.30) (0.19) (0.06) (0.50) (0.34)
(0.70) (0.90) (0.89) (0.56) (0.39) (0.05) (0.94) (0.69) 16.9a 36.4 34.0 9.3 3.4 10.3 46.7a 38.1b 18.5 37.1 33.2 8.1 3.1 10.3 44.5 51.6
(0.95) (1.34) (1.35) (0.96) (0.75) (0.04) (1.39) (1.06)
18.9b,d (0.37) 17.3 (0.22) 17.4 (0.13) 17.5 (0.11) 9.0 (0.42) 9.0 (0.29) 9.5 (0.14) 17.7b,d (0.35) 15.9a (0.20) 15.3 (0.10)
9.4 (0.12)
100.0 81.7 (0.76) 100.0 100.0 82.7 (0.41) 100.0 100.0 82.6 (0.34) 100.0 16.9b,c (0.68) 5.7b,c (0.42) 0.0 15.1b (0.33) 4.6a (0.21) 0.0 11.5 (0.13) 4.0 (0.08) 0.0 12.1 (0.12) 4.2 (0.08) 0.0 43.3b,d (0.83) 30.5b,d (0.75) 31.8b,d (0.78) 33.1b (0.43) 21.0b (0.36) 21.2b (0.37) 22.1 (0.17) 13.5 (0.14) 12.0 (0.13)
AMI but not SMI No mental illness
777
Smoking behaviors among all adults Any past month cigarette use 24.5 (0.16) Past month daily cigarette smoking 15.2 (0.14) Past month nicotine dependence 14.1 (0.14) Past month smoking behaviors among daily smokers Mean cigarettes smoked per day 15.6 (0.09) (continuous) Mean cigarettes smoked per day (categorical)
Contents lists available at ScienceDirect
Annals of Epidemiology journal homepage: www.annalsofepidemiology.org
Brief communication
Cigarette smoking behaviors among adults with serious mental illness in a nationally representative sample Cristie Glasheen PhD, MPH a, Sarra L. Hedden PhD b, Valerie L. Forman-Hoffman PhD, MPH a, Lisa J. Colpe PhD, MPH c, * a b c
Behavioral Health Epidemiology Program, RTI International, Research Triangle Park, NC Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, Rockville, MD National Institute of Mental Health, Division of Services and Intervention Research, Bethesda, MD
a r t i c l e i n f o
a b s t r a c t
Article history: Received 11 April 2014 Accepted 19 July 2014 Available online 30 July 2014
Purpose: This study updates nationally representative information on cigarette smoking behaviors among adults with mental illness, particularly serious mental illness (SMI), to serve as a new benchmark for smoking cessation initiatives. Methods: Data are from the 2008e2012 National Surveys on Drug Use and Health. Prevalence estimates for past month daily smoking, heavy smoking, mean cigarettes consumed per day, nicotine dependence, past month quit ratio, and proportion of cigarettes consumed are presented by mental illness status. Results: Adults with SMI were more likely than adults with any mental illness (AMI) but not SMI and adults without mental illness to engage in smoking behaviors. Adults with AMI but not SMI were more likely to engage in all smoking behaviors compared with adults without mental illness. The past month quit ratio was significantly lower among adults with SMI and among adults with AMI but not SMI than among adults without mental illness. Adults with SMI comprised 6.9% of past month smokers but consumed 8.7% of all cigarettes. Conclusions: Adults with mental illness engage in more smoking behaviors and are less likely to quit than adults without mental illness. In this high-risk population, continued efforts to promote smoking cessation are needed. Published by Elsevier Inc.
Keywords: Smoking Tobacco use disorder Mental health Mental disorders Mentally ill persons
Introduction With the arrival of the 50th anniversary of the Surgeon General’s 1964 report on smoking, significant progress has been made in reducing smoking-related morbidity and mortality in the United States [1]. However, data suggest that this degree of progress has not been seen among those with mental illness [2] who are at higher risk of developing smoking-related morbidity and mortality [3,4] and consume a disproportionate share of cigarettes compared with those without mental illness [5,6]. Through a series of recent initiatives, the National Institute of Mental Health has prioritized improving health and longevity among persons with serious mental illness (SMI). This brief communication provides updated information characterizing smoking behaviors among adults with * Corresponding author. National Institute of Mental Health, Division of Services and Intervention Research, 6001 Executive Boulevard, Bethesda, MD 20892-9663. E-mail address: [email protected] (L.J. Colpe). 1047-2797/$ e see front matter Published by Elsevier Inc. http://dx.doi.org/10.1016/j.annepidem.2014.07.009
mental illness, particularly SMI, by important characteristics to serve as a benchmark to monitor future changes.
Methods Study design and sample description This secondary data analysis uses data from the 2008e2012 National Surveys on Drug Use and Health (NSDUHs). NSDUH is an annual cross-sectional survey of the civilian, noninstitutionalized US population aged 12 years or older. NSDUH sampling uses an independent multistage area probability sample within each state and the District of Columbia. Respondents include residents of households and noninstitutional group quarters, and civilians living on military bases. The survey is administered in the respondent’s residence using face-to-face and audio computer-assisted self-interviewing methods. NSDUH is sponsored by the Substance Abuse and
(0.90) (1.39) (1.50) (1.08) (0.85) (1.81) (1.46) 10.8 29.7b,d 40.1 12.6 6.8b,d 19.8 59.5b,d N/A (0.68) (0.98) (1.00) (0.67) (0.47) (0.01) (1.01) 11.7 34.5 38.8 11.0 4.0 10.5 53.8 N/A (0.36) (0.54) (0.57) (0.40) (0.25) (0.01) (0.58) 10.8 34.8 39.8 10.6 4.0 10.5 54.4 N/A (0.30) (0.44) (0.47) (0.33) (0.21) (0.01) (0.48) 11.0 34.3 39.6 10.9 4.3 10.5 54.7 N/A
c,d
a,b
N/A ¼ not applicable. Difference compared with no mental illness estimate is statistically significant at the .05 level (a) or .01 level (b). Difference compared with AMI but not SMI estimate is statistically significant at the .05 level (c) or .01 level (d). * Low precision; no estimate reported. y Statistical comparisons of median differences were not conducted. SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2008e2010 (revised March 2012) and 2011e2012.
(3.43) (3.48) (2.51) (0.34) (*) (0.18) (2.52) (1.49) 41.1 45.0 13.3 0.6 * 2.1 13.9 66.8b (2.26) (2.30) (1.47) (0.49) (0.25) (0.15) (1.55) (0.81) 42.1 45.2 10.9a 1.4 0.5 1.7 12.7a 68.2b (1.00) (0.99) (0.75) (0.20) (0.13) (0.15) (0.77) (0.35) 39.9 43.5 14.9 1.3 0.4 1.8 16.6 74.2 (0.89) (0.89) (0.66) (0.17) (0.11) (0.11) (0.68) (0.32) 40.3 43.8 14.3 1.3 0.4 1.7 16.0 73.1 14.7b 31.6b,d 36.7a 11.0b 5.9b,d 10.4 53.7b,d 29.6b,d (0.38) (0.48) (0.48) (0.30) (0.19) (0.06) (0.50) (0.34)
(0.70) (0.90) (0.89) (0.56) (0.39) (0.05) (0.94) (0.69) 16.9a 36.4 34.0 9.3 3.4 10.3 46.7a 38.1b 18.5 37.1 33.2 8.1 3.1 10.3 44.5 51.6
(0.95) (1.34) (1.35) (0.96) (0.75) (0.04) (1.39) (1.06)
18.9b,d (0.37) 17.3 (0.22) 17.4 (0.13) 17.5 (0.11) 9.0 (0.42) 9.0 (0.29) 9.5 (0.14) 17.7b,d (0.35) 15.9a (0.20) 15.3 (0.10)
9.4 (0.12)
100.0 81.7 (0.76) 100.0 100.0 82.7 (0.41) 100.0 100.0 82.6 (0.34) 100.0 16.9b,c (0.68) 5.7b,c (0.42) 0.0 15.1b (0.33) 4.6a (0.21) 0.0 11.5 (0.13) 4.0 (0.08) 0.0 12.1 (0.12) 4.2 (0.08) 0.0 43.3b,d (0.83) 30.5b,d (0.75) 31.8b,d (0.78) 33.1b (0.43) 21.0b (0.36) 21.2b (0.37) 22.1 (0.17) 13.5 (0.14) 12.0 (0.13)
AMI but not SMI No mental illness
777
Smoking behaviors among all adults Any past month cigarette use 24.5 (0.16) Past month daily cigarette smoking 15.2 (0.14) Past month nicotine dependence 14.1 (0.14) Past month smoking behaviors among daily smokers Mean cigarettes smoked per day 15.6 (0.09) (continuous) Mean cigarettes smoked per day (categorical)
