SAMHSA and CDC Report on Adult Smoking and Mental Illness: A Special Commentary from Steven Schroeder, MD, SCLC Director

 

The February 5, 2013 issue of the Centers for Disease Control and Prevention's (CDC) MMWR (Morbidity and Mortality Weekly Report) carried a lead article on the results of a Substance Abuse and Mental Health Services Administration (SAMHSA) survey (National Survey on Drug Use and Health, NSDUH): Current smoking among adults aged ≥18 years with mental illness, United States, 2009-2011. The results, which will not come as a surprise to readers of this SCLC communiqué, can be briefly summarized as follows:

• About 20% of those surveyed reported a mental illness in the past 12 months. Since this survey did not include people who were institutionalized in either mental illness treatment facilities or prisons, it is likely that the real number may be slightly higher.
• Compared to the smoking rates among those without mental illnesses (21.4% in this survey, which is slightly higher than other CDC reports, which showed the rate to be 19% in 2011) persons reporting mental illness had much higher rates of smoking, 36.1%.
• Persons with mental illness consumed about 31% of all cigarettes smoked in the U.S. Previous data showed that persons with mental illness and/or substance abuse disorders consumed a higher percentage of all cigarettes smoked: 44%. The discrepancy likely reflects the fact that the SAMHSA survey did not include persons with substance abuse disorders as a stand-alone diagnosis.
• There were great differences amongst the states in smoking prevalences for those with mental health disorders, ranging from a low of 18.2% in Utah to a high of 48.7% in West Virginia. In general, states with higher overall smoking prevalences also had higher rates of smoking among those with mental health disorders.
• As with smoking in the general population, smoking among those with mental health disorders was higher among younger people, those with less education, and those below the federal poverty level.

Why was this report, which was also featured in a high-level press teleconference that included CDC Director Dr. Thomas Freiden and Doug Tipperman from SAMHSA's Center for Substance Abuse Prevention, so important? First of all, it represented the first time that the CDC has given so much attention to the linkage between smoking and mental illness. CDC now realizes that in order to achieve its goals in reducing the level of smoking it must concentrate on those with behavioral health issues. Second, it represents an important collaboration between two large federal agencies that had not previously done much work in partnership. Third, it provided some new information, particularly about the variations among states.

 

Here is some additional information pertinent to some of the questions asked at the teleconference (inlcuding the press release and a fact sheet):

• There are data on the question of whether persons with mental illness really want to quit. An SCLC sponsored survey, conducted on-line by the Depression and Bipolar Support Alliance (DBSA) showed that 74% of respondents expressed a desire to quit. (Prochaska, Reyes, Schroeder, Daniels, Doederlein, and Bergeson: Bipolar Disorders. 2011 13:466-473). Click here to download the article, http://smokingcessationleadership.ucsf.edu/2011_dbsaonlinesurvey_pub.pdf).
• Although it is not clear how much smoking rates among those with mental illness have changed over time, the number of cigarettes smoked by those who smoke has declined, mirroring trends in the general population (Schroeder JAMA 2012; 308:1586-87). Click here for the editorial, http://www.prevent.org/data/files/other%20documents/jama%20-%20schroeder%202012.pdf.
• From the National Association of State Mental Health Program Directors' (NASMHPD) Research Institute (NRI): more and more state psychiatric hospitals are going smoke-free. For example, in 2006 only 41% of hospitals prohibited smoking. By 2011 that number had risen to 79%, and by report that trend is continuing. Click here for the report, http://smokingcessationleadership.ucsf.edu/nri_smokingreport2011_final.pdf.

The bottom line for the Smoking Cessation Leadership Center and its partners is that key federal agencies will focus more on helping those with behavioral health problems stop smoking. Mr. Tipperman highlighted the Pioneers program and the State Leadership Academies in his prepared remarks. We at SCLC are proud to have partnered with SAMHSA in administering those programs.  

 

Sincerely,


Steven A. Schroeder, MDDistinguished Professor of Health and Health Care,
Department of Medicine
Director, Smoking Cessation Leadership Center
University of California, San Francisco