Thursday, June 8, 2023
| Characteristic | Current cigarette smokinga | ||||||
|---|---|---|---|---|---|---|---|
| No past-year mental health condition (n = 6,896) | Past-year any mental illnessb (n = 3,983) | Past-year serious mental illness (n = 1,336) | Past-year mild or moderate mental illness (n = 2,647) | Past-year serious psychological distress alone (n = 1,498) | Past-year major depressive disorder alone (n = 303) | Past-year serious psychological distress and major depressive disorder (n = 1,337) | |
| Overall | 13.6 (13.0–14.3) | 22.8 (21.7–23.8) | 27.2 (25.3–29.0) | 21.2 (19.8–22.6) | 24.5 (22.3–26.7) | 17.6 (13.8–21.5) | 25.0 (23.3–26.8) |
| Survey year | |||||||
| 2019 | 14.6 (14.0–15.2) | 25.2 (24.3–26.2) | 30.1 (27.7–32.6) | 23.6 (22.4–24.8) | 27.7 (25.7–29.6) | 18.5 (15.6–21.4) | 27.2 (25.3–29.2) |
| 2020 | 12.7 (11.7–13.7) | 20.3 (18.4–22.1) | 24.3 (20.9–27.7) | 18.9 (16.3–21.4) | 21.3 (17.3–25.3) | 16.7 (9.4–24.0) | 22.9 (20.0–25.9) |
| Age, y | |||||||
| 18–25 | 9.7 (8.9–10.5) | 14.9 (13.8–16.0) | 18.9 (16.6–21.2) | 13.1 (11.8–14.5) | 14.3 (12.4–16.3) | 10.6 (7.6–13.6) | 16.2 (14.1–18.3) |
| 26–34 | 16.5 (15.6–17.4) | 26.1 (24.4–27.9) | 31.6 (27.9–35.4) | 24.1 (22.3–26.0) | 26.7 (23.3–30.1) | 25.1 (15.7–34.6) | 30.2 (26.2–34.1) |
| 35–49 | 17.4 (16.4–18.3) | 27.8 (26.0–29.6) | 34.4 (30.5–38.3) | 25.3 (23.3–27.4) | 31.6 (28.0–35.2) | 21.5 (15.9–27.2) | 32.1 (27.9–36.3) |
| 50–64 | 15.7 (14.4–17.1) | 27.0 (23.4–30.6) | 27.0 (21.6–32.3) | 27.0 (22.3–31.7) | 32.1 (22.3–41.9) | 15.9 (10.1–21.7) | 28.7 (22.2–35.1) |
| ≥65 | 7.7 (6.7–8.8) | 11.6 (8.4–14.7) | — c | 11.8 (8.3–15.4) | 18.1 (8.8–27.4) | — c | 11.8 (4.9–18.6) |
| Sex | |||||||
| Male | 15.8 (15.0–16.6) | 25.5 (23.8–27.1) | 29.1 (26.0–32.1) | 24.3 (22.2–26.3) | 30.1 (26.2–34.0) | 16.4 (12.2–20.6) | 28.0 (25.0–31.0) |
| Female | 11.4 (10.6–12.2) | 21.2 (19.8–22.5) | 26.1 (23.6–28.6) | 19.4 (17.6–21.2) | 20.7 (18.7–22.7) | 18.4 (13.0–23.7) | 23.3 (20.8–25.9) |
| Sexual orientation | |||||||
| Heterosexual | 13.4 (12.7–14.0) | 22.1 (21.0–23.3) | 27.1 (24.9–29.3) | 20.6 (19.1–22.2) | 24.1 (21.8–26.3) | 18.1 (13.9–22.2) | 24.7 (22.8–26.6) |
| Gay/lesbian | 20.7 (16.1–25.2) | 29.2 (23.8–34.6) | 29.3 (19.1–39.5) | 29.2 (21.6–36.7) | 29.4 (20.6–38.2) | — c | 31.3 (21.0–41.7) |
| Bisexual | 22.3 (19.5–25.0) | 25.9 (22.9–28.9) | 28.5 (24.9–32.2) | 23.9 (20.0–27.8) | 26.8 (22.4–31.2) | 17.1 (9.6–24.5) | 25.4 (21.6–29.1) |
| Race/ethnicity | |||||||
| Hispanic | 8.5 (7.6–9.4) | 19.0 (16.0–22.1) | 23.2 (17.8–28.5) | 17.7 (14.1–21.3) | 21.7 (14.7–28.8) | 12.8 (6.1–19.5) | 18.6 (14.2–22.9) |
| Non-Hispanic American Indian, Alaska Native | 26.0 (18.8–33.2) | 53.3 (40.5–66.2) | 59.2 (34.5–83.8) | 50.8 (33.8–67.8) | 71.0 (50.1–92.0) | — c | 40.8 (19.2–62.4) |
| Non-Hispanic Asian | 7.2 (5.1–9.2) | 7.9 (4.5–11.3) | — c | 8.1 (4.2–11.9) | 6.0 (2.8–9.2) | — c | — c |
| Non-Hispanic Black | 16.2 (14.2–18.2) | 21.0 (16.9–25.0) | 17.4 (11.0–23.9) | 22.1 (17.6–26.6) | 24.8 (18.7–30.9) | — c | 15.9 (10.5–21.4) |
| Non-Hispanic multiple races | 23.4 (18.1–28.6) | 29.1 (22.6–35.5) | 32.5 (22.8–42.3) | 27.9 (19.3–36.4) | 22.8 (11.9–33.7) | 23.0 (10.1–35.9) | 26.4 (18.5–34.4) |
| Non-Hispanic Native Hawaiian, Pacific Islander | 13.5 (8.3–18.7) | — c | — c | — c | — c | — c | — c |
| Non-Hispanic White | 14.8 (13.9–15.7) | 24.1 (22.8–25.3) | 29.6 (27.4–31.9) | 22.1 (20.4–23.8) | 26.0 (23.4–28.6) | 18.6 (13.8–23.5) | 28.0 (26.2–29.9) |
| Education | |||||||
| Less than high school diploma | 21.1 (19.2–23.1) | 36.3 (31.2–41.4) | 46.3 (37.0–55.5) | 33.8 (28.2–39.3) | 33.2 (24.8–41.7) | — c | 41.6 (33.6–49.7) |
| High school diploma/GED | 19.0 (17.5–20.4) | 32.3 (29.5–35.2) | 33.0 (28.4–37.7) | 32.0 (28.7–35.4) | 37.7 (33.2–42.3) | 29.8 (20.4–39.3) | 31.5 (26.9–36.1) |
| Some college/associates degree | 14.8 (13.8–15.8) | 23.1 (21.6–24.6) | 26.3 (23.5–29.1) | 21.7 (19.6–23.9) | 22.2 (19.1–25.4) | 16.8 (12.5–21.0) | 24.2 (21.5–27.0) |
| College graduate | 5.6 (5.1–6.2) | 10.5 (9.3–11.7) | 16.9 (14.2–19.5) | 8.7 (7.6–9.9) | 9.6 (7.5–11.8) | 10.1 (6.5–13.8) | 14.7 (12.1–17.4) |
| Disabilityd | |||||||
| Yes | 15.4 (13.5–17.3) | 26.7 (24.9–28.5) | 29.8 (26.8–32.7) | 24.9 (22.5–27.4) | 27.8 (24.5–31.0) | 23.1 (15.6–30.6) | 29.6 (26.5–32.8) |
| No | 13.3 (12.7–13.9) | 19.8 (18.5–21.2) | 23.9 (21.0–26.7) | 18.9 (17.2–20.6) | 22.7 (20.1–25.4) | 13.9 (10.5–17.3) | 19.8 (17.6–21.9) |
| Annual household income | |||||||
| Income at or below federal poverty threshold | 22.5 (20.4–24.7) | 36.7 (33.6–39.7) | 37.6 (32.0–43.2) | 36.2 (32.5–40.0) | 36.8 (31.3–42.3) | 24.8 (14.5–35.1) | 35.9 (31.0–40.9) |
| Income up to 2x federal poverty threshold | 18.5 (16.9–20.1) | 28.1 (25.9–30.4) | 32.4 (28.1–36.7) | 26.6 (23.7–29.4) | 26.9 (22.9–30.8) | 27.8 (15.8–39.9) | 29.6 (26.2–33.1) |
| Income more than 2x federal poverty threshold | 10.9 (10.3–11.5) | 17.0 (15.9–18.1) | 21.4 (19.0–23.8) | 15.6 (14.3–16.9) | 19.4 (16.5–22.3) | 12.9 (9.9–15.9) | 19.5 (17.2–21.9) |
| Marriage status | |||||||
| Married/living with partner | 10.0 (9.2–10.8) | 17.7 (15.9–19.5) | 22.1 (18.6–25.6) | 16.4 (14.5–18.4) | 21.2 (17.1–25.4) | 15.7 (9.9–21.5) | 20.3 (16.9–23.8) |
| Divorced/separated/widowed | 19.6 (17.7–21.6) | 30.2 (27.9–32.6) | 36.7 (32.1–41.3) | 27.8 (24.9–30.7) | 35.8 (29.3–42.3) | 21.1 (14.8–27.4) | 37.9 (32.6–43.3) |
| Never married | 17.1 (16.1–18.1) | 23.4 (22.2–24.6) | 25.9 (23.3–28.4) | 22.4 (20.9–23.9) | 22.4 (20.4–24.4) | 17.5 (12.4–22.6) | 22.5 (20.4–24.7) |
| Health insurancee | |||||||
| Public | 18.5 (16.9–20.1) | 31.6 (29.2–33.9) | 32.7 (28.8–36.6) | 31.1 (27.9–34.2) | 32.7 (28.9–36.4) | 26.5 (15.8–37.1) | 31.7 (27.9–35.5) |
| Private | 10.5 (9.9–11.1) | 15.7 (14.6–16.8) | 19.8 (17.1–22.4) | 14.5 (13.2–15.8) | 17.3 (14.4–20.2) | 13.1 (10.3–15.9) | 17.3 (15.0–19.6) |
| Uninsured | 23.1 (21.2–25.0) | 37.7 (34.4–40.9) | 43.8 (37.3–50.3) | 35.2 (31.5–38.9) | 37.7 (32.9–42.5) | 24.8 (12.7–36.9) | 40.0 (34.6–45.4) |
| Employment status | |||||||
| Full time | 14.4 (13.7–15.2) | 20.5 (19.1–22.0) | 25.6 (23.3–27.9) | 19.0 (17.3–20.6) | 22.0 (19.4–24.7) | 16.0 (11.2–20.9) | 23.7 (21.1–26.2) |
| Part time | 11.6 (10.3–12.9) | 16.4 (14.4–18.4) | 20.0 (15.7–24.3) | 15.1 (12.9–17.2) | 14.6 (10.9–18.3) | 13.8 (8.4–19.3) | 17.9 (14.0–21.8) |
| Unemployed | 23.3 (20.3–26.2) | 35.7 (31.3–40.1) | 36.8 (27.6–46.1) | 35.2 (29.6–40.8) | 35.4 (29.3–41.4) | 29.2 (13.7–44.6) | 32.2 (25.9–38.4) |
| Other/not in labor force | 12.1 (11.1–13.2) | 26.3 (23.6–28.9) | 30.3 (26.6–34.1) | 24.8 (21.4–28.1) | 30.2 (25.2–35.3) | 19.1 (11.1–27.1) | 28.8 (24.9–32.7) |
| Metropolitan statistical areaf | |||||||
| Large metro | 11.6 (10.8–12.4) | 19.3 (18.0–20.7) | 22.9 (20.1–25.8) | 18.2 (16.4–20.0) | 20.7 (17.3–24.0) | 16.7 (10.4–23.1) | 20.4 (17.8–23.1) |
| Small metro | 15.5 (14.5–16.5) | 24.6 (22.7–26.4) | 30.1 (26.9–33.3) | 22.4 (19.8–25.0) | 26.6 (22.8–30.3) | 16.3 (12.3–20.3) | 28.3 (25.3–31.3) |
| Nonmetro/rural | 17.6 (16.2–18.9) | 31.3 (28.3–34.3) | 34.0 (28.4–39.5) | 30.3 (26.7–34.0) | 33.9 (29.2–38.7) | 24.4 (15.6–33.3) | 33.2 (27.8–38.7) |
| Arrested and booked in past 12 months | |||||||
| Yes | 44.1 (38.9–49.2) | 63.0 (56.8–69.2) | 69.9 (60.8–78.9) | 59.3 (51.4–67.2) | 66.2 (53.2–79.2) | 70.2 (43.4–96.9) | 62.1 (52.1–72.1) |
| No | 30.3 (28.8–31.8) | 40.5 (38.2–42.7) | 41.5 (36.1–46.8) | 40.0 (37.2–42.8) | 47.4 (42.0–52.7) | 21.2 (15.7–26.6) | 44.7 (38.5–51.0) |
Table 1. Percentage of Adults Who Currently Smoke Cigarettes, by Mental Health Condition, National Survey on Drug Use and Health, 2019–2020
Abbreviations: GED, General Educational Development.
a Current cigarette smoking was defined as respondents who smoked ≥100 cigarettes in their lifetime and reported smoking part or all of a cigarette in the 30 days preceding interview. Values are weighted percentage (95% CI).
b Past year any mental illness was defined as respondents who reported serious, moderate, or mild mental illness, serious psychological distress, or a major depressive disorder in the past year.
c Estimates suppressed because relative standard error was >30%.
d Disability was defined as respondents reporting any of the following: deaf or difficulty hearing; blind or serious difficulty seeing, even when wearing glasses; serious difficulty concentrating, remembering, or making decisions because of a physical, mental, or emotional condition; serious difficulty walking or climbing stairs; difficulty dressing or bathing; difficulty doing errands alone such as visiting a doctor’s office or shopping because of a physical, mental, or emotional condition.
e Public and private health insurances are not mutually exclusive; public insurance includes Medicaid, Child Health Improvement Plan, Medicare, Tricare, Champus, Veterans Administration, or some other military insurance.
f Metropolitan statistical areas are based on the 2013 Rural–Urban Continuum Codes (www.ers.usda.gov/data-products/rural-urban-continuum-codes.aspx).
| State | AMIb | AMI and smoke cigarettesb,c | No AMI and smoke cigarettesc,d |
|---|---|---|---|
| State median, % | 21.4 | 24.7 | 16.0 |
| Alabama | 20.5 (16.7–25.0) | 35.0 (25.8–45.6) | 19.9 (15.4–25.4) |
| Alaska | 21.1 (17.5–25.3) | 22.5 (15.5–31.6) | 16.4 (13.0–20.4) |
| Arizona | 24.1 (20.7–27.8) | 16.4 (11.2–23.4) | 12.6 (9.2–17.1) |
| Arkansas | 22.3 (18.3–26.9) | 35.3 (26.8–44.8) | 18.3 (14.1–23.3) |
| California | 20.1 (18.6–21.7) | 19.1 (16.0–22.6) | 11.2 (9.6–13.0) |
| Colorado | 23.3 (19.9–27.0) | 20.7 (14.7–28.3) | 12.2 (9.3–15.9) |
| Connecticut | 15.9 (13.1–19.2) | 18.6 (12.7–26.3) | 11.3 (8.0–15.8) |
| Delaware | 20.8 (17.3–24.7) | 24.2 (18.4–31.1) | 17.0 (12.6–22.4) |
| District of Columbia | 23.7 (20.2–27.7) | 19.8 (13.6–27.8) | 18.2 (13.5–24.2) |
| Florida | 16.9 (15.2–18.7) | 23.1 (18.8–28.0) | 15.9 (13.9–18.2) |
| Georgia | 15.7 (13.2–18.5) | 20.0 (14.1–27.6) | 15.3 (12.4–18.8) |
| Hawaii | 17.9 (14.6–21.8) | 22.6 (15.5–31.8) | 15.6 (12.0–20.1) |
| Idaho | 24.9 (21.5–28.6) | 21.1 (15.3–28.3) | 11.8 (8.2–16.7) |
| Illinois | 20.1 (18.0–22.4) | 23.9 (19.1–29.3) | 15.3 (13.2–17.8) |
| Indiana | 20.6 (17.2–24.5) | 35.0 (28.6–42.0) | 20.1 (16.1–24.9) |
| Iowa | 19.7 (16.0–24.0) | 26.4 (19.4–34.9) | 17.7 (13.5–22.8) |
| Kansas | 28.5 (24.3–33.1) | 25.4 (17.9–34.6) | 16.3 (12.3–21.5) |
| Kentucky | 21.6 (18.1–25.6) | 34.2 (26.5–42.9) | 22.3 (18.2–26.9) |
| Louisiana | 21.1 (17.8–24.9) | 42.1 (32.2–52.7) | 20.2 (16.4–24.5) |
| Maine | 22.0 (17.6–27.1) | 23.8 (15.7–34.4) | 15.0 (10.9–20.4) |
| Maryland | 16.6 (14.1–19.5) | 23.4 (17.6–30.3) | 11.5 (8.8–14.8) |
| Massachusetts | 21.4 (17.2–26.3) | 18.6 (10.8–30.2) | 11.7 (9.6–14.2) |
| Michigan | 22.7 (20.3–25.4) | 27.9 (23.7–32.6) | 18.1 (15.5–21.2) |
| Minnesota | 23.6 (20.8–26.7) | 28.4 (21.3–36.8) | 10.5 (8.4–13.2) |
| Mississippi | 22.1 (18.4–26.3) | 32.4 (22.8–43.7) | 22.6 (18.5–27.4) |
| Missouri | 19.8 (17.0–22.9) | 29.6 (23.2–36.9) | 16.4 (13.2–20.1) |
| Montana | 23.0 (18.8–27.9) | 28.6 (21.3–37.1) | 19.1 (16.4–22.1) |
| Nebraska | 23.0 (20.1–26.2) | 30.5 (21.4–41.3) | 12.3 (9.5–15.9) |
| Nevada | 21.2 (17.2–25.9) | 26.7 (19.7–35.1) | 11.9 (8.9–15.9) |
| New Hampshire | 26.3 (22.1–31.0) | 22.0 (15.7–29.9) | 13.8 (10.7–17.6) |
| New Jersey | 17.8 (15.1–20.8) | 17.9 (12.8–24.5) | 12.1 (9.7–15.1) |
| New Mexico | 21.6 (17.6–26.1) | 25.2 (18.6–33.1) | 15.5 (10.8–21.8) |
| New York | 18.7 (17.0–20.6) | 25.6 (21.6–30.0) | 14.0 (12.2–15.9) |
| North Carolina | 18.6 (16.8–20.6) | 27.0 (20.7–34.3) | 17.9 (15.3–20.8) |
| North Dakota | 18.8 (16.2–21.8) | 29.0 (21.2–38.2) | 18.6 (14.6–23.4) |
| Ohio | 24.8 (22.1–27.7) | 34.2 (29.2–39.5) | 19.1 (16.5–22.1) |
| Oklahoma | 29.1 (25.2–33.3) | 28.7 (22.0–36.5) | 21.4 (17.0–26.5) |
| Oregon | 27.5 (23.7–31.7) | 21.5 (15.3–29.3) | 13.8 (10.8–17.4) |
| Pennsylvania | 19.5 (16.9–22.3) | 29.5 (23.1–36.8) | 18.9 (15.5–22.8) |
| Rhode Island | 23.9 (20.2–28.1) | 20.8 (13.3–31.0) | 16.2 (12.1–21.4) |
| South Carolina | 23.3 (19.5–27.5) | 24.7 (18.7–31.9) | 19.9 (16.8–23.5) |
| South Dakota | 18.4 (15.7–21.5) | 28.6 (19.5–39.8) | 19.4 (14.5–25.5) |
| Tennessee | 19.6 (16.2–23.6) | 32.2 (25.3–40.0) | 18.0 (14.1–22.7) |
| Texas | 17.5 (15.7–19.4) | 23.0 (18.9–27.7) | 14.7 (12.9–16.6) |
| Utah | 31.5 (27.8–35.5) | 11.7 (7.9–17.1) | 7.8 (6.1–10.0) |
| Vermont | 22.8 (19.1–26.9) | 27.4 (20.2–36.0) | 10.4 (8.0–13.5) |
| Virginia | 20.4 (17.8–23.4) | 18.9 (13.7–25.5) | 15.2 (12.4–18.4) |
| Washington | 26.1 (22.4–30.1) | 20.1 (15.1–26.3) | 15.4 (12.3–19.0) |
| West Virginia | 28.3 (24.1–32.9) | 31.6 (23.2–41.4) | 20.7 (16.2–26.2) |
| Wisconsin | 21.1 (18.2–24.2) | 22.1 (16.9–28.3) | 16.0 (12.0–20.9) |
| Wyoming | 24.1 (20.3–28.3) | 25.1 (17.7–34.1) | 19.7 (14.7–25.9) |
Table 2. Percentage of Adults Who Currently Smoke Cigarettes, by State and Mental Illness Status, National Survey on Drug Use and Health, 2019–2020a
Abbreviation: AMI, any mental illness.
a Values are weighted percentage (95% CI) unless otherwise indicated.
b Any mental illness was defined as a participant who reported serious, moderate, or mild mental illness, serious psychological distress, and/or major depressive disorder in the past year.
c Current cigarette smoking was defined as those reporting smoking part or all of a cigarette in the past 30 days before interview.
d No serious, moderate, or mild mental illness, serious psychological distress, or major depressive episode reported over the past year.
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Prevalence of cigarette smoking is disproportionally high among US adults with mental health conditions. Adults with mental health conditions who smoke cigarettes are at increased risk for smoking-related illness and death compared with adults without mental health conditions.
We analyzed pooled data from the 2019 and 2020 National Survey on Drug Use and Health to provide national estimates of current cigarette smoking prevalence among US adults aged 18 years or older who reported having in the past year any mental illness, serious mental illness, mild or moderate mental illness, serious psychological distress, and/or major depressive episode (N = 19,398) and state-level estimates for any mental illness.
Prevalence of cigarette smoking for serious mental illness was 27.2%; serious psychological distress and major depressive disorder, 25.0%; serious psychological distress, 24.5%; any mental illness, 22.8%; mild or moderate mental illness, 21.2%; and major depressive disorder, 17.6%. State-level cigarette smoking prevalence among adults with any mental illness ranged from 11.7% in Utah to 42.1% in Louisiana, with a median of 24.7%.
The prevalence of current cigarette smoking is higher among adults with any mental illness, psychological distress, and major depressive disorder than among those without any mental illness, especially among adults who are non-Hispanic American Indian or Alaska Native, Hispanic, lesbian, gay, or bisexual and among those who are experiencing poverty, are uninsured, or have been arrested and booked in the past year. Continued improvement in integration of smoking cessation interventions into mental health treatment, equitable implementation of comprehensive commercial tobacco control policies, and population-specific approaches could reduce cigarette smoking among adults with mental health conditions.
