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Table 1.  

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).

Table 2.  

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.

CME / ABIM MOC

Disparities in Current Cigarette Smoking Among US Adults With Mental Health Conditions

  • Authors: Caitlin G. Loretan, MPH; Teresa W. Wang, PhD; Christina V. Watson, DrPH; Ahmed Jamal, MBBS
  • CME / ABIM MOC Released: 12/22/2022
  • Valid for credit through: 12/22/2023
Start Activity

  • Credits Available

    Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 1.00 ABIM MOC points

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for primary care physicians, psychiatrists, addiction medicine specialists, and other healthcare professionals who see patients who smoke cigarettes.

The goal of this activity is for learners to be better able to assess the problem of cigarette smoking among US adults with mental illness.

Upon completion of this activity, participants will:

  • Compare the prevalence of cigarette smoking among US adults with mental illness vs those without mental illness
  • Distinguish types of mental illness particularly associated with cigarette smoking
  • Identify the racial/ethnic group with the highest prevalence of cigarette smoking
  • Assess variables associated with higher rates of cigarette smoking among adults with mental illness


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Faculty

  • Caitlin G. Loretan, MPH

    Centers for Disease Control and Prevention
    Atlanta, Georgia

  • Teresa W. Wang, PhD

    Centers for Disease Control and Prevention
    Atlanta, Georgia

  • Christina V. Watson, DrPH

    Centers for Disease Control and Prevention
    Atlanta, Georgia

  • Ahmed Jamal, MBBS

    Centers for Disease Control and Prevention
    Atlanta, Georgia

CME Author

  • Charles P. Vega, MD

    Health Sciences Clinical Professor of Family Medicine
    University of California, Irvine School of Medicine

    Disclosures

    Charles P. Vega, MD, has the following relevant financial relationships:
    Consultant or advisor for: GlaxoSmithKline; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.

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  • Rosemarie Perrin

    Editor
    Preventing Chronic Disease 
    Atlanta, GA

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  • Leigh Schmidt, MSN, RN, CNE, CHCP

    Associate Director, Accreditation and Compliance, Medscape, LLC

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CME / ABIM MOC

Disparities in Current Cigarette Smoking Among US Adults With Mental Health Conditions

Authors: Caitlin G. Loretan, MPH; Teresa W. Wang, PhD; Christina V. Watson, DrPH; Ahmed Jamal, MBBSFaculty and Disclosures

CME / ABIM MOC Released: 12/22/2022

Valid for credit through: 12/22/2023

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Abstract

Introduction

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.

Methods

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.

Results

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%.

Conclusion

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.