Monday, September 25, 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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The NSDUH adult survey response rate was 64.2% in 2019 and 62.8% in 2020 [11]. An unweighted sample of 68,427 adults aged 18 years or older completed interviews in the combined 2019 and 2020 survey years. Our primary study population consisted of 19,398 (28.3%) surveyed adults aged 18 years or older who reported AMI, serious psychological distress, or major depressive disorder in the past year. Of those, 4,251 (21.9%) currently smoked. A total of 6,896 (10.1%) reported no AMI, serious psychological distress, or major depressive disorder and currently smoked. The populations for the state-level analysis were taken directly from NSDUH’s restricted-use data analysis system; therefore, unweighted sample sizes are unknown.
The national prevalence of current smoking during 2019–2020 was 27.2% among adults with serious mental illness, 25.0% among adults with serious psychological distress and major depressive disorder, 24.5% among adults with serious psychological distress alone, 22.8% among adults with AMI, 21.2% among adults with mild or moderate mental illness, and 17.6% among adults with major depressive disorder alone (Table 1). The prevalence of current cigarette smoking among almost all mental health conditions was relatively higher than among adults without a mental health condition, except among a few demographic subgroups reporting serious psychological distress, major depressive disorder, or both. The absolute disparity in current smoking by mental health condition was highest among non-Hispanic American Indian and Alaska Native (non-Hispanic AI/AN) adults with serious psychological distress (45.0%), serious mental illness (33.2%), mild or moderate mental illness (24.8%), or AMI (27.3%); adults with less than a high school diploma and serious mental illness (25.2%) or serious psychological distress and major depressive disorder (20.5%); uninsured adults with serious mental illness (20.7%); and adults arrested and booked in the past 12 months with major depressive disorder (26.1%), serious mental illness (25.8%), or serious psychological distress (22.1%).
State-specific current smoking prevalence among adults with AMI was consistently higher than among adults without AMI (Table 2). By state, cigarette smoking prevalence among adults with AMI ranged from 11.7% in Utah to 42.1% in Louisiana, with a median of 24.7% in South Carolina. State-level absolute disparity in current smoking by AMI ranged from 1.6% in the District of Columbia to 21.9% in Louisiana (Table 2).
