摘要：Objectives. We estimated smoking prevalence, frequency, intensity, and cessation attempts among US adults with selected diagnosed lifetime mental illnesses. Methods. We used data from the 2007 National Health Interview Survey on 23 393 noninstitutionalized US adults to obtain age-adjusted estimates of smoking prevalence, frequency, intensity, and cessation attempts for adults screened as having serious psychological distress and persons self-reporting bipolar disorder, schizophrenia, attention deficit disorder or hyperactivity, dementia, or phobias or fears. Results. The age-adjusted smoking prevalence of adults with mental illness or serious psychological distress ranged from 34.3% (phobias or fears) to 59.1% (schizophrenia) compared with 18.3% of adults with no such illness. Smoking prevalence increased with the number of comorbid mental illnesses. Cessation attempts among persons with diagnosed mental illness or serious psychological distress were comparable to attempts among adults without mental illnesses or distress; however, lower quit ratios were observed among adults with these diagnoses, indicating lower success in quitting. Conclusions. The prevalence of current smoking was higher among persons with mental illnesses than among adults without mental illnesses. Our findings stress the need for prevention and cessation efforts targeting adults with mental illnesses. Smoking is the leading cause of preventable death in the United States and accounts for approximately 1 of every 5 deaths each year. 1 , 2 Although rates of cigarette use have dropped substantially among the general population, 3 smoking continues to be a major public health problem, particularly for persons with mental illness. Between 40% and 85% of persons with various forms of mental illness currently smoke cigarettes, 4 , 5 and these estimates are as much as 4 times as high as the current prevalence of smoking among the US adult population (19.8%). 3 Additionally, persons with mental illness suffer from tobacco-related diseases at twice the rate of same-aged adults without mental illness. 6 , 7 Given these high rates of smoking and increased morbidity and mortality, it is pertinent to investigate and understand the smoking patterns and cessation behaviors of persons with mental illnesses to inform and guide programs and policies that can reach and assist this population. Recent clinical research has effectively addressed the association of cigarette smoking and cessation attempts of persons with specific mental health disorders 4 , 5 , 8 , 9 ; however, population-based data are scant. Lasser et al. 10 used population-based data collected from the National Comorbidity Study in the early 1990s to examine smoking prevalence and behaviors. They found that persons with a mental disorder were twice as likely to smoke as were persons without a mental disorder, yet persons with a mental disorder had a self-reported quit rate between 30% and 37%. Breslau et al., 11 using the same data to examine smoking intensity and frequency, found that preexisting disorders predicted an increased risk for the first onset of daily smoking and for smokers’ progression to nicotine dependence. Using data from the 2002 National Survey of Drug Use and Health, a population-based study, Hagman et al. 12 examined serious psychological distress by use of the Kessler-6 (K6) measure and found that persons with serious psychological distress were more likely to be daily smokers, were less likely to quit smoking, and appeared to smoke more heavily as symptom severity increased. In yet another study, Grant et al. 13 used the National Epidemiologic Survey on Alcohol and Related Conditions and found that nicotine-dependent smokers with a mental health disorder consumed 34.2% of all cigarettes smoked in the United States. Although these population-based studies have added valuable prevalence data on tobacco use by those with mental health disorders, the studies are not without limitations. The Lasser et al. 10 and Breslau et al. 11 studies were based on data collected from 1991 to 1992, a time when overall smoking prevalence in the United States was 26.5%, almost 7 percentage points higher than current reported estimates. With major advances in tobacco control and with similar decreases of smoking prevalence seen among other population subgroups (i.e., Hispanics, Asian/Pacific Islanders, and pregnant smokers), it would be worthwhile to use more current data to determine whether smoking rates of persons with mental health disorders have followed a similar decline. 3 , 14 Additionally, because of the design and scope of many population-based surveys, none of the previous studies was able to comprehensively assess both mental health disorders and cigarette use. 12 Hagman et al. 12 attempted to address this issue with their study; however, they relied solely on the K6 scale. Although the K6 is a validated instrument that is intended to be a proxy measure for current serious psychological distress and mental health impairments, the scale does not measure specific types of mental health disorders or assess the diagnosis of a mental health disorder over the lifespan. To that end, in this study, we sought to specifically examine the prevalence, frequency, and intensity of smoking and cessation attempts by adults with previously diagnosed mental illnesses or serious psychological distress by using 2007 data from the National Health Interview Survey (NHIS). The NHIS is a nationally representative survey that provides extensive information on smoking behaviors and self-reported lifetime diagnoses of specific mental health disorders as well as serious psychological distress by use of the K6 measure.
