Nondaily Smoking Increases in People With Mental Illness

Nondaily cigarette smoking by U.S. adults with common mental health and substance use problems increased significantly between 2005 and 2014, while simultaneously declining among those without these disorders, according to a report in the Journal of Clinical Psychiatry.

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The report also found daily smoking declined among those with and without these disorders.

“While the decrease in daily cigarette smoking among persons with MHSUP [mental health or substance use problem] is promising, the prevalence of cigarette smoking among persons with MHSUP remained very high,” wrote Andrea H. Weinberger, Ph.D., an assistant professor of psychology of Yeshiva University in New York, and colleagues. According to the researchers, the overall prevalence of smoking among people with mental illness and substance use problems in 2014 was more than twice that of those without those conditions.

“There is a commonly held view that nondaily cigarette smoking is not harmful,” the researchers wrote. “However, nondaily cigarette smoking has negative health consequences, many nondaily smokers eventually increase to daily cigarette consumption and nondaily cigarette smokers are less likely to express an intention to quit, relative to daily smokers.”

Weinberger and colleagues analyzed data from the National Survey on Drug Use and Health from 2005 and 2014, comparing current, daily, and nondaily cigarette smoking among adults with and without any mental health or substance use problem. Individuals who reported experiencing past-year major depressive episode, serious psychological stress, substance use disorders, alcohol use disorders, heavy alcohol use, or daily cannabis use were classified as having a mental health or substance use problem (MHSUP). People with a history of smoking who smoked cigarettes 1 to 29 days of the previous 30 days were classified as nondaily smokers, while those who smoked 30 of the previous 30 days were classified as daily smokers.

The prevalence of nondaily cigarette smoking increased from 29.54 percent in 2005 to 33.73 percent in 2014 among people with MHSUP. In contrast, nondaily smoking declined among people without these disorders from 29.13 percent in 2005 to 27.43 percent in 2014. The prevalence of daily smoking declined significantly over the same period among individuals in both groups (from 29.42 percent to 24.21 percent among people with MHSUP; from 13.48 percent to 10.21 percent among people without MHSUP).

“It is not clear whether the increase in nondaily cigarette smoking for persons with MHSUP is due to persons decreasing cigarette smoking from daily to nondaily levels or incident nondaily cigarette smoking,” the researchers wrote. “Future studies should examine reasons for the increase in nondaily cigarette smoking to determine what resources are most needed. Persons who present with both mental health and substance use problems may need additional research and clinical attention to understand and address their greater increasing trend in nondaily smoking.”

They noted as well that the 2008 update to the Clinical Practice Guidelines for Treating Tobacco Use and Dependence recommends routine screening for cigarette smoking, including the use by physicians of “the 5 A’s”:

• Ask patients if they smoke.

• Advise patients to quit.

• Assess patients’ motivation for quitting.

• Assist with quit attempts.

• Arrange follow-up contacts.

“When patients enter treatment for MHSUP, it provides an opportunity to identify smokers (nondaily and daily) and provide cessation treatment options,” Weinberger and colleagues wrote.

The study was supported by a National Institutes of Health/National Institute on Drug Abuse grant. ■