Commercial tobacco use still a problem, especially among people with mental health conditions
Smoking rates have significantly declined over the past few decades, thanks to remarkable public health efforts in commercial tobacco control and prevention. Despite this progress, certain populations continue to use tobacco at disproportionately higher rates.
People with mental health and/or substance use challenges continue to smoke at rates 2-3 times higher than the general population, according to a study published in the Annual Review of Public Health.
And they pay the price; compared to people without serious mental illness, Minnesota adults with serious mental illness and a tobacco-related disease die approximately 32 years sooner, according to data from the Minnesota Department of Health.
Tobacco is the leading behavioral cause of death. Over 45% of the 540,000 annual tobacco-related deaths in the United States are individuals with mental illness and/or other substance use disorders. This is higher than the total of all deaths caused by suicide, alcohol or drug induced.
Not only does having a mental health or substance use challenge make a person more at risk for using tobacco, but using tobacco increases the likelihood of using other substances, according to the New England Journal of Medicine.
Smoking is also associated with greater depressive symptoms, psychiatric hospitalization, and suicidal behavior, according to a different study in the New England Journal of Medicine and a study in the Journal of Psychiatric Research.
People want help
There is good news. There is a cultural shift currently happening in the fields of mental health and substance use in Minnesota. There is greater recognition that people in this population want to quit using tobacco, according to a study in the journal Addiction, and that mental health and substance use professionals are well-positioned to support tobacco recovery. This workforce has the skillset to help people manage stress, navigate challenges, and increase health-promoting behavior.
Ways Hennepin is working to help those who want to quit
Hennepin County is working to support people in these groups in ways that align with county goals to improve health and ensure that people are protected and safe. Hennepin County Public Health recently sponsored a cohort process, which provided staff training and technical assistance to county-contracted providers to help them to integrate tobacco treatment into their mental health and substance use services, as well as adopt tobacco-free grounds policies to support recovery.
Dedicated to reducing health disparities, continuous improvement and community engagement, HCPH will continue to identify ways to support tobacco recovery within mental health and substance use treatment. HCPH contributes to the growing base of Minnesota providers who are increasing access to tobacco treatment and tobacco-free grounds policies.
Sources for the graph
U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. Printed with corrections, January 2014. Mokdadet al,JAMA2004; 291:1238-1245. Mokdadet al;JAMA. 2005; 293:293
Tobias, D.K., Hu, F.B., (2018). The association between BMI and mortality: implications for obesity prevention. The Lancet. 916-917. Xu, J., Murphy, S.L., Kochanek, K.D., Bastian, B., Arias, E. (2018). Deaths: Final Data for 2016. National Vital Statistics Reports. 67(5). United States Department of Health and Human Services. Hyattsville, MDL National Center for Health Statistics. Source (1MB, PDF)
Special thanks to Behavioral Health & Wellness Program for providing this figure.
Acknowledgements and sources
This article was written in partnership with the American Lung Association and Health Promotion.
Schroeder SA, & Morris CD. Confronting a neglected epidemic: Tobacco cessation for persons with mental illnesses and substance abuse problems. Annu Rev Public Health. 2010; 31: 297-314).
(Minnesota Health Care Programs (MHCP) Client Data, M.D.o.H. Services, Editor. 2008-2012.)
(Kandel, E. R., & Kandel, D. B. (2014). A molecular basis for nicotine as a gateway drug. The New England Journal of Medicine, 371(10), 932–943)
(Khaled, S. M., Bulloch, A. G., Williams, J. V., Hill, J. C., Lavorato, D. H., & Patten, S. B. (2012). Persistent heavy smoking as risk factor for Major Depression (MD) incidence: Evidence from a longitudinal Canadian cohort of the National Population Health Survey.
Journal of Psychiatric Research 46(4), 436-443; Berlin, I., Hakes, J. K., Hu, M. C., & Covey, LS (2015). Tobacco use and suicide attempt: Longitudinal analysis with retrospective reports. PLoS ONE, 10(4): e0122607.)
(Siru, R., Hulse, G. K., & Tait, R. J. (2009). Assessing motivation to quit smoking in people with mental illness: a review. Addiction, 104(5), 719-733)