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A Population-Based Prevalence Study

Karen Lasser, MD; J. Wesley Boyd, MD, PhD; Steffie Woolhandler, MD, MPH; David U. Himmelstein, MD; Danny McCormick, MD, MPH; David H. Bor, MD

JAMA. 2000;284:2606-2610.

Context  Studies of selected groups of persons with mental illness, such as those who are institutionalized or seen in mental health clinics, have reported rates of smoking to be higher than in persons without mental illness. However, recent population-based, nationally representative data are lacking.

Objective  To assess rates of smoking and tobacco cessation in adults, with and without mental illness.

Design, Setting, and Participants  Analysis of data on 4411 respondents aged 15 to 54 years from the National Comorbidity Survey, a nationally representative multistage probability survey conducted from 1991 to 1992.

Main Outcome Measures  Rates of smoking and tobacco cessation according to the number and type of psychiatric diagnoses, assessed by a modified version of the Composite International Diagnostic Interview.

Results  Current smoking rates for respondents with no mental illness, lifetime mental illness, and past-month mental illness were 22.5%, 34.8%, and 41.0%, respectively. Lifetime smoking rates were 39.1%, 55.3%, and 59.0%, respectively (P<.001 for all comparisons). Smokers with any history of mental illness had a self-reported quit rate of 37.1% (P = .04), and smokers with past-month mental illness had a self-reported quit rate of 30.5% (P<.001) compared with smokers without mental illness (42.5%). Odds ratios for current and lifetime smoking in respondents with mental illness in the past month vs respondents without mental illness, adjusted for age, sex, and region of the country, were 2.7 (95% confidence interval [CI], 2.3-3.1) and 2.7 (95% CI, 2.4-3.2), respectively. Persons with a mental disorder in the past month consumed approximately 44.3% of cigarettes smoked by this nationally representative sample.

Conclusions  Persons with mental illness are about twice as likely to smoke as other persons but have substantial quit rates.

Author Affiliations: Departments of Medicine (Drs Lasser, Woolhandler, Himmelstein, McCormick, and Bor) and Psychiatry (Dr Boyd), The Cambridge Hospital and Harvard Medical School, Cambridge, Mass; and Department of Religion, Smith College, Northampton, Mass (Dr Boyd).

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