Smoking characteristics of adults with selected lifetime mental illnesses: results from the 2007 National Health Interview Survey.

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.

Cigarette smoking women of reproductive age who use oral contraceptives: results from the 2002 and 2004 behavioral risk factor surveillance systems.

BACKGROUND: Despite health warnings about the increased risk of cerebrovascular disease among women who smoke while using oral contraceptives (OCs), prior research suggests that OC use is still prevalent among women who smoke cigarettes. Our objective was to investigate the prevalence of OC use among cigarette smoking women of reproductive age in the United States. STUDY DESIGN: We extracted data from the 2002 and 2004 Behavioral Risk Factor Surveillance System surveys of 76,544 women between 18 and 44 years of age who reported using some form of contraception. OC use, or self-reported use of "the pill," was examined among those who currently smoke, either everyday or some days. Multivariable logistic regression models were used to compare OC use between smoking and nonsmoking women. RESULTS: One fourth (26.9%) of U.S. women who smoke compared with 34.6% of nonsmoking women reported currently using OCs. After adjusting for age, race/ethnicity, marital status, education level, binge drinking, and health care coverage, women who smoke were 0.6 (95% confidence interval [CI], 0.6-0.7) times as likely to use OCs as nonsmoking women. Among women aged 35 to 44 years, the odds of OC use among smokers was even further reduced (odds ratio [OR], 0.3; 95% CI, 0.3-0.4) compared with nonsmokers. CONCLUSION: Among U.S. women of reproductive age who use contraception, particularly among women aged 35 to 44 years, those who smoke cigarettes are significantly less likely to use OCs than those who do not.

Adult tobacco survey - 19 States, 2003-2007.

PROBLEM/CONDITION: Tobacco use is the leading cause of preventable death in the United States. REPORTING PERIOD: This report includes data collected during February 2003-November 2007. DESCRIPTION OF THE SYSTEM: The Adult Tobacco Survey (ATS) is a state-administered, random-digit--dialed telephone survey of the noninstitutionalized U.S. population aged >or=18 years. ATS collects data on tobacco use, smoking cessation, secondhand smoke exposure, risk perception and social influences, health influences, and tobacco-related policy issues in the United States. ATS was developed primarily for evaluation of state tobacco control programs rather than for surveillance and offers states a great deal of flexibility in terms of when and how often the surveys can be conducted. During 2003-2007, a total of 33 state ATSs were conducted by 19 states, with sample sizes ranging from 1,301 to 12,734 completed and partially completed interviews. RESULTS: ATS data indicate that during 2003-2007, 13.3%-25.4% of adults smoked cigarettes (median: 19.2%); fewer adults smoked cigars (median: 6.4%) or used smokeless tobacco (median: 3.5%). The majority of tobacco users used one tobacco product (median: 82.5%). In most states, approximately half of cigarette smokers reported that they would try to quit in the next 6 months (median: 58.4%), and approximately half made an attempt to quit in the preceding year (median: 46.8%). The majority of adults (i.e., smokers and nonsmokers combined) reported that smoking should not be allowed at all in workplaces (median: 77.6%), restaurants (median: 65.5%), public buildings (median: 72.5%), or indoor sporting events/concerts (median: 72.1%). One third of adults reported smoking should not be allowed at all in cocktail lounges or bars (median: 33.1%). The percentage of adults who reported having smoke-free policies at work or home ranged from 51.2% to 75.2% (median: 61.7%). INTERPRETATION: These data indicate that respondents support certain state tobacco control measures; for example, the majority of adults in participating states were supportive of smoke-free policies as well as of an increase in tobacco excise tax. However, one of every five tobacco users in the participating states used multiple tobacco products, a behavior that was more common among young adults. Therefore, these data also underscore a continued need for monitoring and evaluating evidence-based, comprehensive U.S. tobacco control programs and policies. PUBLIC HEALTH ACTIONS: State ATSs can be used by states to monitor and evaluate comprehensive statewide tobacco control programs. Continued surveillance of tobacco use and tobacco control outcome indicators are needed to monitor, evaluate, and improve state programs that address tobacco use, cessation, and secondhand smoke exposure.

The relationship between smoking status and serious psychological distress: findings from the 2007 Behavioral Risk Factor Surveillance System.

OBJECTIVES: To examine the associations between smoking and quit attempts with psychological distress and also by socioeconomic groups. METHODS: Using data on 172,938 adult respondents from the 2007 Behavioral Risk Factor Surveillance System we used the Kessler-6 scale to assess psychological distress among never, former, some-day, and everyday smokers and smokers attempting to quit. RESULTS: Everyday smokers and attempting quitters had higher mean levels of 30-day psychological distress than never smokers. Compared with never smokers, the odds of having serious psychological distress (SPD) were: former smokers, 1.3 (95 % CI: 1.1-1.6); some-day smokers, 2.5 (95 % CI: 2.0-3.1); and everyday smokers, 3.3 (95 % CI: 2.8-3.8). As for unsuccessful quit attempts, the odds were highest for current smokers (3.3 [95 % CI: 2.8-3.8]) versus never smokers. Among current smokers, persons with less than high school education, income less than $ 50,000, or who were unemployed or unable to work had the highest odds of reporting SPD. CONCLUSIONS: Given the association between current smoking behaviors and psychological distress, future tobacco prevention and control efforts may benefit by including components of mental health, especially for low SES populations.

Associations between smoking cessation and anxiety and depression among U.S. adults.

Many studies have shown a relationship between smoking and depression. However, few studies have examined the association between current depression and smoking and even fewer used large cross-sectional data to support these findings. Using the 2006 Behavioral Risk Factor Surveillance System data (n=248,800), we compared rates of lifetime depression, lifetime anxiety, current depression, and current depressive symptoms among smokers who unsuccessfully attempted to quit (unsuccessful quitters), former smokers (successful quitters), and smokers who made no attempts to quit (non-quitters). Unsuccessful quitters experienced more lifetime depression and anxiety than non-quitters (OR=1.2; 95% CI, 1.0-1.4), whereas successful quitters experienced less (OR=0.7, 95% CI, 0.6-0.8). Current depression prevalence was 14.3% among non-quitters, 18.8% among unsuccessful quitters, and 8.0% among successful quitters. On average, unsuccessful quitters also experienced more days of depressive symptoms during the previous month than either non-quitters or successful quitters. Our results suggest that smokers who attempt to quit unsuccessfully may experience lifetime depression as well as current depression at a higher rate than other smokers and former smokers.

Associations between health-related quality of life and smoking status among a large sample of U.S. adults.

OBJECTIVE: To examine the association between self-perceived health-related quality of life (HRQoL) and smoking status. METHODS: We used data from 2006 Behavioral Risk Factor Surveillance System, USA participants in four states (n=17,800) to compare the HRQoL of current smokers who unsuccessfully attempted to quit (unsuccessful quitters), former smokers, and never smokers with the HRQoL of current smokers who made no attempts to quit (non-quitters). RESULTS: Overall, unsuccessful quitters were more likely than non-quitters to report frequent mental distress, physical distress, and pain but not frequent depressive symptoms; former and never smokers were less likely than non-quitters to report frequent depressive symptoms. When study subjects were stratified by sex, these associations held true for men, but not for women. Among women, the prevalence of frequent mental and physical distress among former smokers and never smokers was not significantly different from the prevalence among non-quitters, whereas unsuccessful quitters were 2.4 times more likely to report frequent mental distress and 2.1 times more likely to report frequent physical distress than were non-quitters. CONCLUSIONS: Certain HRQoL characteristics were worse among smokers who unsuccessfully attempted to quit and better among former smokers than among smokers who made no attempts to quit.