While the overall smoking rate has declined, including a drop among youth to a record low of 6 percent, the numbers do not tell the whole story. Tobacco use disproportionately affects many populations—including people in low-income communities, racial and ethnic minorities, LGBT individuals, members of the military and those with mental health conditions—who have a long and documented history of being targeted by the tobacco industry.

People with mental health conditions—depression, anxiety and ADHD, for example—or substance use disorders make up 25 percent of the population, but they account for 40 percent of all cigarettes smoked in the U.S.

1 in 3

1 in 3 adults with mental illness smoke compared to 1 in 5 adults without mental illness.

The higher smoking rates—1 in 3 adults with mental illness smoke compared to 1 in 5 adults without mental illness—contribute to a shorter life expectancy. People with mental illness die about five years earlier than those without these disorders, and many of these deaths are caused by smoking cigarettes.

The disproportionate effect tobacco has on this population, and other marginalized groups, is due to various social and economic disadvantages. One factor that these populations have in common: they have all been exploited by the tobacco industry.

Courting People with Mental Health Conditions

The tobacco industry has marketed to people with mental health conditions in several ways, including giving free cigarettes away to psychiatric facilities.

Industry documents show that tobacco companies targeted psychiatric facilities with product promotions and giveaways during the 1980s and 1990s, and that facilities also requested cigarette donations. An example can be found in a 1995 letter from a mental illness and substance abuse treatment center in North Carolina that refers to multiple cigarette donations the facility had received over the years: “In the past, your company has made our clients a lot happier during the holidays by providing us with several cases of cigarettes.” The tobacco company responded to the request with 800 sample cigarettes.

The tobacco industry has also supported some common misconceptions about tobacco and mental health—that cigarettes have a therapeutic effect and quitting will make symptoms worse—by funding misleading research studies. Companies have promoted messages that cigarettes will “improve your mood” and “help you to relax,” said Dr. Jill M. Williams, professor of psychiatry and director of the division of addiction psychiatry at Rutgers University-Robert Wood Johnson Medical School, at the 2017 Warner Series on tobacco and social justice.

Contrary to messages from the industry, research shows that quitting tobacco improves treatment outcomes for substance use and mental health conditions. Multiple studies have shown that people with a substance use disorder are more successful at avoiding a relapse if they quit tobacco while seeking treatment for an addiction. Research also shows that people in recovery from depression or mood disorders experience fewer symptoms if they quit tobacco as part of their treatment.

Barriers to Quitting

Despite the benefits of quitting tobacco, people with mental health conditions face many barriers when it comes to quitting.

Many treatment centers do not offer smoking cessation services, and the tobacco industry has also supported efforts to block smoking restrictions at mental health facilities. A journal article on tobacco use and schizophrenia found that Big Tobacco “hired legal counsel to monitor research on hospital smoking restrictions."

Given the targeted marketing to this population, it may not be surprising that people with mental illness have less successful quit rates than others.

Tobacco “is the number one cause of death in this population,” said Williams, “and there is tremendous evidence that people can quit smoking, and when people do, they have better mental health outcomes and certainly would live longer and better lives.”

For more information on the disproportionate effect tobacco has on certain populations, including racial and sexual minorities and low-income communities, read the Achieving Health Equity report.

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