News Release

Smoking in underserved communities nearly double the US national rate

Study finds higher smoking rates with mental health conditions and substance use disorders

Peer-Reviewed Publication


Although rates of smoking and smoking-related cancers have declined in the United States in recent years, some people may be at higher risk for cigarette use and nicotine addiction and could therefore gain significant benefits from tobacco prevention and cessation programs. New research indicates that the prevalence of smoking in underserved communities is nearly double the national prevalence, and that smoking is linked with mental health conditions and substance use disorders in these communities. The findings are published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.

For the study, Sue C. Lin, PhD, MS, of the Health Resources and Services Administration within the U.S. Department of Health and Human Services, analyzed results from the 2014 Health Center Patient Survey to assess the prevalence of smoking among adults from underserved communities who received primary care at federally qualified health centers. These centers serve individuals and families from underserved communities including people experiencing homelessness, agricultural workers, and residents of public housing. The team also examined associations of smoking with co-occurring mental health conditions and substance use disorders.

Among the major findings:

  • The prevalence of smoking among adults from underserved communities was 28.1%, compared with 14.0% reported in the general U.S. population.
  • Among those who currently smoked, 59.1% had depression and 45.4% had anxiety.
  • Non-Hispanic Black adults who smoked had more than two times the odds of reporting substance use disorders.
  • Individuals at or below 100% of the federal poverty level had more than two times the odds of having mental health conditions, and those who were unemployed had more than three times the odds for substance use disorders.

“Our study underscores the importance of understanding the association and increased risk of mental health conditions and substance use disorders among adults from underserved communities who smoke while also addressing socioeconomic risk factors to achieve better health outcomes,” said Dr. Lin. “The study further highlights the significance of tailored smoking cessation treatments for individuals from underserved communities that will support cancer prevention care.”

Additional Information

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Full Citation:

“Disparities in smoking prevalence and associations with mental health and substance use disorders in underserved communities across the United States.” Sue C. Lin, Naomie Gathua, Cheryl Thompson, Alek Sripipatana, and Laura Makaroff. CANCER; Published Online: March 7, 2022 (DOI: 10.1002/cncr.34132).

URL Upon Publication:

Author Contact: Martin Kramer, Director of Communications for the Health Resources and Services Administration, at,, or +1 301-443-3376.

About the Journal
CANCER is a peer-reviewed publication of the American Cancer Society integrating scientific information from worldwide sources for all oncologic specialties. The objective of CANCER is to provide an interdisciplinary forum for the exchange of information among oncologic disciplines concerned with the etiology, course, and treatment of human cancer. CANCER is published on behalf of the American Cancer Society by Wiley and can be accessed online.

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About Wiley

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