Smoking is the leading cause of preventable death in the United States and the single most important avoidable cause of disease and premature death worldwide, according to background information in the article. Among psychiatric outpatients and inpatients, studies have found elevated smoking rates, and a recent national survey discovered higher smoking rates in persons with psychiatric disorders than those without.
Bridget F. Grant, Ph.D., Ph.D., from the National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Md., and colleagues used data from interviews with 43,093 adults living both in and out of group homes to examine nicotine and other drug use in conjunction with psychiatric disorders. The interviews were part of the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Study participants were assessed for nicotine dependence, alcohol and drug use disorders, mood disorders (e.g. depression, mania), anxiety disorders (e.g. social phobia, generalized anxiety), and personality disorders (e.g. obsessive-compulsive) in face-to-face interviews.
The researchers found that among the total sample, 28.4 percent were current users of any tobacco product, 24.9 percent were current cigarette smokers, and 12.8 percent (n = 4,962) were nicotine dependent. Those who were nicotine-dependent consumed 57.5 percent of all cigarettes smoked in the United States. Among respondents with nicotine dependence, the prevalence of any alcohol use disorder was 22.8 percent, while 21.1 percent had a mood disorder, 22 percent had an anxiety disorder, and 31.7 percent had a personality disorder. Prevalence of drug use disorder among nicotine-dependent persons was 8.2 percent.
Nicotine dependence was most prevalent among persons with an alcohol or drug use disorder (34.5 percent and 52.4 percent, respectively). Among individuals with a mood, anxiety, or personality disorder, nicotine dependence was identified in 29.2 percent, 25.3 percent, and 27.3 percent, respectively.
"Nicotine-dependent and psychiatrically ill individuals consume about 70 percent of all cigarettes smoked in the United States," write the authors. "The results of this study highlight the importance of focusing smoking cessation efforts on individuals who are nicotine dependent, individuals who have psychiatric disorders, and individuals who have comorbid [related] nicotine dependence and other psychiatric disorders. Further, awareness of industry segmentation strategies can improve smoking cessation efforts of clinicians and other health professionals among all smokers and especially among the most vulnerable."
(Arch Gen Psychiatry. 2004; 61:1107-1115. Available post-embargo at archgenpsychiatry.com.)
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