A population-based examination of cigarette smoking and mental illness in Black Americans

Abstract

Introduction: This study examines the relation between tobacco use and cessation with lifetime and past year mental illness in a nationally representative sample of Blacks.

Methods: This cross-sectional study analyzed nationally representative data from 3,411 adult Blacks participating in the 2001-2003 National Survey of American Life. Smoking prevalence and quit rates according to lifetime and past year Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition mental disorders were assessed by a modified version of the Composite International Diagnostic Interview.

Results: Compared with those without mental illness, respondents with a lifetime, past year, or past month mental illness had a higher smoking prevalence (20.6%, 35.6%, 36.0%, and 45.4%, respectively) and lower quit rate (40.5%, 31.2%, and 26.2%, respectively). The odds of being a current smoker among Blacks with mental illness in their lifetime, past year, and past month, after adjusting for age, gender, education, poverty, and marital status were 1.76 (95% CI = 1.39-2.22), 1.57 (95% CI = 1.22-2.03), and 2.20 (95% CI = 1.56-3.12), respectively. Mental illness also was associated with heavier smoking. Blacks with past year mental illness represented 18.1% of the sample, yet consumed 23.9% of cigarettes smoked by Black smokers. Past year (odds ratio [OR] = 0.72, 95% CI = 0.53-0.97) and past month (OR = 0.54, 95% CI = 0.29-0.98) mental illness were associated with a lower odds of quitting for at least 1 year.

Conclusions: Findings indicate that mental illness is significantly associated with tobacco use in Blacks. Tobacco cessation interventions that address mental illness as a barrier to cessation are needed.

Figure 1.

Smoking prevalence and intensity according to the number of lifetime mental disorders for Blackss. Mental disorders are defined using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), as assessed by the Composite International Diagnostic Interview, administered in the National Survey of American Life (American Psychiatric Association, 1994; Jackson, Torres, et al., 2004; Kessler & Ustun, 2004). Estimates are weighted to be nationally representative of the Black adult population. Heavier smokers are defined as smoking 11 or more cigarettes per day (CPD). Lighter smokers are defined as smoking 10 or fewer CPD (Haiman et al., 2006).