Smoking bans effective among mentally ill

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Photo by Kathryn Crandall.

Previous research suggests that smokers with mental illness generally have more difficulty quitting cigarettes than smokers who are not mentally ill. But a new Yale study suggests that statewide restaurant and bar smoking bans are just as effective at reducing smoking among both populations.

Past studies have demonstrated a correlation between statewide restaurant and bar smoking bans and reduced smoking among the general population, and authors of the current study explored whether this effect extends to the mentally ill. They found that such bans do lead to greater likelihood of smoking cessation among the mentally ill, as well as being more effective among males with alcohol use disorders and females suffering from anxiety disorders than among people with no mental illness at all.

The findings suggest that policy change is capable of addressing high rates of smoking among the mentally ill, said Andrew Hyland, study co-author and department chair of health behavior at the Roswell Park Cancer Institute

“This was the first investigation to examine how smokers with specific psychiatric diagnoses altered smoking in response to enactment of smoke-free legislation in bars and restaurants,” said Sherry McKee, professor of psychiatry at the Yale School of Medicine and co-author of the study. “Results demonstrated that implementation of smoke-free laws increased rates of quitting among smokers with mental illness, although results were not uniform across all diagnoses.”

Roughly 30 to 40 percent of smokers in the United States have a mental illness, and this population consumes nearly half of the cigarettes in America. Researchers, medical professionals and policy makers are increasingly aware of this public health issue, but the effects of statewide tobacco control policies on those with mental illness were previously unclear, according to Philip H. Smith, a postdoctoral fellow at the Yale School of Public Health and study lead author.

Since smokers with mental illness are more dependent on nicotine and have more difficulty quitting smoking than those without mental illness, the researchers hypothesized that the implementation of smoking bans would be less effective in reducing smoking among those with mental illness than among individuals who are not mentally ill. To test this hypothesis, researchers analyzed data from the National Epidemiologic Survey on Alcohol and Related Conditions, identifying eight states — Connecticut, New York, Delaware, Maine, Massachusetts, Rhode Island, Washington and Vermont — that implemented smoking bans in bars and restaurants. They then compared the likeliness of smokers living in those eight states giving up cigarettes with smokers living in other states and examined whether associations varied by mental illness.

The research team did not find a disparity between the reductions in the amount of cigarettes smoked per day by those with mental illness and by those without. Statewide smoking bans in bars and restaurants resulted in an overall decrease in the number of cigarettes smoked per day among men, regardless of whether these men had a psychiatric illness. Women, with the exception of those diagnosed with mood disorders, also smoked fewer cigarettes per day due to these bans.

“What this means to public health practitioners or to elected officials who are trying to reduce health disparities is that things like higher cigarette prices and smoke-free laws should serve to reduce the disparity that we currently have,” Hyland said. “They’re not only reducing tobacco consumption for everyone, but for those with certain mental health disabilities.”

Hyland added that he and the other study authors need to apply some of their findings to inform current public policy debates. He is also interested in studying smoking reduction in other populations, since this study solely focused on adults with mental illnesses and did not produce any data about the effects of tobacco control policies on adolescent smokers.

Smith said he hopes to find more associations between tobacco reducing measures and smoking among people with mental illness. He is currently investigating whether increases in cigarette prices are also associated with reduced smoking among these individuals.

“Our findings highlight the importance of continuing to examine how tobacco control policies and interventions influence smoking among those with mental illness, and of considering new policies that may directly target smoking among those with mental illness,” Smith said.

According to the Centers for Disease Control and Prevention, an estimated 42.1 million people in the United States smoke cigarettes.

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