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Original research
Prevalence of smoking, quit attempts and access to cessation treatment among adults with mental illness in Brazil: a cross-sectional analysis of a National Health Survey
  1. Erica Cruvinel1,
  2. Edward Liebman1,
  3. Isabel Leite2,
  4. Jinxiang Hu3,
  5. Kimber P Richter1
  1. 1Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
  2. 2School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
  3. 3Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA
  1. Correspondence to Dr Erica Cruvinel; ericacruvinel{at}


Objectives Determine the national prevalence of smoking and factors related to smoking among adults with mental illness (PLWMI; people living with mental illness) in Brazil.

Design Cross-sectional study.

Setting We used data from the nationally representative general health survey Pesquisa Nacional de Saude of 2013, which included the Global Adult Tobacco Survey (GATS) module.

Participants The survey used a complex probabilistic sample to collect data from 60 202 Brazilians 18 years or older. Primary and secondary outcomes: smoking prevalence and access to smoking cessation treatment. We also assessed past tobacco use, quit attempts and quit ratio among people with and without mental illness. Analyses were conducted in R and were weighted to account for the survey design and generate national estimates.

Results In Brazil, the 2013 smoking prevalence among PLWMI was 28.4% and among people with no mental illness was 12.8%. Both groups had high rates of past-year quit attempts (51.6% vs 55.3%) but the lifetime quit ratio among PLWMI was much lower than those with no mental illness (37% vs 54%). Adjusted odds showed PLWMI were more likely to be current smokers (OR (95% CI)=2.60 (2.40 to 2.82), less likely to be former smokers (OR (95% CI)=0.62 (0.55 to 0.70)) and as likely to have tried to quit in the past year (OR (95% CI)=0.90 (0.78 to 1.02)). Very few (3.7%) PLWMI and fewer with no mental illness (2.6%) received cessation treatment.

Conclusion Smoking rates among PLWMI are roughly double the rate in the general population. Compared with Brazilian smokers without mental illness, those with mental illness were significantly less likely to quit even though as many tried to. Few Brazilians appear to be using publicly available cessation services. Expanding utilisation of treatment might be a good place to start for Brazil to further decrease the prevalence of smoking among PLWMI.

  • prevalence
  • tobacco use
  • smoking cessation
  • mental disorders
  • delivery of health care

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  • Contributors EC coordinated the design, analysis and writing the manuscript. KPR participated in the design, analysis and in preparing the manuscript. EL performed the statistical analyses and participated in preparing the manuscript. JH performed the statistical analyses. IL participated in the design and in preparing the manuscript. All of the authors wrote the article, and they were responsible for the final content of the manuscript. All of the authors contributed to the design of the research and read, edited and approved of the final draft of the manuscript.

  • Funding The American Association of University Women (AAUW) international postdoctoral fellowship.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. We used data from the nationally representative Brazilian National Health Survey “Pesquisa Nacional de Saúde — PNS” that is publicly available at