Diverging trends in smoking behaviors according to mental health status

Introduction: People with mental health disorders are much more likely to smoke compared to those who do not. This study investigates recent trends in smoking behaviors among both these populations in England.

Methods: We used survey responses from adults (aged 16 years and older) living in households in England who participated in the Health Survey for England from 1993 to 2011 (n = 11,300 per year on average). Linear regression was used to quantify annual changes over the time period in smoking prevalence, daily cigarette consumption, and desire to quit among respondents with and without 2 indicators of mental disorder (self-reported longstanding mental illness and recent use of psychoactive medication).

Results: Among survey respondents who did not report a longstanding mental illness, there were long-term declines in smoking prevalence (-0.48% per year, 95% confidence interval [CI] = -0.56 to -0.40) and daily cigarette consumption (-0.14% per year, 95% CI = -0.17 to -0.11). Similar declines were also seen among respondents not taking psychoactive medications. However, there were no long-term changes in smoking prevalence and cigarette consumption among respondents who reported these indicators of mental disorder, although smoking prevalence among those taking psychoactive medications may have declined during the later part of the study period. Smokers both with and without the 2 indicators of mental disorder showed similar levels of desire to quit smoking.

Conclusions: Smoking is largely unchanged since 1993 among those with indicators of longstanding mental disorders or recent psychoactive medication usage, although declines have been observed among those without such indicators of mental disorder.