Tobacco use among those with serious psychological distress: Results from the national survey of drug use and health, 2002☆
Introduction
Despite the continued decline of tobacco use over the past few decades, certain sub-populations continue to have high rates of smoking. Previous clinical research has consistently documented elevated rates of cigarette use among those with specific mental health disorders in comparison to the general population (Hughes et al., 1986, Prochaska et al., 2004, Vanable et al., 2003). Overall, the prevalence rates for current cigarette use among clinical samples have been shown to vary depending upon the type of disorder ranging from approximately 40% to 85% for those with schizophrenia, major depression, bipolar disorder and other serious mental health disorders (Kalman, Baker-Morissette, & George, 2005). Also, individuals with the most severe forms of mental illnesses (e.g., schizophrenics) are more addicted to tobacco, with heavier smoking and elevated scores on clinical measures of nicotine dependence (Gonzalez-Pinto et al., 1998, Hughes et al., 1986, Tidey et al., 2005, de Leon et al., 2002).
At this time, there is a paucity of research that has examined rates of cigarette use among those with mental health disorders using a nationally representative sample. Lasser, Boyd, Woolhandler, Himmelstein, McCormick, and Bor (2000), using data from the National Comorbidity Study (NCS), documented that persons with specific past month mental health disorders were twice as likely to smoke and consumed nearly half (44.3%) of all cigarettes sold in the U.S. Additionally, quit rates for those smokers with mental health problems ranged from 27–34%, which were lower compared to smokers who did not have any history of a mental health disorder (i.e., 43%). More recently, Grant, Hasin, Chou, Stinson and Dawson (2004), examined results from the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and found that individuals with a current psychiatric disorder made up 30.3% of the population and consumed 46.3% of all cigarettes consumed in the United States.
The ability to assess tobacco use among those with mental health disorders at the population level is complicated by the intended purpose and scope of the specific population-based health survey. At this time, there are no publicly available population surveys that comprehensively assess both mental health disorders and tobacco use. For example, the National Comorbidity Study (NCS) was chiefly designed to document the prevalence of specific mental health disorders, while the specific tobacco use indicators within this survey are limited to examining only cigarette consumption (Lasser et al., 2000). Alternatively, other population based health surveys, such as the National Survey of Drug Use and Health (NSDUH), and the National Health Interview Survey (NHIS) provide more extensive coverage of tobacco use, including other tobacco products, nicotine dependence indicators, and the economic and financial implications of smoking, but they do not incorporate extensive assessment of specific psychological disorders.
Recently, there has been an increased effort to incorporate brief psychological screening tools in population-based surveys in order to measure an individual's current mental health status. The K6 scale, a brief psychological screening instrument, was developed by Kessler et al. (2002) to screen at the population level for individuals with possible severe mental illness. Specifically, the K6 scale consists of six questions, which ask respondents to report how frequently they experience symptoms of serious psychological distress (SPD) within a particular reference period. Although the K6 focuses on non-specific psychological distress, the scale has been clinically validated. Because of its high specificity, the majority of cases detected by the K6 would meet DSM-IV criteria for certain mental health disorders (Kessler et al., 2002, Kessler et al., 2003). In sum, its brevity, strong item response characteristics, and ability to discriminate DSM-IV cases from non-cases make the K6 ideal for general population-based health surveys.
The National Survey of Drug Use and Health (NSDUH) has included the K6 scale for some years now, but we found no peer-reviewed literature examining the relationship between tobacco use and SPD using this survey. Thus, the purpose of the present study was to document the prevalence of tobacco use products, dependence, and quit behavior among those with and without SPD utilizing the 2002 National Survey of Drug Use and Health.
Section snippets
Survey description
Data for the current study was derived from the 2002 National Survey of Drug Use and Health (NSDUH), which provides national alcohol and drug use estimates for the U.S. civilian population annually. The NSDUH is a 50-State design, with independent stratified, multistage, area probability samples selected from each State to yield nationally representative findings.
Subject interviews were conducted anonymously in-person by responding to questions via a computer-assisted interview module. In 2002,
Demographic differences by SPD status
Overall, 8.3% of adults in the U.S. were found to have serious psychological distress (SPD) in the past year. As shown in Table 1, individuals with and without SPD differed significantly on a number of demographic variables (all p's < .0001). Most notably, adults with SPD were more likely to be female (66% vs. 50.7%) and between the ages of 18–25 (22.9% vs. 14%) compared to those without SPD. In addition, SPD respondents were more likely to be employed part-time, live in a densely populated area,
Discussion
Our findings indicate that SPD was a significant contributor to ever and past month tobacco use. As expected, individuals with SPD were significantly more likely to be ever cigarette smokers, smoked cigarettes within the past month, and smoke cigarettes daily. Similarly, they are more likely to ever smoke any tobacco, cigars and pipes, and consume any tobacco, cigars, and pipes within the past month. A greater percentage of those with SPD were tobacco dependent and were more likely to have
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Parts of this manuscript were presented at the 2007 Society for Research on Nicotine and Tobacco's (SRNT) Annual Conference in Austin, Texas. The current study was funded by grants from the Robert Wood Johnson Foundation Substance Abuse Policy Research Program (Grant #56397) and from the National Institute of Mental Health (NIMH: Grant #1R03MH077273-01A1).