The rates of smoking by adults with mental and/or substance use disorders (MH/SUD) fell by about 10% between 2008 and 2019, a study in Addiction suggests. The decline in smoking and increase in smoking abstinence coincided with greater gains in insurance coverage for adults with MH/SUD, according to the authors.
“These findings, which hold after controlling for age, sex and race/ethnicity, are among the first to identify meaningful, population-level reductions in smoking and increases in abstinence among adults with MH/SUD, a group that has maintained significantly higher smoking rates in recent decades despite the implementation of numerous preventive public health measures and clinical interventions that have driven change in the general adult population,” wrote Timothy B. Creedon, Ph.D., of the U.S. Department of Health and Human Services and colleagues.
The researchers analyzed data collected between 2008 and 2019 as part of the National Survey on Drug Use and Health (NSDUH)—an annual survey of approximately 70,000 people living in the United States. One of the primary objectives of the NSDUH is to track trends in alcohol, tobacco, and other drug use.
Specifically, Creedon and colleagues examined trends in smoking among adults with and without MH/SUD before and after the health insurance expansions under the Affordable Care Act (ACA) took effect. Such expansions included coverage of young adult family members under age 26 in 2010 and Medicaid expansion and the launch of the private marketplaces in 2014.
The researchers examined three measures of cigarette use by 448,762 adults aged 18 to 64 who participated in the NSDUH during the study period:
- Any current smoking (defined as having smoked at least 100 cigarettes over lifetime and smoked all or part of at least one cigarette in the 30 days prior to completing the NSDUH survey).
- Daily smoking (smoked all or part of at least one cigarette during 25 or more of the 30 days).
- Recent smoking abstinence (smoked at least 100 cigarettes over lifetime but no cigarettes in last 30 days).
When comparing pooled data from 2008-2009 with 2018-2019, Creedon and colleagues found that current smoking rates of adults with MH/SUD decreased from about 38% to 28% while current smoking rates of adults without MH/SUD decreased from about 21% to 16%—a significant difference in decrease of about 5 percentage points for people with MH/SUD. Similarly, adults with MH/SUD experienced a greater drop in daily smoking. Recent smoking abstinence rates for adults with MH/SUD increased from about 7.5% to 11%, while recent smoking abstinence rates for adults without MH/SUD increased from about 9.5% to 12%—a difference in increase of 1 percentage point for people with MH/SUD.
In 2008-2009, the adjusted prevalence of any insurance coverage (defined as at least 10 of 12 months prior to NSDUH survey) was about 6 percentage points lower for adults with MH/SUD (72%) than for adults without MH/SUD (78%), Creedon and colleagues wrote. In 2018-2019, there was only a two-point difference in percentage points between the two groups (with 82% of people with MH/SUD with insurance coverage compared with 84% of people without MH/SUD with insurance coverage). Having any health insurance for at least 10 of the 12 months prior to being surveyed was strongly associated with a reduction in the likelihood of any current smoking and daily smoking and an increase in the likelihood of recent smoking abstinence, they added.
“[T]his study presents new evidence that smoking among adults living with MH/SUD has begun to decline substantially and that health insurance coverage expansions may play a supporting role in these important reductions,” Creedon and colleagues concluded.
For related information, see the Psychiatric Services article “Smoking Cessation Medication Prescribing for Smokers With and Without Mental Illness.”
(Image: iStock/eternalcreative)
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