Trends in Smoking Among Adults With Mental Illness and Association Between Mental Health Treatment and Smoking Cessation
Trends in Smoking Among Adults With Mental Illness and Association Between Mental Health Treatment and Smoking Cessation
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DOI：
10.1001/jama.2013.284985
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发表时间：
2014-01-08
影响因子：
120.7
通讯作者：
Flores, Michael
中科院分区：
文献类型：
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作者：
Le Cook, Benjamin;Wayne, Geoff Ferris;Flores, Michael
重要性 美国在降低烟草使用率方面已取得重大进展。然而，戒烟工作的重点是普通人群，而不是患有精神疾病的个人，因为他们的烟草使用率和尼古丁依赖率更高。 目的 评估精神疾病患者的烟草使用率是否有所下降，并检查心理健康治疗和戒烟之间的关系。 设计、环境和参与者 使用对非机构化美国居民进行的全国代表性调查来比较不同年龄段的吸烟率趋势 患有和没有精神疾病以及多种疾病的成年人（2004-2011 年医疗支出小组调查 [MEPS]），并比较接受和未接受心理健康治疗的患有精神疾病的成年人的戒烟率（2009-2011 年国家药物使用和健康调查 [NSDUH]）。 MEPS 样本包括 32 156 名患有精神疾病的受访者（具体为报告严重心理困扰、可能患有抑郁症或正在接受精神疾病治疗）和 133 113 名没有精神疾病的受访者。 NSDUH 样本包括 14 057 名患有精神疾病的终生吸烟者。 主要结果和测量 目前的吸烟状况（初步分析；MEPS 样本）和戒烟，以过去 30 天内不吸烟的终生吸烟者为例（二次分析；NSDUH 样本）。 结果 在没有精神疾病的个体中，调整后的吸烟率显着下降（19.2%[95% CI，18.7-19.7%] 至 16.5%[95% CI, 16.0%-17.0%]； P < .001），但在精神疾病患者中变化不大（25.3%[95% CI, 24.2%-26.3%] 至 24.9%[95% CI, 23.8%-26.0%]；P = .50），显着差异为 2.3%（95% CI, 0.7%-3.9%）（P = .005）。去年接受过心理健康治疗的精神疾病患者比未接受治疗的患者更有可能戒烟 (37.2%[95% CI, 35.1%-39.4%]) (33.1%[95% CI, 31.5%-34.7%]) (P = .005)。 结论和相关性 2004 年至 2011 年间，个人吸烟率下降患有精神疾病的人明显少于没有精神疾病的人，尽管 接受心理健康治疗的人的戒烟率更高。这表明针对普通人群的烟草控制政策和戒烟干预措施对于精神疾病患者并没有那么有效。
IMPORTANCE Significant progress has been made in reducing the prevalence of tobacco use in the United States. However, tobacco cessation efforts have focused on the general population rather than individuals with mental illness, who demonstrate greater rates of tobacco use and nicotine dependence.OBJECTIVES To assess whether declines in tobacco use have been realized among individuals with mental illness and examine the association between mental health treatment and smoking cessation.DESIGN, SETTING, AND PARTICIPANTS Use of nationally representative surveys of noninstitutionalized US residents to compare trends in smoking rates between adults with and without mental illness and across multiple disorders (2004-2011 Medical Expenditure Panel Survey [MEPS]) and to compare rates of smoking cessation among adults with mental illness who did and did not receive mental health treatment (2009-2011 National Survey of Drug Use and Health [NSDUH]). The MEPS sample included 32 156 respondents with mental illness (operationalized as reporting severe psychological distress, probable depression, or receiving treatment for mental illness) and 133 113 without mental illness. The NSDUH sample included 14 057 lifetime smokers with mental illness.MAIN OUTCOMES AND MEASURES Current smoking status (primary analysis; MEPS sample) and smoking cessation, operationalized as a lifetime smoker who did not smoke in the last 30 days (secondary analysis; NSDUH sample).RESULTS Adjusted smoking rates declined significantly among individuals without mental illness (19.2%[95% CI, 18.7-19.7%] to 16.5%[95% CI, 16.0%-17.0%]; P < .001) but changed only slightly among those with mental illness (25.3%[95% CI, 24.2%-26.3%] to 24.9%[95% CI, 23.8%-26.0%]; P = .50), a significant difference in difference of 2.3%(95% CI, 0.7%-3.9%) (P = .005). Individuals with mental illness who received mental health treatment within the previous year were more likely to have quit smoking (37.2%[95% CI, 35.1%-39.4%]) than those not receiving treatment (33.1%[95% CI, 31.5%-34.7%]) (P = .005).CONCLUSIONS AND RELEVANCE Between 2004 and 2011, the decline in smoking among individuals with mental illness was significantly less than among those without mental illness, although quit rates were greater among those receiving mental health treatment. This suggests that tobacco control policies and cessation interventions targeting the general population have not worked as effectively for persons with mental illness.