The prevalence of cigarette smoking among adults is now at a modern low of 15 percent, and youth rates are also down for high school seniors, with only 3.4 percent smoking daily. Yet this is not a time to become complacent and move on to other public health problems. As many as 40 million people still smoke, and half of them will die prematurely as a result. Furthermore, smoking rates remain high among the most vulnerable populations, such as people with mental illnesses or substance use disorders, necessitating policies and strategies targeted specifically at them, as well as support for tobacco control at the federal, state, and local levels.
Smoking rates have declined much faster among prosperous, well-educated people than they have among the less fortunate. As a result, smoking is now concentrated among special populations: People with mental illnesses have smoking rates that range from 30 percent to more than 50 percent, depending on the specific diagnosis. People with substance use disorders have even higher rates—from about 50 percent for those who abuse alcohol to more than 77 percent for those who abuse heroin. The LGBTQ populations, people with less education, prisoners, and homeless people also have smoking rates that are higher, sometimes much higher, than the overall population’s rate. Yet these special populations are a part of that general population. Excluding them would bring the population smoking rate closer to 10 percent.
Addressing smoking among vulnerable populations requires motivating and engaging the clinical, governmental, and advocacy organizations that serve those clients. This involves challenging several erroneous but deeply ingrained myths, such as the beliefs that individuals with a chronic mental illness do not want to quit smoking, are unable to, rely on smoking to treat their underlying disease, or do not suffer much damage from smoking. The Smoking Cessation Leadership Center at the University of California, San Francisco, has been working collaboratively with the Substance Abuse and Mental Health Services Administration (SAMHSA) to hold leadership academies in 15 different states to create a plan to drive down smoking rates among people with mental illnesses or substance use disorders. In addition, the center has worked with clinical organizations such as the American Psychiatric Nurses Association, the American Psychiatric Association, and the American Psychological Association, advocacy groups such as the National Alliance on Mental Illness, and consortiums such as the National Council for Behavioral Health to accomplish those goals. A recent collaboration with the American Cancer Society has engaged multiple organizations to create a national roundtable on behavioral health and tobacco use.
Although it is premature to assess the effectiveness of these efforts, over the past few years smoking among people with behavioral health conditions has declined at a faster rate than for the general population, although it is still at a much higher level.
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