Elucidating The Smoking Cessation Process Among Socioeconomically Disadvantaged Smokers With Serious Mental Illness

Abstract

Introduction The decline in smoking prevalence has been paralleled by widening mental health and socioeconomic disparities in smoking rates.1 To identify points of intervention, this dissertation presents three studies that elucidate the smoking cessation process among socioeconomically disadvantaged smokers with serious mental illness (SMI). Methods The following studies are secondary data analyses of the OPTIN study. ICD-9 codes categorized participants into SMI (n=1044) and non-SMI (n=1277) groups. The first study utilized mediation analysis to examine whether physician cessation treatment advice and physician bias mediate the association between SMI and treatment utilization. The second study utilized logistic regression to examine the intervention effect among smokers with and without SMI, and whether it was more effective for smokers with SMI. Using multinomial and linear regressions, the third study examined how smoking abstinence affects binge drinking and mental health among smokers with and without SMI. Results In the first study, smokers with SMI utilized treatments at higher rates than those without SMI. This effect was mediated by physician treatment advice (Proportion Mediated=11.7%), but not bias. In the second study, the intervention increased treatment utilization in the SMI (51.6% vs 38.1%) and the non-SMI group (38.6% vs 25.8%). The intervention increased abstinence in the non-SMI group (18.1% vs 12.8%) and the SMI group (14.7% vs 10.8%). There were no significant interactions. In the third study, smokers who quit had lower odds of binge drinking for more than 3 days per month in the SMI (OR = 0.26) and the non-SMI group (OR = 0.42). Smokers who quit had lower depression scores in the SMI (2.37 vs 2.71) and the non-SMI group (1.59 vs 1.75). In the SMI group, smokers who quit reported lower anxiety scores (55.61 vs. 59.03). Discussion These studies highlight the importance of healthcare providers in the cessation process, demonstrate that proactive outreach is effective for treatment utilization and abstinence, and provide evidence for beneficial effects of smoking abstinence in the domains of mental health and alcohol use. These findings underscore the need to facilitate access and utilization of cessation treatments among smokers with mental illness.