By Lauren DeSouza- Master of Public Health, Simon Fraser Public Research University – Canada
https://nhcrisishouse.com/our-team/
Staff Research and Content Writer

© Copyright – SUD RECOVERY CENTERS – A Division of Genesis Behavioral Services, Inc., Milwaukee, Wisconsin – February 2024 – All rights reserved.

People with mental health concerns are much more likely to smoke compared to the general population. 23% of US adults with any mental illness report past-30-day smoking, compared to 14.5% of adults without mental illness. Concerningly, harmful narratives persist about the purported “benefits” of smoking on one’s mood. These narratives, present among both patients and providers, keep smoking rates high and quit rates low among people with mental health concerns.

There is limited research on ways to effectively communicate the benefits of quitting smoking to people with mental health concerns. While there is a plethora of public health campaigns aimed at helping people quit smoking or preventing smoking uptake, there are no federal campaigns targeted at those with mental health concerns.

                                                                     Image via Centers for Disease Control and Prevention

A new study aims to close this gap by examining the effectiveness of several health messages about smoking among people with mental health concerns. The study aimed to determine whether a message about the benefits of quitting smoking on mental health or physical health was most effective in inducing motivation to quit smoking among people with mental health concerns.

What is the relationship between smoking and mental health?

Narratives about the effects of smoking on mood are rife with misinformation. Several harmful myths persist that can dissuade people with mental health concerns from attempting to quit or successfully quitting smoking.

Many healthcare providers and patients alike believe:

  • Smoking can reduce stress or improve mood.
  • Smoking is a necessary coping mechanism for those with mental health disorders.
  • One’s mental health would suffer if they quit smoking.

These myths emerged from tobacco industry marketing that positioned smoking as a stress-relief tool. The tobacco industry has targeted people with mental health concerns for decades (see below image of a Lucky Strike ad), contributing to higher-than-average smoking rates and tobacco-related deaths among this population. People with mental health concerns are more likely to die from a smoking-related illness than from their mental health condition. 60% of people with mental health conditions who smoke will die from a tobacco-related illness.

                                                                           Image via Stanford University

Research has proven that the narrative that smoking benefits mental health is false. Smoking worsens mental health. Quitting smoking can reduce symptoms of anxiety and depression and can even reduce dependence on psychiatric medications by up to 25%.

Unfortunately, quit rates are also much lower among people with mental health concerns than in the general population. People with mental health concerns are only half as likely to quit compared to the general population. These lower quit rates are partly attributable to the persistent myth that smoking is beneficial for mental health. Thus, targeted interventions are needed to correct these false narratives and increase cessation rates among people with mental health concerns.

What did this study do?

This is one of the first studies to evaluate a smoking cessation message targeted at people with mental health concerns. In this study, researchers conducted an online experiment with 419 daily smokers with or without a lifetime history of anxiety and/or depression. The researchers randomly assigned participants to view a message focused on the benefits of quitting smoking on mental health or a message about the benefits of quitting smoking on physical health. These messages were written at an approximately 8th-grade reading level.

The researchers were also interested in assessing participants’ beliefs about the effects of smoking on mood. They used the Wisconsin Inventory of Smoking Dependence Motives (WISDM-68), a measure that uncovers smoking motives that contribute to cigarette dependence. Participants completed this inventory before viewing the health messages.

After viewing the message, participants were asked about their motivation to quit smoking, any mental health concerns they had about quitting, and their perceived effectiveness of the message.

The researchers hypothesized that people who smoke cigarettes and have a history of anxiety or depression will be more motivated by messages about the mental health benefits of quitting than about the physical health benefits of quitting.

What were the results?

As the researchers predicted, study participants who smoke daily and had ever had anxiety and/or depression found the message about the mental health benefits of quitting smoking more motivating and more effective than the message about the physical health benefits of quitting. Conversely, those who had never had anxiety or depression were more motivated to quit based on the message about physical health benefits.

                                                                                             Image via Freepik

Participants with a lifetime history of anxiety and/or depression were more likely than those without to believe that smoking improves one’s mood. Similarly, these participants had more concerns that quitting smoking would negatively impact their mood or their mental health symptoms. 

Of note, the intensity of a participant’s concern that quitting would negatively impact their mood was proportional to the intensity of their mental illness. Participants who scored higher on screenings for anxiety or depression (meaning they had more severe symptoms) also scored higher on the Concerns About Quitting measure used in this study.

What should we do with this information?

This study suggests that public health messages that highlight the mental health benefits of quitting smoking may increase motivation to quit among those with a history of anxiety and/or depression. This study provides preliminary research on how to effectively communicate the mental health benefits of quitting smoking to people with anxiety and/or depression. The researchers conclude that positive messaging about the benefits of quitting smoking on mental health may help close the gap in smoking rates between those with mental health conditions and those without.

This research also emphasizes the need for tailored anti-smoking public health campaigns for people with mental health concerns. Such messaging should address the persistent harmful myths about the benefits of smoking on mood and mental health. Moreover, this messaging should highlight how quitting smoking can improve one’s mental health.

The researchers suggest that this research may help the Food and Drug Administration (FDA) craft effective messages to address smoking in those with anxiety and/or depression.

What are the key takeaways?

  • People with mental health concerns often believe the myth that smoking positively impacts their mood.
  • Messages addressing the mental health benefits of quitting smoking may increase motivation to quit among those with a history of anxiety and/or depression.
  • Public health campaigns to promote smoking cessation should be tailored to those with mental health concerns and focus on the mental health benefits of quitting.
  • Tailored, effective public health campaigns can help address the disproportionately high smoking rates in people with mental health conditions.

References

Marc L. Steinberg, Rachel L. Rosen, Ollie Ganz, Olivia A. Wackowski, Michelle Jeong, Cristine D. Delnevo, Communicating the benefits of quitting smoking on mental health increases motivation to quit in people with anxiety and/or depression, Addictive Behaviors, Volume 149, 2024, 107903, ISSN 0306-4603, https://doi.org/10.1016/j.addbeh.2023.107903.

World Health Organization. The vicious cycle of tobacco use and mental illness – a double burden on health. November 8 2021. https://www.who.int/europe/news/item/08-11-2021-the-vicious-cycle-of-tobacco-use-and-mental-illness-a-double-burden-on-health

Centers for Disease Control and Prevention. People with Mental Health Conditions. Last Updated February 5, 2024. https://www.cdc.gov/tobacco/campaign/tips/groups/people-with-mental-health-conditions.html