Association for Public Policy Analysis & Management

Research Objective: One in five people in the U.S. are estimated to experience “any mental illness” (AMI); this group, however, represents 40% of annual, U.S. adult cigarette consumption. Previous studies have linked AMI with higher nicotine dependence, and reduced success when attempting to quit smoking, even after controlling for factors associated with long-term nicotine use. Such studies have frequently relied upon cross-sectional data or smaller, lab-based studies, as there have been few opportunities to access high-quality, representative longitudinal data from a cohort of adult smokers. This study leverages longitudinal panel data available from the Population Assessment of Tobacco and Health (PATH) Study to better inform policies to help reduce the burden of smoking among adults suffering from AMI.

Study Design: This study examined variation in the relationships between AMI, nicotine dependence, smoking cessation attempts, and average length of cessation attempt between adults with and without AMI using nationally-representative data from three waves (2013-2016) of the PATH Study. Primary outcomes were likelihood of making a cessation attempt within the previous 12 months, and average length of a smoker’s most recent quit attempt if he had attempted cessation. AMI was measured in each wave using three subscales (Internalizing, Externalizing, and Substance Abuse symptoms) of the Global Appraisal of Independent Needs-Short Screener (GAIN-SS), a validated measure of AMI adapted for the PATH Study. Nicotine dependence was measured in each wave based on average score on items from the Wisconsin Inventory of Smoking Dependence Motives (WISDM). Linear and logistic regressions with random effects were fit to the data, controlling for participant sex, age, race/ethnicity, educational attainment, and annual household income.

Population Studied: 8,218 U.S. adult current, established conventional cigarettes smokers in Wave 1 of the PATH Study, who participated in all three waves of data collection.

Principal Findings: High severity scores on the internalizing and externalizing symptom subscales were associated with greater odds of making a cessation attempt within the previous 12 months (AOR:1.25, p<0.01; 1.22, p<0.01 respectively). Also associated with higher odds of making a quit attempt were obtaining “Some college” (AOR: 1.20, p<0.01), a Bachelor’s degree (AOR:1.40, p<0.01), and being classified as Hispanic (AOR: 1.43, p<0.01). Neither AMI, nor any other covariates with the exception of being male (: 0.76, p<0.01), were significantly associated with variation in the average length of the most recent cessation attempt.

Conclusions: While adult smokers with AMI may be as highly motivated to attempt to quit smoking, or more so, than their counterparts without AMI, we still see high rates of smoking and little variation in cessation attempt success for these individuals over time.

Implications for Policy or Practice: Results suggest that policymakers hoping to reduce the substantial burden of smoking-related morbidity among this population could be best served to focus not merely on motivating quit attempts among adults with AMI, as they already appear highly motivated to attempt cessation. Rather, investing in research related to how best to tailor sustained cessation support to adults with AMI may prove more effective in turning attempt into success.