Article Title

Smoking Prevalence and Use of Cessation Medications Among Patients With Psychiatric Disorders in an Integrated Health Care Delivery System: A Case-Control Study

Publication Date



behavioral health conditions, smoking prevalence


Background/Aims: Although impressive gains have been made in recent decades in reducing overall rates of smoking in the United States, individuals with behavioral health conditions continue to smoke at high rates and have limited success with quitting. The current study tested whether longitudinal disparities in smoking prevalence would also be found among individuals with behavioral health conditions in an integrated health care delivery system with convenient access to tobacco treatments.

Methods: This secondary analysis examined smoking prevalence over four years in a subsample of Kaiser Permanente Northern California patients diagnosed with the five most prevalent behavioral health conditions (cases) in 2010 (n=155,733): depression, anxiety, substance use disorders, bipolar spectrum disorders, and attention deficit hyperactivity disorders (ADHD). Nonbehavioral health condition-matched controls were created for all unique cases (n=155,733). Smoking status for each of the behavioral health cases and matched controls was compared over a 4-year period (2010–2013) using a logistic regression generalized estimating equation model. Logistic regression analyses also were used to compare tobacco cessation medication use in 2010 among smokers with behavioral health conditions and smoking-matched controls.

Results: Participants with behavioral health conditions had significantly higher odds of smoking over the 4-year period compared to matched controls (P<0.001 for all). Patients with substance use disorders and bipolar spectrum disorders had the largest differences in odds of smoking relative to their matched controls. Smoking prevalence decreased over 4 years overall, but to a lesser extent among cases with depression, anxiety, substance use disorders and bipolar disorder compared to controls (P<0.001 for all). With the exception of ADHD, smokers with behavioral health conditions were significantly more likely than matched controls who smoked to utilize tobacco cessation medications in 2010 (P<0.001 for all).

Discussion: Similar to findings in the general U.S. population, results from an integrated health care delivery system indicate that smoking prevalence is decreasing at slower rates among individuals with versus without behavioral health conditions. Findings highlight the potential to address smoking among disproportionately impacted groups within a health care setting.




April 7th, 2015


April 28th, 2015