Tobacco Use and Serious Mental Illness: A Deadly Combination

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Americans with serious mental illness are 70 percent more likely to be tobacco users 1

New York, NY – Tobacco accounts for 443,000 deaths in the United States annually, and 45 percent of those deaths are among individuals with serious mental illness 2. Those with serious mental illness not only have significantly higher tobacco use prevalence rates than the general population, but also consume more cigarettes per day and have lower quit rates on average 3. In observance of National Mental Health Month, May is an opportune time to recognize the disproportionate impact of tobacco use among individuals with serious mental illness - specifically the health disparities experienced by this population as a result of such disproportionate use - as well as the critical need for intervention strategies tailored to this high-risk population.

In New York State, several efforts are underway to address the issue of tobacco use among the individuals with serious mental illness. Of note, the New York State Department of Health's Bureau of Tobacco Control has funded 10 regional contractors to work with health care organizations across the State, including inpatient and outpatient mental health treatment facilities, to support the implementation of health systems improvements that will assure that every patient is screened for tobacco use and receives evidence-based tobacco dependence counseling and treatment, if desired, as part of the standard care delivery. As the Center of Excellence for Health Systems Improvement (COE for HSI) for a Tobacco-Free New York, CAI supports regional contractors in these efforts, developing tools and resources to assist regional contractors in their work within mental health treatment facilities. The COE for HSI also works on the Statewide-level to promote a policy environment that facilitates the integration of evidence-based tobacco dependence treatment into care delivery in these settings.

"With the support of evidenced-based tobacco dependence treatment and trained health care professionals, populations with serious mental illness are just as capable of quitting successfully as other tobacco users," said Elizabeth Jones, Director of the COE for HSI. "The COE for HSI and the 10 regional contractors were funded to build the capacity of health systems serving individuals with serious mental illness and the professional working within them to deliver life-saving tobacco dependence treatment to their patients."

Tobacco use is more prevalent in those with serious mental illness than in the general population, with 36 percent of the adult population using tobacco as opposed to 21 percent, respectively 4. Tobacco use rates are estimated to be 59 percent for people diagnosed with schizophrenia, 46 percent for those with bipolar disorder, and 38 percent for people with serious psychological diseases 5.

"There is an epidemic of tobacco-related disease among those suffering from serious mental illness," noted Elizabeth Jones. "Individuals with serious mental illness treated in the public health system die 25 years earlier than the general population, frequently from tobacco-related diseases, such as cancer, heart disease, and lung disease. And these individuals do not survive serious mental illness just to die from tobacco. As such, it is the responsibility of the health care systems that treat individuals with serious mental illness to address tobacco use among their patients and deliver evidence-based tobacco dependence treatment at every opportunity."

For more information about the work of the COE for HSI, visit

About CAI: CAI is a global nonprofit organization dedicated to improving the health and well-being of underserved populations worldwide. For 35 years, CAI has provided customized capacity building services to health and human service organizations in over 23 countries and in all 50 states. Offering over 1,500 training programs annually, CAI's passionate staff works to fulfill its mission: to use the transformative power of education and research to foster a more aware, healthy, compassionate and equitable world. For more information about CAI, visit our website:

About the Center of Excellence for Health System Improvement: With funding from the New York State Department of Health Bureau of Tobacco Control, CAI serves as the Center of Excellence for Health Systems Improvement (COE for HSI) for a Tobacco-Free New York. The COE for HSI promotes large-scale systems and policy changes to support the universal provision of evidence-based tobacco dependence treatment services. The COE for HSI aims to support 10 Regional Contractors throughout New York State working regionally with health care systems and organizations that serve those populations for which tobacco use prevalence rates have not decreased in recent years - adults with low income, less than a high school diploma, and/or serious mental illness. Focused on providing capacity-building assistance services around topics like how to engage and obtain buy-in from leadership to implement the kinds of systems-level changes that will result in identification and intervention with every tobacco user who seeks care, the COE for HSI also will offer materials and resources to support contractors in their regional work. For more information about the Center of Excellence for Health Systems Improvement, visit

1 "CDC Vital Signs: Current Cigarette Smoking Among Adults Aged 18=>18 Years with Mental Illness – United States, 2009-2011," Centers for Disease Control and Prevention, February, 2013,

2 "Smoking Cessation," National Alliance on Mental Illness, 2015,

Glasheen C, Hedden Sl, Forman-Hoffman VL, Colpe LJ. Cigarette smoking behaviors among adults with serious mental illness in a nationally representative sample. Ann Epidemiol. 2014 Oct; 24(10):776-80.

"CDC Vital Signs: Adult Smoking Focusing on People with Mental Illness," Centers for Disease Control and Prevention, February, 2013,

5 McClave AK, McKnight-Eily LR, Davis SP, Dube SR. Smoking characteristics of adults with Selected Lifetime Mental Illnesses: Results from the 2007 National Health Interview Survey. American Journal of Public Health, 2010; 100:12, 2464-72.


This website was developed with funding provided by the New York State Department of Health Bureau of Tobacco Control to CAI. Its contents are solely the responsibility of CAI and do not necessarily represent the official views of the New York State Department of Health.