Summary: Analysis of nationally representative U.S. survey data shows large declines in cigarette smoking from 2006 to 2019 among adults with major depression, substance use disorders, or both—evidence that tobacco prevention and cessation efforts are reaching populations at higher risk for nicotine dependence.
Source: NIH
New research published in JAMA reports sizable reductions in cigarette use among U.S. adults with major depressive episodes, substance use disorders (SUDs), or both between 2006 and 2019.
This analysis was conducted by researchers at the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, in collaboration with the Substance Abuse and Mental Health Services Administration (SAMHSA). It draws on more than 558,000 responses to the National Surveys on Drug Use and Health (NSDUH) collected from 2006 through 2019.
Overall, the findings suggest that public health campaigns, policy initiatives, and expanded access to cessation treatments have helped reduce cigarette smoking even in groups typically at higher risk. At the same time, the study highlights persistent disparities: people with psychiatric conditions remain more likely to smoke than those without such diagnoses.
“These results show that population-level declines in tobacco use are achievable for people with psychiatric disorders,” said Nora Volkow, M.D., director of NIDA and a co-author of the study. “Evidence-based smoking cessation treatments are safe and effective, and integrating them with behavioral health care can improve mood, reduce stress and anxiety, and support better long-term outcomes for people facing depression or substance use disorders.”
Cigarette smoking remains the leading preventable cause of disease and premature death in the United States. Declines in smoking prevalence over recent decades are commonly attributed to a combination of factors: broader availability and insurance coverage of cessation therapies, higher cigarette prices, widespread smoke-free policies, public education campaigns, and other evidence-based tobacco control measures.
Quitting smoking reduces the risk of cancer, heart disease, stroke, and lung disease. For people with psychiatric conditions, cessation has been associated with reductions in anxiety and depression symptoms, a lower risk of developing new substance use disorders, and overall improvements in quality of life.
Previous studies had suggested little change in smoking prevalence among people with major depressive episodes or substance use disorders. By examining NSDUH data for adults 18 and older from 2006–2019, the current analysis offers a more detailed and updated picture across a large, nationally representative sample.
Among the surveyed population, approximately 53% were women, 41% were aged 18–25, and 62% identified as non-Hispanic White. After adjusting for sociodemographic factors—age, sex, race and ethnicity, education, and family income—the researchers documented significant declines in past‑month cigarette smoking across groups:
- Adults with a past‑year major depressive episode: a 13.1% decline in past‑month smoking from 2006 to 2019.
- Adults without a major depressive episode: an 8.2% decline over the same period.
- Adults with a past‑year substance use disorder: a 10.9% decline.
- Adults without a substance use disorder: a 7.8% decline.
- Adults with co‑occurring major depression and SUD: a 13.7% decline, compared with a 7.6% decline among adults without either condition.
As a result, the gap in past‑month cigarette smoking prevalence between adults with and without major depressive episodes narrowed, falling from an 11.5 percentage‑point difference in 2006 to 6.6 percentage points in 2019.
Wilson Compton, M.D., NIDA’s Deputy Director and the study’s senior author, described the findings as a public health success while noting the need for continued effort: “Declines in smoking among people with depression and substance use disorders are encouraging, but providers must continue to treat tobacco use alongside other behavioral health conditions. Integrating smoking cessation into behavioral health services will help people live longer, healthier lives.”
Declines in smoking were observed across nearly every age, sex, and racial and ethnic subgroup examined for adults with past‑year major depressive episodes or SUDs, with one notable exception: non‑Hispanic American Indian and Alaska Native adults did not show significant decreases in smoking rates during the study period. Because these communities have among the highest smoking prevalence and the lowest quit rates nationally, the authors emphasize the importance of directing additional prevention and cessation resources to American Indian and Alaska Native populations.
The authors also call for future research to capture tobacco use trends among groups not covered by the NSDUH sampling frame—such as people who are institutionalized or those experiencing unsheltered homelessness—because these individuals may face elevated risk for both psychiatric disorders and tobacco use. Monitoring changes in cigarette smoking and nicotine vaping among people with and without psychiatric conditions during and after the COVID‑19 pandemic is another priority.
About this mental health research news
Author: Press Office
Source: NIH
Contact: Press Office – NIH
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Original Research: Open access.
“Trends in prevalence of cigarette smoking among US adults with major depression or substance use disorders, 2006-2019” by B Han, ND Volkow, C Blanco, D Tipperman, EB Einstein, WM Compton. JAMA
Abstract
Trends in prevalence of cigarette smoking among US adults with major depression or substance use disorders, 2006-2019
Importance
Tobacco use remains disproportionately concentrated among people with mental illness.
Objectives
To evaluate trends in past‑month cigarette smoking among U.S. adults with versus without past‑year major depressive episodes, substance use disorders, or both, using nationally representative data.
Design, Setting, and Participants
Exploratory, serial, cross‑sectional study using data from 558,960 individuals aged 18 years or older who participated in the 2006–2019 National Surveys on Drug Use and Health.
Exposure
Past‑year major depressive episode (MDE) and substance use disorder (SUD) defined by Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) criteria.
Main Outcomes and Measures
Past‑month self‑reported cigarette use, adjusted for sociodemographic characteristics.
Results
In the sample of 558,960 adults, 41.4% (unweighted) were aged 18–25 years, 29.8% were aged 26–49 years, and 53.4% were women. From 2006 to 2019, past‑month cigarette smoking declined significantly among adults with MDE (from 37.3% to 24.2%; average annual percent change −3.2), adults with SUD (from 46.5% to 35.8%; average annual percent change −1.7), and adults with co‑occurring MDE and SUD (from 50.7% to 37.0%; average annual percent change −2.1). Declines were significant across nearly all examined age, sex, and racial and ethnic subgroups with the exception of American Indian and Alaska Native adults, who did not show statistically significant decreases.
Conclusions and Relevance
Between 2006 and 2019, self‑reported cigarette smoking prevalence fell substantially among U.S. adults with major depressive episodes, substance use disorders, or both. Continued, targeted efforts are needed to further reduce tobacco use, expand access to cessation services, and address persistent disparities—especially among American Indian and Alaska Native communities.