Singaporean smokers with psychiatric illnesses unlikely to quit

Smoking and nicotine dependence (ND) appear to be more prevalent among people with mental illnesses, according to a recent Singapore study. These individuals also show a lower propensity to undergo cessation.

“Given that the readiness to quit and awareness towards cessation programmes are low among the smokers, concerted efforts through educational programmes and policy changes are crucial to achieve successful cessation,” the researchers said.

Outpatients from the Institute of Mental Health were enrolled (n=380; mean age, 39.8±12 years; 55.3 percent male) and administered a modified version of the Global Adult Tobacco Survey. A total of 150 participants were smokers, corresponding to a prevalence rate of 39.5 percent. Majority (53.4 percent) were seeking psychiatric care for schizophrenia spectrum and other psychiatric disorders. [Int J Environ Res Public Health 2020;doi:10.3390/ijerph17155571]

The mean age at smoking initiation was 16.4±7.6 years, and most (86 percent) of the current smokers did so on a daily basis. Males dominated the smoker group, comprising 77.3 percent of the category. Thirty-four participants were past smokers, who started the habit at an average age of 16.5±4.6 years. Majority of current and past smokers reported having a family history of the habit. Cigarettes were the smoking device of choice (91.3 percent).

Similarly, most of the current (88.7 percent) and past (97 percent) smokers reported initiating the habit long before being diagnosed with their mental condition (mean, 137.8±108 months).

ND was detected in 52 percent (n=78) of the current smokers and in 30.3 percent (n=10) of past smokers. The difference was statistically significant (p=0.022).

In the past year, more than half (52 percent; n=78) of the current smokers made an attempt to quit the habit, though 86 percent (n=129) said that they had not sought medical assistance for cessation in the past 12 months.

In line with this, 56.7 percent of current smokers reported that they had no plans of quitting in the next 6 months, as opposed to only 10.7 percent who expressed interest in cessation in the next month. Higher prices of cigarettes (36.7 percent) emerged as the most common factor that would encourage smokers to quit.

Past smokers had been abstinent from the habit for a mean of 95.6±112.6 months before the interview. About 35 percent took one to two attempts at cessation, 32.4 percent needed three to four attempts, and 23.5 percent succeeded after more than six tries. Only four past smokers used nicotine replacement therapy. A prohibitive cost of the cigarettes (64.7 percent) was the top reason for cessation.

“The findings from the study indicate that policy changes to restrict the availability of cigarettes, increase the cost, and awareness-creation towards the health-related risks could promote smoking cessation,” the researchers said.

“While a lot of resources are directed towards cessation programmes, the accessibility of the programmes remains suboptimal and thus needs to be improved in order to reduce the health disparity between psychiatric patients and the general public,” they added.