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Dr. Diaz, Mr. Rendon, and Ms. Velásquez are affiliated with the department of statistics at the Universidad Nacional in Medellin, Colombia. Ms. Susce and Dr. de Leon are affiliated with the University of Kentucky Mental Health Research Center at Eastern State Hospital in Lexington. Send correspondence to Dr. de Leon at the University of Kentucky Mental Health Research Center, 627 West Fourth Street, Lexington, Kentucky 40508 (e-mail, firstname.lastname@example.org). Harold Alan Pincus, M.D., Terri L. Tanielian, M.A., and Amy M. Kilbourne, Ph.D., M.P.H., are editors of this column.
U.S. general population surveys, which do not include patients with severe mental illness who do not live in standard housing arrangements, show that tobacco-smoking behaviors are associated with psychiatric disorders (1).
However, very few smoking surveys in the United States or other countries compare persons with severe mental illnesses with the general population (1). This study compared smoking rates among 560 outpatients with severe mental illnesses from facilities in central Kentucky with those among adults from the Kentucky general population.
We defined an "ever smoker" as a person 18 years or older who has smoked more than 100 cigarettes during his or her life and a "current smoker" as an ever smoker who currently smokes daily or some days. The prevalence rates of ever smoking, current smoking, and smoking cessation among ever smokers were examined by computing odds ratios (ORs) with 95 percent bootstrap confidence intervals (CIs).
A total of 303 patients (54 percent) were male, 457 (82 percent) were white, 93 (17 percent) were black, and ten (2 percent) were from another race. Clinical diagnoses, made by treating physicians, included schizophrenic disorders (265 patients, or 47 percent), mood disorders (166 patients, or 30 percent) and other diagnoses (129 patients, or 23 percent).
Figure 1 shows the percentages of patients and the general population for each smoking category. Further analyses indicated that compared with the general population, patients were three times as likely to ever smoke (OR=3.0, CI=2.4 to 3.6, p<.001), five times as likely to be a current smoker (OR=5.0, CI=4.2 to 5.9, p<.001), and about one-fifth as likely to stop smoking (OR=.18, CI=.13 to .24, p<.001). After gender stratification and comparison of prevalence rates at the .05 level of significance, the analysis found that compared with male adults in Kentucky, male patients had significantly higher ever and current smoking rates and significantly lower smoking cessation prevalence rates. Similar differences were observed among females.
Smoking cessation among ever-smoking patients versus ever smokers from the general population varied significantly across genders: The OR for males (OR=.12; CI=.07 to .18) was lower than the OR for females (OR=.29, CI=.19 to .42) (χ2=8.9, df=1, p=.003). This finding suggests an interaction between gender and patient status.
Specific smoking education programs and treatment campaigns targeted to patients with severe mental illness are needed.
Dr. Diaz was partially supported by the research director's office (direccion de investigaciones) of the Universidad Nacional in Medellin in Colombia.
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