Addressing Tobacco Use in Adults with Psychotic Disorders

Beth Han, MD, PhD, MPH

A study published today in JAMA provides important insights into the prevalence and characteristics of tobacco use among adults with a history of psychosis.

Investigators call for tailored tobacco cessation interventions for this population, which could significantly improve their health outcomes and reduce premature mortality based on the study findings.

The intent of the investigation was to determine if the prevalence of tobacco product use, severity of nicotine dependence, and cessation methods among community-dwelling adults differ between individuals with and without psychosis.

When data from the Population Assessment of Tobacco and Health (PATH) Study were analyzed to evaluate the study parameters, results showed a higher prevalence of tobacco use, polytobacco use, and severity of nicotine dependence among adults with psychosis compared with those without psychosis.

Linking Psychosis to Tobacco Use

Data from the analysis displayed 2.9% of the participating adults reported a lifetime diagnosis of psychosis. These adults had a higher prevalence of tobacco use within the past month (41.3%) when compared with adults without psychosis (27.7%).

Those with psychosis were also more likely to use cigarettes, e-cigarettes, and other tobacco products in most subgroups. Additionally, they had a higher prevalence of polycombustible tobacco use and polycombustible and noncombustible tobacco use, according to the study.

When examining adults who engaged in cigarette use within the past month, those with psychosis had a higher adjusted mean nicotine dependence score overall and within specific age, sex, and race/ethnicity subgroups. They were also more likely to make a quit attempt and use counseling, a quitline, or a support group for tobacco cessation.

Interventions, Implications & Future Research

Investigators analyzed data from 29,045 adults who participated in the PATH Study's Wave 5 survey between December 2018-November 2019 and were 18 years or older. Participants were classified as having lifetime psychosis based on a self-reported diagnosis of schizophrenia, schizoaffective disorder, psychosis, or psychotic illness or episode they received from a clinician.

Reliance on self-reported data was a limitation acknowledged by investigators because it may be subject to social desirability bias. Additionally, they noted the study did not examine the reasons for the higher prevalence of tobacco use among adults with psychosis.

Future research could explore the factors contributing to this disparity and identify effective interventions to reduce tobacco use in this population.

Results highlighted the need for customized interventions, and investigators urged mental health providers to prioritize tobacco screening and cessation interventions for adults with a history of psychosis and policymakers should invest in evidence-based programs to reduce tobacco use in this vulnerable population. Additionally, they stated these interventions should be evidence-based and appropriate for age, sex, and race/ethnicity.

References:

1. Han B, Aung TW, Volkow ND, et al. Tobacco Use, Nicotine Dependence, and Cessation Methods in US Adults With Psychosis. JAMA Netw Open. 2023;6(3):e234995. doi:10.1001/jamanetworkopen.2023.4995