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RESEARCH AND PRACTICE: Changes in Cigarette Use and Nicotine Dependence in the United States: Evidence From the 2001–2002 Wave of the National Epidemiologic Survey of Alcoholism and Related Conditions
RESEARCH AND PRACTICE: Changes in Cigarette Use and Nicotine Dependence in the United States: Evidence From the 2001–2002 Wave of the National Epidemiologic Survey of Alcoholism and Related Conditions
Goodwin et al. (1 August 2009)
[Abstract][Full text][PDF]
Changes in Cigarette Use and Nicotine Dependence in the United States: Evidence... POTENTIAL BIAS IN USE OF A BIRTH COHORT ANALYSIS TO ESTIMATE NICOTINE DEPENDENCE IN US SMOKERS
30 October 2009
Gary A. Giovino, Professor and Chair Department of Health Behavior; School of Public Health and Health Professions; University at Buffalo
There has been considerable debate about whether the population of
smokers in the United States is becoming increasingly “hard core” (i.e.,
less willing or able to quit) as tobacco control progresses.1,2 Goodwin
and colleagues analyzed data from the 2001-2002 National Epidemiological
Survey of Alcoholism and Related Conditions to assess a component of
hardening, the prevalence of nicotine dependence in the population of
smokers.3 In an attempt to minimize differential mortality, they
restricted their sample to persons born during 1946 to 1985, creating four
birth cohorts of persons who at the time of survey were approximately 45-56, 35-44, 25-34, and 18-24 years old.
Despite their age restriction, the analysis is likely biased by
differential mortality. Early age of initiation is a predictor of
increased mortality and of increased number of cigarettes smoked each
day.4,5 As observed in the Cancer Prevention Study-II, for example,
overall mortality increases with increasing age, increasing cigarettes/day
and earlier age of initiation.4,6 The differences across categories of
age of initiation and cigarettes/day were observed even when comparing
persons as young as 30-34 years old with those in older age groups.6
Among persons born during 1946-1957 and 1958-1967, those who started
earlier in life were more likely than those who started later in life to
have become heavier smokers and thus be more dependent on nicotine.7 But
CPS-II data indicate they were also more likely to have died before the
2001/2002 NESARC was administered, thus artificially lowering the estimate
of lifetime dependence in the older birth cohorts.6
Another concern is the statement that the “overall rate of cigarette use
declined between 1964 and 2002.”3 Members of the 1946-1957 birth cohort
were between 7 and 18 years of age in 1964. How can the authors
estimate smoking in the U.S. population in 1964 using data on persons who
were 7-18 years old at the time?
The authors correctly point out that the ideal way to determine if the
population is becoming increasingly dependent would be with a surveillance
system designed to systematically assess tobacco use and dependence over
time. Such a system would ideally incorporate measures of other host
factors (e.g., co-morbidities), as well as measures of product
characteristics, pro-tobacco marketing, and tobacco control activities.8
Birth cohort analyses should in general be avoided, especially as
evaluation of the Family Smoking Prevention and Tobacco Control Act
evolves.9,10
References:
1. National Cancer Institute. Those Who Continue to Smoke. Smoking
and Tobacco Control Monograph No.15. Bethesda, MD: U.S. Department of
Health and Human Services, National Institutes of Health, National Cancer
Institute, NIH Publication No. 03-5370, 2003.
2. Giovino GA, Chaloupka FJ, Hartman AM, Gerlach Joyce K, Chriqui J,
et al. Cigarette smoking prevalence and policies in the 50 states: an era
of change – the Robert Wood Johnson Foundation ImpacTeen Tobacco Chart
Book. Buffalo, NY: University at Buffalo, State University of New York,
2009. Available at:
http://www.impacteen.org/generalarea_PDFs/chartbook_final071009.pdf.
Accessed October 30, 2009.
3. Goodwin RD, Keyes KM, Hasin DS. Changes in cigarette use and
nicotine dependence in the United States: evidence from the 2001-2002 Wave
of the National Epidemiologic Survey of Alcoholism and Related Conditions.
American Journal of Public Health 2009;99(8):1471-1477.
doi:10.2105/AJPH.2007,127886.
4. U.S. Department of Health and Human Services. The health
consequences of smoking: A report of the Surgeon General. Atlanta, GA:
U.S. Department of Health and Human Services, Centers for Disease Control
and Prevention, National Center for Chronic Disease Prevention and Health
Promotion, Office on Smoking and Health; 2004.
5. Taioli E, Wynder EL. Effect of age at which smoking begins and
frequency of smoking in adulthood [letter]. New England Journal of
Medicine 1991;324(13):968-969.
6. Smokefree.gov. Learn about your risk from smoking (or the risk
of a smoker you know). Available at:
http://www.smokefree.gov/smokersrisk/. Accessed October 30, 2009.
7. U.S. Department of Health and Human Services. The health
consequences of smoking: nicotine addiction. A report of the Surgeon
General. Rockville, MD: U.S. Department of Health and Human Services,
Public Health Service, Centers for Disease Control, Center for Health
Promotion and Education, Office on Smoking and Health. DHHS publication
no. (CDC) 88-8406; 1988.
8. Giovino GA, Biener L, Hartman AM, Marcus SE, Schooley MW,
Pechacek TF, et al. Monitoring the tobacco use epidemic I. Overview:
Optimizing measurement to facilitate change. Preventive Medicine 2009;48(1
Suppl):S4-S10.
9. U.S. Food and Drug Administration. Tobacco Products. Available
at: http://www.fda.gov/TobaccoProducts/default.htm. Accessed on October
30, 2009.
10. Hatsukami DK, Giovino GA, Eissenberg T, Clark PI, Lawrence D,
Leischow S. Methods to assess potential reduced exposure products.
Nicotine & Tobacco Research 2005;7(6):827-844.
ANALYTIC ESSAY FORUM: Mental Health Disparities
Safran et al. (1 November 2009)
[Abstract][Full text][PDF]
Mental Health Disparities Culturally-Tailored Mental Health Care
5 November 2009
Katie J Olson, Clinical Psychology Graduate Student John F. Kennedy University
It was with great pleasure that I read Mark Safran and colleagues’
November 2009 article, “Mental Health Disparities.” While seeking to
reduce disparities in healthcare based on patients’ socioeconomic status,
race/ethnicity, gender and geography is the responsibility of all
healthcare providers, Safran and colleagues provide a well-supported look
at the complexities of fostering change when various factors in multiple
systems must be taken into account.
As a graduate student at John F. Kennedy University, in each of my
courses I am exposed to the limitations of conventional psychological
thought when working with non-dominant culture clients. This, in the
context of my background in public health and interest in health
psychology/behavioral medicine has led me to discover that a good part of
our current medical management of various problems is essentially devoid
of any information regarding diversity factors.
Rather than ignoring or seeking to “overcome” cultural differences,
healthcare providers who seek to identify those aspects of their client’s
race or ethnicity that are unique or different from the dominant culture
and attempt to understand those differences as strengths are in the
fortunate position of being able to incorporate those features into
strategies for increasing adherence to treatment and increasing the
quality of treatment outcomes. The field of mental health can no longer
afford to take a generalist approach to treatment, assuming that “one size
fits all.” Even as healthcare providers are able to spend less and less
time with their patients, the diversity of those clients demands treatment
plans that are culturally tailored and therefore more likely to produce
desired outcomes or at the very least, alleviate the intensity of
suffering. The United States has come a long way in admitting that mental
health care disparities exist among different groups; now agencies across
the healthcare spectrum must continue to expand the research on
empirically-based, efficacious strategies for successfully addressing the
mental health needs of minority populations.
Best regards,
Katie Olson, MPH
Mental Health Disparities Tobacco Use as a Cause of Mental Health Disparities
4 November 2009
Erica S Solway, Researcher University of California, San Francisco
Marc Safran and colleagues’ November 2009 article “Mental Health
Disparities” raises several important issues and considerations related to
disparities in the prevalence of mental illness based on factors such as
socioeconomic status, race and ethnicity, gender, and geography.
One important cause of health disparities for people with mental
illnesses left
unmentioned in this article is the continued high smoking prevalence in
this
population. People with serious mental illnesses live 25 fewer years than
the
general population, 1,2,3 and a majority of these years of lost life are
due to
tobacco use. 4 Depending on the diagnosis and how tobacco use is defined,
an estimated 50-90% of individuals with serious mental illness or
addictions
are tobacco dependent, 5 and individuals with mental illnesses smoke 44.3%
of the cigarettes consumed in the U.S. 6 Approximately 200,000 of the
443,000 people who die prematurely from smoking each year are people with
mental illnesses or substance use disorders. 4,5 These high rates have
been
attributed to numerous physiological, social, and cultural factors 7
including
the reality that tobacco use is often ignored or even encouraged in mental
health settings and is not considered a disorder like other mental
illnesses or
addictions. 4,5
The Federal Collaborative for Health Disparities Research (FCHDR)
Mental
Health Science Group is providing valuable leadership in developing a
research agenda to address mental health disparities. Similarly, the
National
Mental Heath Partnership for Wellness and Smoking Cessation is a
partnership of mental health and smoking cessation organizations and
researchers who have convened around the goal of addressing the high rates
of tobacco use and reducing health disparities for people with mental
illnesses. The Partnership developed in March 2007 with the support of the
Smoking Cessation Leadership Center at the University of California, San
Francisco and has grown to include over 30 organizations committed to
developing a national consensus on the need to increase opportunities for
wellness among mental health consumers and staff and ensure that smoking
cessation treatments and tools are readily available. The Partnership’s
various
activities addressing these disparities include the development of
training
materials for psychiatric hospitals as they create and implement smoke-
free
policies and materials to train peer counselors, data collection, a
program
with SAMHSA grantees to enhance their smoking cessation initiatives, and
efforts to incorporate smoking cessation information into wellness
programs.
For more information on the Partnership and tobacco-related health
disparities and behavioral health, please visit:
http://smokingcessationleadership.ucsf.edu/BehavioralHealth.htm.
References:
1 Colton, C. W. & Manderscheid, R. W. (2006). Congruencies in
increased
mortality rates, years of potential life lost, and causes of death among
public
mental health clients in eight states. Preventing Chronic Disease, 3(2),
Retrieved from http://www.cdc.gov/pcd/issues/2006/apr/05_0180.htm
2 Lutterman, T., Ganju, V., Schacht, L., Shaw, R., Monihan, K., et
al. (2003).
Sixteen state study on mental health performance measures. DHHS
Publication No. (SMA) 03-3835. Rockville, MD: Center for Mental Heath
Services, Substance Abuse and Mental Heath Services Administration.
Retrieved from http://www.nri-
inc.org/reports_pubs/2003/16StateStudy2003.pdf
3 Parks, J., Svendsen, D., Singer, P., & Foti, M. E. (2006).
Morbidity and
mortality in people with serious mental illness (Technical Report 13).
Alexandria, VA: National Association of State Mental Health Program
Directors
Medical Directors Council. Retrieved September 15, 2008 from
http://www.nasmhpd.org/general_files/publications/med_directors_pubs/Mo
rtality%20and%20Morbidity%20Final%20Report%208.18.08.pdf
4 Schroeder, S. A. (2009). A 51-year-old woman with bipolar disorder
who
wants to quit smoking. Journal of the American Medical Association,
301(5),
522-531.
5 Williams, J. M. & Ziedonis, D. (2004). Addressing tobacco among
individuals
with a mental illness or an addiction. Addictive Behaviors, 29, 1067-1083.
6 Lasser, K., Boyd, J. W., Woolhandler, S., Himmelstein, D. U.,
McCormmick,
D., & Bor, D. H. (2000). Smoking and mental illness: A population-
based
prevalence study. Journal of the American Medical Association, 284(20),
2606-2610.
7 Ziedonis, D. M. & Williams, J. M. (2003). Management of smoking
in people
with psychiatric disorders. Current Opinion in Psychiatry, 16, 305-315.
