Trends in Prevalence of Cigarette Smoking Among US Adults With Major Depression or Substance Use Disorders, 2006-2019

Importance

Tobacco use is highly concentrated in persons with mental illness.

Objectives

To assess trends in past-month prevalence of cigarette smoking among adults with vs without past-year depression, substance use disorders (SUDs), or both, using nationally representative data.

Design, Setting, and Participants

Exploratory, serial, cross-sectional study based on data from 558 960 individuals aged 18 years or older who participated in the 2006-2019 US National Surveys on Drug Use and Health.

Exposure

Past-year major depressive episode (MDE) and SUD usingDiagnostic 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

Of the sampled 558 960 adults, 41.4% (unweighted) were aged 18 to 25 years, 29.8% (unweighted) were aged 26 to 49 years, and 53.4% (unweighted) were women. From 2006 to 2019, the past-month self-reported cigarette smoking prevalence declined significantly among adults with MDE from 37.3% to 24.2% for an average annual percent change of −3.2 (95% CI, −3.5 to −2.8;P < .001), adults with SUD from 46.5% to 35.8% for an average annual percent change of −1.7 (95% CI, −2.8 to −0.6;P = .002), and adults with co-occurring MDE and SUD from 50.7% to 37.0% for an annual average annual percent change of −2.1 (95% CI, −3.1 to −1.2;P < .001). The prevalence declined significantly for each examined age, sex, and racial and ethnic subgroup with MDE and with SUD (allP < .05), except for no significant changes in American Indian or Alaska Native adults with MDE (P = .98) or with SUD (P = .46). Differences in prevalence of cigarette smoking between adults with vs without MDE declined significantly for adults overall from 11.5% to 6.6%, for an average annual percent change of −3.4 (95% CI, −4.1 to −2.7;P < .001); significant average annual percent change declines were also seen for men (−5.1 [95% CI, −7.2 to −2.9];P < .001); for women (−2.7 [95% CI, −3.9 to −1.5];P < .001); for those aged 18 through 25 years (−5.2 [95% CI, −7.6 to −2.8];P < .001); for those aged 50 years or older (−4.7 [95% CI, −8.0 to −1.2];P = .01); for Hispanic individuals (−4.4 [95% CI, −8.0 to −0.5];P = .03), and for White individuals (−3.6 [95% CI, −4.5 to −2.7];P < .001). For American Indian or Alaska Native adults, prevalence did not significantly differ between those with vs without MDE during 2006-2012 but was significantly higher for those with MDE during 2013-2019 (difference, 11.3%; 95% CI, 0.9 to 21.7;P = .04). Differences among those with vs without SUD declined for women for an average annual percent change of −1.8 (95% CI, −2.8 to −0.9;P = .001).

Conclusions and Relevance

In this exploratory, serial, cross-sectional study, there were significant reductions in the prevalence of self-reported cigarette smoking among US adults with major depressive episode, substance use disorder, or both, between 2006 and 2019. However, continued efforts are needed to reduce the prevalence further.