An estimated 53 percent of adults with serious mental illness (SMI) — including schizophrenia, schizoaffective disorder, bipolar disorder and major depression — smoke cigarettes, compared to only 18 percent of the general population.
In fact, smoking is one of the primary reasons those with serious mental illness have a decreased life expectancy of up to 25 years.
Although research has shown that most smokers with SMI want to quit, they are less likely to do so or to take advantage of available smoking cessation treatments.
In order to better understand why quit rates are so low in this population, researchers from Dartmouth College and Harvard Medical School conducted a new study to investigate how social networks might affect the outcomes of smokers with SMI who participate in smoking cessation programs.
For the study, the researchers conducted interviews with 41 men and women (average age 47) who had been diagnosed with serious mental illness: 42% had a psychiatric diagnosis of bipolar disorder; 32% had major depressive disorder; and 26% had schizophrenia or schizoaffective disorder.
Each participant had also attended one of the smoking cessation programs offered in the community mental health centers throughout New Hampshire.
The researchers asked participants to identify their social contacts and their relationships, including whom they spent the most time with during a typical week. They were also asked to identify up to five people who had said or done anything to influence their smoking habits in the past year.
Each person then named up to 10 social contacts (friends, family members, roommates, romantic partners, coworkers or others) with whom they spent the most time and/or who had influenced their efforts to quit smoking.
The participants were asked how strong their relationship was with each contact; whether and how often they had smoked cigarettes with each contact in the past 12 months; if each contact was a current, former or never smoker; and whether each contact had ever helped them quit or gotten in the way of them quitting.
A total of 44% of the 243 contacts cited by participants were family members, with 12% identified as parents; friends comprised 45% of social networks — with coworkers, neighbors, peers at the mental health center, and members of a shared social group comprising the rest of the network.
According to the findings, 52% of the contacts given were current smokers; 30% never smokers; and 18% former smokers. In addition, 63% of participants had smoked with a contact at least once per month during the past year.
Overall, 57% of the contacts had helped a participant quit smoking within the past year, whereas 14% of contacts hindered a participants’ efforts to quit smoking. Finally, 90% of contacts approved of the participants using counseling to quit smoking, while 75% approved of using medications to quit.
The findings show that the strongest influence on quitting was having a contact who had previously quit smoking. This decreased the odds of the participant still being a smoker after attending cessation treatment. Having a highly connected friend group also lowered the odds of a participant still smoking post-treatment.
So having former smokers in one’s social network may be a key resource for quitting, particularly among vulnerable groups where there is a high prevalence and acceptability of smoking.
“As researchers and behavioral health specialists, it’s important we investigate these social networks and their impact on our health, so we can design better public health programs and policies, particularly for vulnerable or disadvantaged groups like people with serious mental illness,” says lead author Kelly Aschbrenner, assistant professor at The Dartmouth Institute for Health Policy and Clinical Practice.
The findings are published in the journal Translational Behavioral Medicine.