Disparities Persist in Smoking Cessation

Overall smoking rates in the United States are declining, but some vulnerable populations like the LGBT and the mentally ill communities still struggle to quit.


Supported by a grant from Pfizer

While the overall rates for smoking in the United States are declining, the battle is far from over. The statistics tell an upsetting story as smoking relates to vulnerable populations, like the mentally ill and the LGBT community. People in those communities are more likely to smoke and less likely to quit.

The good news about smoking is just over 15 percent of the general U.S. population smokes today, compared to almost 21 percent in 2005.

And, the rate of smokers has decreased among some minority groups as well. In 2014, 17.5 percent of African Americans reported smoking cigarettes in the past month, down from 21.5 percent in 2005. Among Hispanics, that rate fell from 16.2 percent in 2005 to 11.2 percent in 2014.

So where and why do problems remain?

"For decades, the media has been broadcasting the dire consequences of tobacco addiction …" writes Sally Susman, executive vice president of corporate affairs at Pfizer. "Yet while we are witnessing significant declines in smoking rates in the general population, one-quarter of the LGBT community continues to be hooked."

Susman surmises that the stress caused by prejudice and stigma—both risk factors for nicotine addiction—may fuel tobacco use in the LGBT community. And she says there is a lack of resources to support people in the LGBT community trying to kick the habit.

The statistics are even worse among people with mental illness. The National Survey on Drug Use and Health reports that one in three people living with mental illness smokes cigarettes. Among those with schizophrenia, depression and bipolar disorder, 50 percent will die of a tobacco-related issue, like cancer or respiratory or vascular disease.

And despite their desire to quit, these vulnerable people fail in large numbers: Although more than 75 percent want to stop smoking, just 29 percent will ultimately succeed.

Why the disparity? Studies suggest that there needs to be more positive reinforcement; that having a desire to quit is simply not enough without the proper support, education and treatment.

LGBT individuals and those with mental illness desperately need and deserve the help of their providers and the surrounding community to support them in their efforts to get—and stay—tobacco-free.

Education goes a long way toward success. Yet, mental health centers are woefully lacking, with only one in four offering any type of smoking cessation treatment. The same goes for substance abuse treatment centers, where just 42 percent offer tobacco cessation services and even fewer that provide cessation counseling.

Additionally, staff members of mental health facilities that have smoke-free policies need to be aware of the importance of keeping the environment tobacco free for their patients. They should also be fully informed about the availability and safety of cessation drugs and other treatments to help their patients in their efforts to quit.

Although the Affordable Care Act and marriage equality laws have fueled momentum to grant the LGBT community equal access to health services, Susman cites a 2015 issue brief by the Kaiser Family Foundation showing that obstacles to health care still remain because of sexual orientation or gender identity. In addition, they may face job-related discrimination and lack of employment opportunities, which deprives them of employer-sponsored health insurance plans.

What can be done?

Susman says Pfizer is well aware of the unequivocal divide that exists in both smoking and quitting rates between the general population and social and sexual minorities and is committed to helping. "We collaborate with health care providers, governments and local communities to support and expand access to reliable, affordable health care … especially among communities where nicotine addiction rates are disproportionately high."

Part of Pfizer's effort involves improving access for the mentally disabled to the drug varenicline (Chantix, Champix), a drug it manufactures to help people stop smoking. It is the first oral non-nicotine treatment backed by the U.S. Food and Drug Administration since bupropion was approved in 1997.

The drug, however, carries the FDA's strongest warning that the drug may be associated with an increased risk of serious neuropsychiatric symptoms among people with psychiatric illnesses.

Research continues, but several recent studies have found no evidence to support the warning that the drug can cause mental problems to worsen. As a result of one recent study, the European Medicines Agency, Europe's main drug regulator, has removed the warning from verenicline labels in Europe.

With 1,300 people dying of tobacco-related deaths in this country each day, it's time to make sure everyone has access to education and support that could help them stop smoking.

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