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Tobacco Screening and Counseling in the U.S.: Smokers With Mental Health and Substance Use Problems

      Introduction

      Individuals with mental health and substance use problems have higher rates of smoking and tobacco-related morbidity and mortality than the general population. These increased rates can be explained, in part, by lower cessation rates compared with overall declines in tobacco use in recent years. The purpose of this study was to examine tobacco screening and cessation counseling in healthcare settings to compare rates for adults with mental health and substance use problems with those without such problems.

      Methods

      A nationally representative sample of adult smokers (N=42,534) from the 2013 to 2016 National Surveys on Drug Use and Health was analyzed using logistic regression to estimate ORs for screening and counseling, adjusting for demographic and socioeconomic characteristics, past-month smoking frequency, and past-year receipt of mental health and substance use treatment. Additionally, predicted probabilities of screening and counseling were calculated across groups to compare regression-adjusted rates of each service. Analyses were conducted in 2017.

      Results

      Compared with smokers without mental health or substance use problems, smokers with mental health and substance use problems and smokers with only mental health problems had higher odds of screening and counseling (all p<0.001); however, smokers with only substance use problems did not (screening p=0.91, counseling p=0.45).

      Conclusions

      Like smokers with mental health problems, smokers with only substance use problems are at increased risk of tobacco-related morbidity and mortality. Yet, unlike smokers with mental health problems, their rates of tobacco screening and cessation counseling by general medical providers do not reflect this elevated risk.
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