Multiple perspectives on tobacco use among youth with mental health disorders and addiction

Youth and young adults (hereafter ‘youth’) with mental health disorders and addictions are much more likely to use tobacco than their peers in the general population. Further, smoking has been found to cause recurrent behavioral problems and is related to an increased risk of lifetime depression. But little research has been done to understand the tobacco habits of this population.

A study was conducted to gather multiple perspectives—from youth aged 13-25 with mental health disorders and addictions as well as from professionals with experience in community-based treatment and tobacco control policy—on smoking behaviors and facilitators and barriers to tobacco cessation for the target population.

The study was composed of: 

• 230 surveys of youth
  
  • 59.4% male
    
• 11 interviews with professionals
• 32 youth in focus groups
  
  • 59.4% male 
  • 50% white, 46.9% Hispanic/Latino; 9.4% African-American; 6.3% Native American 
  • All were receiving treatment at rural and urban community mental health centers

Neither focus groups nor surveys were limited to participants who identified as smokers.

Survey results

The survey found that 44% of respondents currently used tobacco. Many were motivated to quit (44%), and the majority had tried to quit previously. However, most did not receive any aid in prior quit attempts, did not want counseling or help from others in future quit attempts, and had little knowledge of available cessation resources.

Interview and focus group results

 Five themes emerged from the interviews and focus groups:

1. Motivation to quit

• While youth generally described themselves as under-motivated to quit, they agreed with professionals that intervention might be very helpful in helping them move towards healthy behavioral change.
  
• 37.5% of youth participants reported that good physical health is a motivator.

2. Social influence 

• Both peers and family were seen as highly influential in encouraging or discouraging tobacco use.
• More than half of youth participants reported that peer strategies would help their cohort quit.
  
• Professionals supported this idea to a much lesser extent. 
  
• Professionals and youth saw the media as a key culprit in promoting tobacco use.

3. Barriers to treatment were only reported by professionals. These included:

• Limited time with each client
• Concern that quit attempts would exacerbate their clients’ behavioral issues. They reported a common perception that smoking is a necessary evil that helps to manage psychiatric symptoms. o
  
• Community treatment centers’ lack of awareness of tobacco cessation resources

4. Tobacco-free policy

• Both professionals and youth asserted that tobacco-free policies would decrease smoking.

The fifth theme was cessation treatment needs. These included:

Education

• Youth noted the lack of tobacco programs outside school, and expressed a desire for schools and providers to discuss treatment options. 
• Professionals and youth agreed that scare tactics focusing on the health consequences of tobacco would be effective.

Counseling

• Many professionals considered one-on-one interventions to be necessary.
• Both cohorts stated that interventions should be tailored to individuals with mental health disorders and addictions.

 Nicotine replacement therapy (NRT) and other pharmacotherapy

• All youth participants who reported smoking desired the opportunity to use NRT and pharmacotherapy. 
• Half of professionals saw medications as inappropriate for youth, whereas the other half asserted that these aids weren’t used enough.

Quitline services

• Although professionals reported directing young clients to the state quitline, youth participants were generally unaware that a quitline or any other community resources existed.

Self-guided treatment 

• Youth wanted self-guided resources that didn’t require direct professional intervention (e.g., internet-based services).
• In general, both cohorts agreed that most available treatments were geared towards adults.
  
  

Contrary to common perceptions, many youth with mental disorders and addictions are motivated to quit smoking, and most have tried to quit. However, by and large, they are not using provider-driven treatments or quitlines. Although professionals tend to recommend individual, clinic-based interventions, youth desire peer advocacy, technology-based interventions, and NRT or pharmacotherapy. However, the findings of this study further suggest that mental health and addictions providers are positioned, as behavioral change agents, to offer tobacco cessation treatments.

The research, “Multiple Perspectives on Tobacco Use Among Youth with Mental Health Disorders and Addictions” was conducted by Chad D. Morris, PhD, Mandy G. May, MPH; Karen Devine, MSW; Shawn Smith, MA, MBA; Tamara DeHay, PhD; and John Mahalik, PhD, MPA. The article was published in Volume 25, Issue sp5 in the May/June 2011 edition of the American Journal of Health Promotion and is available here.