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Still a mystery if smoking, mental health are connected

Times Press - 1/5/2017

The incidence of smoking in the United States has steadily decreased for nearly all demographic categories, but still poses a threat for one group - those affected with mental health problems.

David Zauche, a senior program manager with the Altarum Institute, wrote in a post titled, "America's Number One Health Disparity?" that behavioral health patients die from tobacco-related diseases at a much higher rate than the general population.

"The rate of disease and death, and we are talking about the common diseases that kill so many people, like heart disease and cancer and the like, are much more common among folks with behavioral health diagnoses than in the general population in great measure because they use the tobacco at a much a higher rate," Zauche said.

Travis Fisher, psychiatrist with Froedtert & the Medical College of Wisconsin, said that trend has been known for a while because of several large studies that have been conducted, some by the Centers of Disease of Control and Prevention, but there isn't a consensus in the medical community if mental health contributes to increased tobacco use.

"If you want the shortest and truest answer it is we don't know," Fisher said. "We have been researching the question for quite a few years now. There is some evidence that suggests it may just be a correlation because if you look at the general population and ask who is more likely to smoke, it is those who are less educated, lower socio-economic status, have more health problems, have more family conflict. All of those things make it more likely that you have mental health issues."

According to the post dated Aug. 9, Zauche attributes one cause to the marginalization and stigmatization of the behavioral health population and another to a lack of support by staff at mental health treatment centers, some of whom he wrote smoke themselves, to smoke-free policies and cessation efforts.

Zauche was not certain why this population begins smoking, but said they continue because of the addiction to nicotine.

"It is the withdrawal, the uncomfortable withdrawal they go through a quit attempt, and people don't want that withdrawal," Zauche said. "It is uncomfortable. It is not life threatening like alcohol, but your body does not want to go through that withdrawal from that drug that it is addicted to, in this case nicotine."

Zauche said he believes tobacco use among mental health patients would fall if health care providers were motivated and trained to provide tobacco cessation assistance. "It is not hard to provide that treatment," Zauche said. "We all know what smokers need to quit and it is not expensive to provide that treatment, but is another thing to do."