Policy reforms that expand insurance coverage may play a supporting role in discouraging smoking among adults living with mental health and/or substance use disorders.
Despite an overall decline in smoking in the US over the past 50 years, people with mental health and substance abuse disorders (MH/SUD) have shown less reduction in smoking than people without MH/SUD.
A recent study analyzed smoking and insurance coverage trends among US adults with and without MH/SUD, finding evidence that improvements in smoking and abstinence outcomes for adults with MH/SUD appear to be associated with increases in health insurance coverage. Since 2014, the Affordable Care Act (ACA) has led to major changes in the US health insurance market that may impact tobacco use among those with MH/SUD.
“We hypothesized that insurance expansion would have a larger effect on insurance coverage among those with MH/SUD compared to those without MH/SUD; and that increased insurance coverage would be associated with improved smoking outcomes among those with MH/SUD,” wrote the authors of this study.
The data for this study were obtained from 2008 to 2019 records from the National Survey on Drug Use and Health, an annual cross-sectional survey. There was a total of 448,762 respondents to the survey, aged 18 to 64 years.
Outcome variables were measured by recent cigarette use and past-year health insurance coverage.
Comparing pooled data from 2008-2009 and 2018-2019, current smoking rates of adults with MH/SUD decreased from 37.9% to 27.9%, while current smoking rates of adults without MH/SUD decreased from 21.4% to 16.3%.
Across the 2008-2019 study period, adults with MH/SUD were more likely to report current smoking (34.2% vs 19.0%) and daily smoking (24.2% vs 13.5%). Adults with MH/SUD were less likely to report abstinence from smoking (8.9% vs 10.1%).
Additionally, adults with MH/SUD were more likely to be younger,