Modeling cigarette smoking disparities between people with and without serious psychological distress in the US, 1997–2100

• Published in: Preventive medicine Vol. 166; p. 107385
• Main Authors: Xi, Qin, Meza, Rafael, Leventhal, Adam, Tam, Jamie
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2023
• Subjects: Cigarette Smoking - epidemiology; Female; Health disparity; Health policy; Humans; Male; Mental health; Prevalence; Psychological Distress; Serious mental illness; Serious psychological distress; Smokers - psychology; Smoking; Smoking Cessation; Stress, Psychological - psychology; Tobacco use; United States - epidemiology; United States; Tobacco use; Health policy; Serious psychological distress; Mental health; Serious mental illness; Health disparity; Smoking
• ISSN: 0091-7435; 1096-0260
• DOI: 10.1016/j.ypmed.2022.107385

Cigarette smoking rates are significantly higher among people with serious psychological distress (SPD) compared to the general population. US simulation models that project future smoking disparities by SPD status could inform policy interventions, but have not been developed. We calibrated two compartmental models to the National Health Interview Survey 1997–2018 for populations with and without SPD, calculating smoking prevalence, mortality, and life-years lost by SPD status under different scenarios from 2023 to 2100. Under the Status Quo, smoking prevalence among women with SPD falls from 27.0% in 2023 to 10.7% in 2100 (men: 30.1% to 12.2%). For women without SPD, it declines from 9.4% to 3.1% (men: 11.5% to 4.0%). The absolute difference in smoking prevalence between those with and without SPD decreases over time, whereas the relative smoking prevalence ratio increases. From 2023 to 2100, 609,000 premature smoking-attributable deaths would occur in the SPD population, with 8 million life-years lost. Under an ideal tobacco control scenario for people with SPD, in which all smokers quit in 2023 and no new smoking initiation occurs thereafter, up to 386,000 of these premature deaths could be averted with 4.9 million life-years gained. Preventing smoking initiation could avert up to 18% of these deaths, while improving smoking cessation could avert up to 82%. Smoking-related disparities for people with SPD will persist unless a shift in tobacco control substantially improves cessation and prevents initiation in this subpopulation. Smoking disparities by SPD may widen in relative but narrow in absolute terms, so both perspectives should be evaluated. •First tobacco simulation model of population with serious psychological distress.•609,000 smoking-attributable deaths to occur in this population through 2100.•Up to 386,000 of these premature deaths could be averted in the population.•Trends in disparities depend on the type of metric used: absolute or relative.•Improving cessation for this group leads to large, short-term public health benefit.