mental illness have been suggested to be associated with increased tobacco use, leading to research into personality traits among smokers. An example is the reported association between a personality trait, such as sensation seeking, and tobacco use among college students (Zuckerman and Kuhlman 2000). The empirical focus on particular individual behaviors is extremely important and avoids the issue of whether such behaviors necessarily represent diseases or behavioral deviations in need of clinical management per se, a potential problem with the biomedical model of health and disease (Brandt and Gardner 2000). Of course, our understanding of the genesis of these traits is often incomplete, as are the biological explanations for tobacco use rates and risks in general.
Cigarette smoking rates differ across broad demographic groups in the United States. Rates are higher in men than in women and among younger persons than older persons. African American and Hispanic adults have similar smoking prevalence rates to whites, whereas Asians overall have somewhat lower rates than whites and American Indians/Alaska Natives have somewhat higher rates than whites (CDC 2004b). Of particular interest, smoking rates are also higher among lower-socioeconomic groups (CDC 2004a). These socioeconomic disparities in tobacco exposure have been the subject of research with respect to explaining variation in tobacco use and resulting health status (King et al. 2004). It has also been suggested that young, “working class” adults have been important targets for commercial tobacco marketing (Barbeau et al. 2004).
The themes of poverty, lower socioeconomic status (SES), and health and social disparities pervade many of the high risk groups for tobacco use. However, the relation between lower SES and higher tobacco use rates is complex and multifactorial and requires substantial further inquiry. While some tobacco control programs have attempted intervention based on SES or broad demographic characteristics per se, many high-risk populations enriched with lower-SES individuals are identified largely by their intersection with various social institutions, such as the health care system, prisons, school counseling programs, and homeless shelters.
Patients and survey respondents with clinical or research diagnoses of many important major mental illnesses have been reported to have higher rates of cigarette smoking and nicotine dependence. These include schizophrenia, major depressive disorder, any alcohol use disorder, any substance abuse disorder, anxiety disorders, mania, and personality disorders (Breslau 1995; Breslau et al. 1991; Breslau et al. 1993; Breslau et al. 1994; Fagerstrom et al. 1996; Grant et al. 2004; Hughes et al. 1986; Lasser et al. 2000). Some studies find higher smoking rates with increasing severity of the psychiatric condition, and these findings have been observed in both white and non-white populations (de Leon et al. 2002). In addition, other psychiatric conditions less frequently studied have been associated with a higher prevalence of smoking, including social phobia, agoraphobia, panic disorder, panic attacks, dysthymia, antisocial behavior and conduct disorders, and post-traumatic stress disorder (Lasser et al. 2000).
Studies on the association of mental illness and smoking have varied designs, inclusion criteria, and other methods. Some are clinic-based, while others are in geographically defined populations. Participation rates vary and, in some of the clinical studies, are unspecified. Patient diagnoses in clinical studies are usually based on individual practitioner designations, without