Smoking and Quitting Beliefs, Attitudes, and Behaviors Among Smokers With Severe Mental Illness From Three Race/Ethnicity Groups

Abstract

Objective: Most people with severe mental illness do not use evidence-based smoking cessation treatments. Ethnic and racial identification among people with severe mental illness may add complexity to their participation in smoking cessation interventions. The purpose of this qualitative study was to explore smoking and smoking cessation attitudes, beliefs, and behaviors among three race/ethnicity groups of smokers with severe mental illness. Methods: Researchers inquired into day-to-day smoking activities and quit attempts in six focus groups with 36 randomly selected African American, Latino, and White smokers with severe mental illness. Transcripts were reviewed to identify prominent themes, and first-person perspectives were selected to provide a description of smoking norms, motivation to quit, and sources of quit information. Results: Participants of all three race/ethnicity groups reported that multiple facets of their lives contributed to smoking initiation and maintenance, including the belief that smoking was a key strategy for coping with mental illness symptoms, reinforcement within institutional living situations and treatment environments, and lack of resources to obtain effective treatments. African Americans and Latinos with severe mental illnesses tended to seek advice about smoking from a broad social network of family and friends and expressed misinformation about and mistrust of medical cessation treatments. Conclusions: Smoking cessation policies and interventions for smokers with severe mental illness should be tailored to address the smoking culture in mental health settings and the variation in health-seeking attitudes and behaviors across race/ethnicity groups.

Keywords:

• smoking cessation
• severe mental illness
• racial disparities

ACKNOWLEDGMENTS

We wish to acknowledge the contributions of Robert Drake, MD, PhD, who provided helpful comments on several drafts of the article. This research was supported by the Bristol-Myers Squibb Foundation as part of larger program to develop and pilot a behavioral intervention to increase motivation for smoking cessation among minorities with severe mental illnesses.