Cigarette Smoking and Health Characteristics in Individuals With Serious Mental Illness Enrolled in a Behavioral Weight Loss Trial

Abstract

Objective: Cigarette smoking is the most preventable cause of disease and death in the U.S. We examined the prevalence of smoking and the association between smoking status and health characteristics in persons with serious mental illness. Methods: A total of 291 overweight or obese adults with serious mental illness were enrolled in a behavioral weight loss trial. Cigarette smoking, co-occurring medical diagnoses, dietary intake, blood pressure, cardiovascular fitness, body mass index, quality of life, and psychiatric symptoms were assessed at baseline in 2008 through 2011. Fasting glucose and lipid markers were measured from blood samples. Cardiovascular risk profile was calculated based on the global Framingham Health Study Risk Equation. Results: A total of 128 (44%) of participants were current smokers or had smoked in the previous year. The smokers had significantly higher diastolic blood pressure and blood triglyceride levels, and lower high-density lipoprotein cholesterol than the nonsmokers, adjusted for age, sex, education level, and diagnosis. They were more likely to have a history of emphysema and had a 10-year cardiovascular disease risk of 13.2%, significantly higher than the 7.4% in the nonsmokers. The smokers also had elevated ratings of psychopathology on the Behavior and Symptom Identification Scale (BASIS-24). Smokers did not differ from nonsmokers in cardiovascular fitness, body mass index, depression, quality of life, or other comorbid medical diagnoses. There was no characteristic in which smokers appeared healthier than nonsmokers. Conclusions: The prevalence of smoking in this contemporary cohort of individuals with serious mental illness who were motivated to lose weight was more than twice that in the overall population. Smokers had more indicators of cardiovascular disease and poorer mental health than did nonsmokers. The high burden of comorbidity in smokers with serious mental illness indicates a need for broad health interventions.

Keywords:

• smoking
• health
• cardiovascular
• serious mental illness
• weight loss

ACKNOWLEDGMENTS

This study was funded by NIMH R01MH 080964, Randomized Trial of Achieving Healthy Lifestyles in Psych Rehabilitation (Daumit, PI).