Skip directly to site content Skip directly to search


Español  Other Languages


Centers for Disease Control and Prevention. CDC twenty four seven. Saving Lives, Protecting People
 Search

		Submit


Smoking & Tobacco Use


Section Navigation
			
			CDC Home








Unfair and Unjust Practices and Conditions Harm People with Behavioral Health Conditions and Drive Health Disparities						Print
																Related Pages
										african american couple looking concernedPeople with behavioral health conditions have also been harmed by unjust practices related to the sale of commercial tobacco.
People with behavioral health conditions are subject to more negative judgements and stigmatization than people with physical health conditions.15
People with behavioral health conditions have also been harmed by unjust practices related to the sale of commercial tobacco*.5
african american couple looking concernedPeople with behavioral health conditions have also been harmed by unjust practices related to the sale of commercial tobacco.
Tobacco companies funded research to support ideas that have been proven to be untrue, including the hypothesis that people with schizophrenia could not develop lung cancer, and the idea that people with mental health conditions need cigarettes to treat their symptoms.16 Tobacco industry lobbyists have cited this disproven research to resist efforts to promote smokefree policies in psychiatric hospitals.17 Misperceptions that smoking could alleviate symptoms of mental health conditions may affect mental health providers’ willingness to offer smoking cessation treatments to people with behavioral health conditions.18Tobacco companies have created marketing plans that target population groups, including people who use illicit substances. One example was “Project SCUM” (Sub-Culture Urban Marketing), a 1990’s marketing strategy that attempted to co-brand tobacco as part of drug culture through product placement in shops that sold related paraphernalia.17People with behavioral health conditions have also experienced discrimination and harm from systems meant to protect and improve health and well-being, including health care and medical science.
capital building in DC
Until the passage of the Education for All Handicapped Children Act in 1975 it was legal to exclude children with behavioral health conditions from schools. Before the passage of the law, Congress found that four million children with disabilities were either excluded from public school services or served inappropriately.19
The Americans with Disabilities Act – passed in 1990 – did not fully or evenly protect people with behavioral health conditions from workplace discrimination until clarifications were adopted in 2008.19,20
Health insurance coverage for behavioral health conditions has historically been less generous than coverage for medical care. Protections have expanded over time, starting with the Mental Health Parity Act of 1996 and the Mental Health Parity and Addiction Equity Act of 2008. There was no requirement that all insurance plans cover behavioral health conditions until the Patient Protection and Affordable Care Act of 2010.19,21There are also current reasons—like the ones explored below—that help explain why commercial tobacco affects the health of people with behavioral health conditions.The tobacco industry targets people with behavioral health conditions with marketing and advertisingMarketing plays a big role in whether people try or use commercial tobacco products. Commercial tobacco ads make smoking seem more appealing and increase the chance that someone will try smoking for the first time or start using commercial tobacco products regularly.22,23,24,25
Tobacco companies spend billions of dollars each year to aggressively market their products. They also target specific populations, including people who have behavioral health conditions, with commercial tobacco advertising.17For example:
vape shop signTobacco companies market and advertise tobacco products to people with behavioral health conditions.
Advertisements for commercial tobacco products often incorporate images of carefree people who are smoking, socially engaged, and with freedom from stress and anxieties.17
In one study of a large, metropolitan area, people who had a serious mental health condition were twice as likely as those without a serious mental health condition to live in a neighborhood with more tobacco retailers and more advertisements for commercial tobacco product.26
Commercial tobacco brands use donations to civic groups as a way of generating influence and bolstering their public image. The industry has a history of making financial contributions to organizations that work with people with behavioral health conditions and have given free or discounted cigarettes to psychiatric facilities.16,17To help protect people with behavioral health conditions from tobacco marketing and discourage tobacco use, states and communities could consider increasing prices and prohibiting price discounts, prohibiting the sale of flavored tobacco products, and either allowing fewer stores in a neighborhood to sell commercial tobacco products or prohibiting tobacco product sales altogether.27
**“Commercial tobacco” means harmful products that are made and sold by tobacco companies. It does not include “traditional tobacco” used by Indigenous groups for religious or ceremonial purposes*.Next Section: Commercial Tobacco Product Use and Behavioral Health Conditions Can Affect Each Other >Top of Page
ReferencesSubstance Abuse and Mental Health Services Administration. Results from the 2016 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, 2017 [accessed 2022 Feb 25].
Center for Behavioral Health Statistics and Quality. (2020). Results from the 2019 National Survey on Drug Use and Health: Detailed tables. Rockville, MD: Substance Abuse and Mental Health Services Administration [accessed 2022 Feb 25].
Druss BG, Zhao L, Von Esenwein S, Morrato EH, Marcus SC. Understanding Excess Mortality in Persons With Mental Illness: 17-Year Follow Up of a Nationally Representative US Survey. Medical Care 2011;49(6):599–604 [accessed 2022 Feb 25].
Schroeder S A, Morris CD. Confronting a neglected epidemic: tobacco cessation for persons with mental illnesses and substance abuse problems. Annual Review of Public Health, 2010;31:297–314 [accessed 2022 Feb 25].
Richter KP, Arnsten JH. A rationale and model for addressing tobacco dependence in substance abuse treatment. Substance Abuse Treatment, Prevention, and Policy. 2006;1(1):23 [accessed 2022 Feb 25].
Tam J, Warner KE, Meza R. Smoking and the reduced life expectancy of individuals with serious mental illness.  American Journal of Preventive Medicine. 2016; 51(6):958–966 [accessed 2022 Feb 25].
Apollonio DE, Malone RE. Marketing to the marginalised: tobacco industry targeting of the homeless and mentally ill. Tob Control. 2005;14(6):409-415 [accessed 2022 Feb 25].
Campbell BK, Le T, Andrews KB, Pramod S, Guydish J. Smoking among patients in substance use disorders treatment: associations with tobacco advertising, anti-tobacco messages, and perceived health risks. Am J Drug Alcohol Abuse. 2016;42(6):649-656 [accessed 2022 Feb 25].
Marynak K, Vanfrank B, Tetlow S, et al. Tobacco Cessation Interventions and Smoke-Free Policies in Mental Health and Substance Abuse Treatment Facilities—United States, 2016. Morbidity and Mortality Weekly Report, 2018;67(18):519-23 [accessed 2022 Feb 25].
Jamal A, Phillips E, Gentzke AS, et al. Current Cigarette Smoking Among Adults - United States, 2016. MMWR Morb Mortal Wkly Rep. 2018;67(2):53-59 [accessed 2022 Feb 25].
Cook BL, Wayne GF, Kafali EN, Liu Z, Shu C, Flores M. Trends in Smoking Among Adults With Mental Illness and Association Between Mental Health Treatment and Smoking Cessation. JAMA. 2014;311(2):172–182 [accessed 2022 Feb 25].
Dickerson F, Schroeder J, Katsafanas E, et al. Cigarette Smoking by Patients With Serious Mental Illness, 1999-2016: An Increasing Disparity. Psychiatr Serv. 2018;69(2):147-153 [accessed 2022 Feb 25].
Young-Wolff KC, Hickman NJ 3rd, Kim R, Gali K, Prochaska JJ. Correlates and prevalence of menthol cigarette use among adults with serious mental illness. Nicotine Tob Res. 2015;17(3):285-291 [accessed 2022 Feb 25].
NIH State‐of‐the‐Science Panel. National Institutes of Health State‐of‐the‐Science conference statement: tobacco use: prevention, cessation, and control. *Ann Intern Med.* 2006;145:839‐844 [accessed 2022 Feb 25].
Centers for Disease Control and Prevention, Substance Abuse and Mental Health Services Administration, National Association of County Behavioral Health & Developmental Disability Directors, National Institute of Mental Health, The Carter Center Mental Health Program. Attitudes Toward Mental Illness: Results from the Behavioral Risk Factor Surveillance System. Atlanta (GA); Centers for Disease Control and Prevention; 2012 [accessed 2022 Feb 25].
Prochaska JJ, Hall SM, Bero LA.  Tobacco use among individuals with schizophrenia: What role has the tobacco industry played? Schizophr. Bull. 2008;34:555–67 [accessed 2022 Feb 25].
Prochaska JJ, Smita D, Young-Wolff KC.  Smoking, mental illness, and public health. Annual Review of Public Health. 2017; 38: 165-185[accessed 2022 Feb 25].
Lawn S, Pols R. Smoking bans in psychiatric inpatient settings? A review of the research. Aust. N. Z. J. Psychiatry. 2005;39:866–85[accessed 2022 Feb 25].
Cummings JR et al. Addressing public stigma and disparities among persons with mental illness: the role of federal policy. American Journal of Public Health. 2013;103(5): 781-5 [accessed 2022 Feb 25].
Americans with Disabilities Act of 1990, Pub. L. No. 101-336, 104 Stat. 327 [accessed 2022 Feb 25].
Patient Protection and Affordable Care Act, 2010, Pub. L. No. 111-148, 124 Stat. 119 [accessed 2022 Feb 25].
Carson NJ, Rodriguez D, Audrain-McGovern J. Investigation of mechanisms linking media exposure to smoking in high school students. Prev Med. 2005;41(2): 511-20 [accessed 2022 Feb 25].
Charlesworth A, Glantz SA. Smoking in the movies increases adolescent smoking: A review. Pediatrics 2005;116(6): 1516-28 [accessed 2022 Feb 25].
U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2022 Apr 28].
National Cancer Institute. The Role of the Media in Promoting and Reducing Tobacco Use. Tobacco Control Monograph No. 19. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute. NIH Pub. No. 07-6242, June 2008 [accessed 2022 Apr 28].
Young-Wolff KC, Henriksen L, Delucchi K, Prochaska JJ. Tobacco retailer proximity and density and nicotine dependence among smokers with serious mental illness. Am J Public Health. 2014;104(8):1454-1463 [accessed 2022 Feb 25].
Robertson L, McGee R, Marsh L, Hoek, J. A systematic review on the impact of point-of-sale tobacco promotion on smoking. Nicotine & Tobacco Research. 2015;17(1): 2-17 [accessed 2022 Feb 25].
Centers for Disease Control and Prevention. Vital Signs: Current Cigarette Smoking Among Adults Aged ≥18 Years With Mental Illness—United States, 2009–2011. Morbidity and Mortality Weekly Report 2013;62(5):81-7 [accessed 2022 Feb 25].
Lohr JB, Flynn K. Smoking and schizophrenia. Schizophr Res. 1992;8(2):93-102 [accessed 2022 Feb 25].
Prochaska JJ. Smoking and Mental Illness—Breaking the Link. New England Journal of Medicine, 2011;365:196-8 [accessed 2022 Feb 25].
McEwen BS. Stress, adaptation, and disease. Allostasis and allostatic load. Ann N Y Acad Sci. 1998;840:33-44 [accessed 2022 Feb 25].
Slopen N, Dutra LM, Williams DR, et al. Psychosocial stressors and cigarette smoking among African American adults in midlife. Nicotine Tob Res. 2012;14(10):1161-1169 [accessed 2022 Feb 25].
Weinberger AH, Gbedemah M, Wall MM, Hasin DS, Zvolensky MJ, Goodwin RD. Cigarette use is increasing among people with illicit substance use disorders in the United States, 2002-14: emerging disparities in vulnerable populations. Addiction. 2018;113(4):719-728 [accessed 2022 Feb 25].
Prochaska JJ, Delucchi K, Hall SM. A meta-analysis of smoking cessation interventions with individuals in substance abuse treatment or recovery. Journal of Consulting and Clinical Psychology. 2004;72(6), 1144 [accessed 2022 Feb 25].
Compton W. The need to incorporate smoking cessation into behavioral health treatment. *The*American Journal on Addictions. 2018; 27(1):42–43 [accessed 2022 Feb 25].
Taylor G, McNeill A, Girling A, Farley A, Lindson-Hawley N, Aveyard P. Change in mental health after smoking cessation: systematic review and meta-analysis. BMJ. 2014; 348:1151. [accessed 2022 Feb 25].
Vital Signs: Adult Smoking Focusing on People with Mental Illness [PDF - 3.2 MB], February 2013 [accessed 2022 Feb 25].
Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. The N-SSATS Report: Tobacco Cessation Services. September 19, 2013. Rockville, MD [accessed 2022 Feb 25].
Brown, CH et al. Factors influencing implementation of smoking cessation treatment within community mental health centers. Journal of Dual Diagnosis. 2015;11(2): 145-50 [accessed 2022 Feb 25].
DiGiulio A, Jump Z, Babb S, et al. State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Accessing Treatments — United States, 2008–2018. MMWR Morb Mortal Wkly Rep 2020;69:155–160 [accessed 2022 Feb 25].
Smoking Cessation Leadership Center. Fact Sheet: The Tobacco Epidemic Among People With Behavioral Health Disorders. San Francisco: Smoking Cessation Leadership Center, University of California, 2015 [accessed 2022 Feb 25].
U.S. Department of Health and Human Services. Smoking Cessation. A Report of the Surgeon General. [PDF - 10 MB] Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2020 [accessed 2022 Feb 25].
Davis KC, Duke J, Shafer P, Patel D, Rodes R, & Beistle D Perceived effectiveness of antismoking ads and association with quit attempts among smokers: evidence from the Tips from Former Smokers campaign. Health Communication. 2017; 32(8), 931-938 [accessed 2022 Feb 25].
							
					
							Last Reviewed:  June 27, 2022						Source: 	Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion
					Facebook
        Twitter
        LinkedIn
        Syndicate homeHomeOffice on Smoking and Health (OSH)plus iconOSH Partners with StatesFunding Opportunity AnnouncementsInteragency Committee on Smoking and Healthplus iconMembership RosterNewsroomStay ConnectedOrganizationSmoking & Tobacco Use FeaturesQuit Smokingplus iconHow to Quitplus iconBenefits of QuittingBasic Informationplus iconHealth Effectsplus iconCancerHeart Disease and StrokeChronic Obstructive Pulmonary Disease (COPD)Smoking During PregnancyEquality in Smoking & Disease: Nobody Wins!Electronic Cigarettesplus iconAbout Electronic Cigarettes (E-Cigarettes)Quick Facts on the Risks of E-cigarettes for Kids, Teens, and Young AdultsEmpower Vape-Free Youth CampaignMenthol Tobacco Productsplus iconState Menthol Fact SheetsMenthol Tobacco Products are a Public Health ProblemMenthol Smoking and Related Health DisparitiesAddressing Menthol Tobacco ProductsHeated Tobacco ProductsYouth Tobacco PreventionCommercial Tobacco and Health Equityplus iconBlack and African American Peopleplus iconHealth BurdenUnfair and Unjust Practices and ConditionsSecondhand SmokeQuitting TobaccoAmerican Indian and Alaska Native Peopleplus iconHealth BurdenUnfair and Unjust Practices and ConditionsSecondhand SmokeQuitting TobaccoAsian, Native Hawaiian, and Pacific Islander Peopleplus iconHealth BurdenUnfair and Unjust Practices and ConditionsQuitting TobaccoHispanic and Latino Peopleplus iconHealth BurdenUnfair and Unjust Practices and ConditionsSecondhand SmokeQuitting TobaccoLGBTQ+ Peopleplus iconHealth BurdenUnfair and Unjust Practices and ConditionsQuitting TobaccoPeople Across Geographic Regionsplus iconHealth BurdenUnfair and Unjust Practices and ConditionsSecondhand SmokeQuitting TobaccoPeople with Behavioral Health Conditionsplus iconHealth BurdenUnfair and Unjust Practices and ConditionsCommercial Tobacco Product Use and Behavioral Health Conditions can Affect Each OtherQuitting TobaccoPeople with Low Socioeconomic Statusplus iconHealth BurdenUnfair and Unjust Practices and ConditionsSecondhand SmokeQuitting TobaccoSecondhand Smokeplus iconGeneral InformationTrends and DisparitiesHealth ProblemsSecondhand Smoke in the CommunitySecondhand Smoke in the HomeSmokefree PoliciesResourcesGoing Smokefree Mattersplus iconBars and RestaurantsCasinosIn Your HomeMultiunit HousingSurgeon General's Reports on Smoking and Tobacco Useplus icon2020 SGR—Smoking Cessation2016 SGR—E-Cigarette Use Among Youth and Young AdultsHistorical ReportsA Brief HistoryArchiveData and Statisticsplus iconFast Facts and Fact Sheetsplus icon**Smoking and Cigarettes**Diseases and DeathHealth Effects of Cigarette SmokingTobacco-Related MortalityCigarette Smoking in the U.S.Adult DataCessationCost and ExpendituresEconomics**Smokeless Tobacco**Health EffectsProducts and MarketingSmokeless Tobacco Product Use in the United States**Other Tobacco Products**CigarsHookahsLow Yield Cigarettes**Secondhand Smoke****Youth Tobacco Use**Youth DataSmoking in the MoviesTrends in Tobacco Use Among Youth**Tobacco Industry**Tobacco Brand PreferencesIndustry MarketingSurveysplus iconNational Youth Tobacco Survey (NYTS)Alaska Native Adult Tobacco Survey Guidance ManualAmerican Indian Adult Tobacco SurveyScientific Evidence BriefsSTATE SystemMorbidity and Mortality Weekly Reports (MMWR)Vital SignsPatient Careplus iconPatient Care Settings and Smoking Cessationplus iconCardiovascular Care SettingsRespiratory Care SettingsCancer Care SettingsMaternal and Infant Care SettingsClinical Interventions to Treat Tobacco Use and Dependence Among AdultsClinical Cessation ToolsPatient Cessation MaterialsQuitlines and Other Cessation Support ResourcesClinical Education and TrainingE-Cigarettes and Patient CareState and Community Workplus iconTobacco Control Programsplus iconCessation Materials for Tobacco Control ProgramsNetworking2Save: Co-op AgreementGuidelines and ResourcesProgram FundingEvidence Based Guides for StatesState Fact SheetsTobacco Ingredient and Nicotine ReportingTobacco Counter-Marketing CampaignGlobal Tobacco Controlplus iconAbout Global Tobacco Surveillance System (GTSS)GTSSDataThe Global Adult Tobacco Survey (GATS) AtlasHelp & Glossaryplus iconGlossaryData and DocumentationUsing the GTSSData HomepageUsing the GTSSData Explorer PageContact UsMultimedia & Toolsplus iconMedia Campaign Resource Center (MCRC)Publication Catalog To receive email updates about Smoking & Tobacco Use, enter your email address: Email Address			What's this				Submit
 Tips From Former
Smokers®
Division of Cancer
Prevention and Control
Lung Cancer
National Comprehensive
Cancer Control Program
Division of Reproductive
Health
 Facebook
Twitter
YouTube


About CDC
					Contact Us
					800-232-4636
 Facebook Twitter Instagram LinkedIn Youtube Pinterest Snapchat
 CONTACT CDC
				Contact Us
							Call 800-232-4636
							Email Us
			ABOUT CDC
				About CDC
							Jobs
							Funding
			POLICIES
				Accessibility
							External Links
							Privacy
							Policies
							No Fear Act
							FOIA
							OIG
							Nondiscrimination
							Vulnerability Disclosure Policy
			CONNECT WITH US
				Facebook
								Twitter
								Instagram
								LinkedIn
							Youtube
								Pinterest
								Snapchat
								Email
			LANGUAGES
				Español
							繁體中文
							Tiếng Việt
							한국어
							Tagalog
							Русский
							العربية
							Kreyòl Ayisyen
							Français
							Polski
							Português
							Italiano
							Deutsch
							日本語
							فارسی
							English


U.S. Department of Health & Human Services
			Accessibility
			External Links
			Privacy
			Policies
			No Fear Act
			FOIA
			Nondiscrimination
			OIG
			Vulnerability Disclosure Policy
			USA.gov


Exit Notification / Disclaimer Policy Close
 Links with this icon  indicate that you are leaving the CDC website. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.
				Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
				You will be subject to the destination website's privacy policy when you follow the link.
				CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Website Disclaimers
 Cancel Continue