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Economic impact of smoking for persons with mental disorders

Institution: University of California, San Francisco
Investigator(s): Hai-Yen Sung, Ph.D.
Award Cycle: 2009 (Cycle 18) Grant #: 18XT-0092 Award: $246,701
Subject Area: Tobacco-Use Prevention and Cessation
Award Type: Exploratory/Developmental Award

Initial Award Abstract
California’s Tobacco Control Program has led to substantial declines in cigarette consumption and smoking prevalence. Adult smoking prevalence rate declined from 22.7% in 1988 to 14.0% in 2005. Nonetheless, approximately 3.8 million adults in California continued to smoke as of 2005. To further reduce the smoking epidemic, we need anti-smoking interventions that target the sub-populations who still have relatively high smoking rates. Persons with mental illness comprise the largest, most vulnerable, and yet understudied group of smokers. They have been shown to account for a disproportionately large proportion (about a third) of current smokers in the United States, consuming about 44% of cigarettes sold here. The association between smoking and mental disorders is a new area of research. While recent literature has begun to examine the prevalence of tobacco use among the mentally ill in the United States, little has been done in the California population. Furthermore, little is known about the impact of smoking on the healthcare cost and productivity losses among this vulnerable group.

The objective of this study is to examine the smoking behavior and estimate the economic burden of smoking among California adults who have mental disorders. Persons with mental disorders will be identified by using the K6 scale, a measure based on six self-reported questions about serious psychological distress. This study has three specific aims.

Aim 1. To determine the number and prevalence of mentally ill Californians who are current smokers, daily smokers, and former smokers. We will also examine their average number of cigarettes smoked per day. Analysis will be done separately for males and females, and for Hispanics, Asians, African Americans, and other Californians.

Aim 2. To estimate the excess health care costs attributable to smoking among mentally ill adults. Four types of health care costs will be analyzed: hospitalizations, ambulatory care, prescription drugs, and home health care. Per person and total state costs will be estimated. We will test whether current or former smokers incur higher annual health care costs compared with never smokers. We will also examine whether the excess health care costs are mainly attributed to treatment for smoking-related diseases, mental health specialty care, or other care.

Aim 3. To estimate the value of productivity losses due to smoking-related diseases among mentally ill adults. Three measures of productivity losses will be considered: work loss days, bed disability days, and lost earnings. Per person and total state values will be estimated.

We hypothesize that persons with mental illness will be more likely to smoke and that mentally ill smokers are more likely to be daily smokers and consume more cigarettes compared to persons without mental illness. We also hypothesize that mentally ill smokers will incur excess health care costs and greater productivity losses than non-mentally-ill smokers.

Aim 1 will be estimated using the California Health Interview Survey data. In Aims 2-3, econometric models of the impact of smoking on health care cost and productivity losses will first be estimated using the linked National Health Interview Survey and Medical Expenditure Panel Survey data. The estimated parameters will then be applied to the California Health Interview Survey data to derive California-specific estimates.

This study will provide the first population-based estimates of smoking prevalence in California and the first comprehensive assessment of the economic burden of smoking among persons with mental disorders. The findings from this study will provide useful information for tobacco control policymakers, public health legislators, and mental health providers to enhance their efforts towards incorporating smoking cessation interventions in the treatment for mental illness.