Cigarette smoking and serious psychological distress: a population-based study of California adults

This study examines differences in smoking behaviors between adults with and without serious psychological distress (SPD) in California, which has the longest running comprehensive tobacco control program in the world.

Cross-sectional data from the 2007 California Health Interview Survey on 50,880 noninstitutionalized adults were used to analyze smoking prevalence, cigarette consumption, and quit ratio. Persons with SPD were identified using the K6 scale, a clinically validated psychological screening instrument.

About 3.8% of California adults screened positive for SPD in the past 30 days (acute SPD) and an additional 4.8% screened positive for SPD in the past 2-12 months (recent SPD). Persons with SPD were more likely to be current smokers than those without SPD (adjusted odds ratios [AOR] = 2.54, 95% CI = 2.02-3.19 for acute SPD and AOR = 2.20, 95% CI = 1.79-2.71 for recent SPD). Current smokers with acute SPD were more likely to smoke ≥20 cigarettes daily than those without SPD (AOR = 1.59, 95% CI = 1.06-2.39). The quit rate was lower among ever-smokers with acute (AOR = 0.46, 95% CI = 0.35-0.62) or recent SPD (AOR = 0.55, 95% CI = 0.42-0.71) than those without SPD. While persons with acute or recent SPD comprised 8.6% of adults, they consumed 19.2% of all cigarettes in California.

In California, adults with SPD were more likely to be current smokers and to smoke heavily and less likely to quit than those without SPD. The findings underscore the need for effective smoking cessation strategies targeting this group.