Smoking and mental health - NCSCT

Population strategies to prevent smoking in mental disorders 6
Follow-up studies of English mental health trusts 4 years after implementation
of smoke-free policy suggest that the opportunity to use the policies as a driver
of health promotion is being widely missed. Policy enforcement in mental health
trusts is often deficient, with blanket exemptions being granted frequently to all
smokers, and inadequate support from staff to address tobacco dependence
among patients. 75,78 A recent assessment in a large mental health trust in
England revealed that, despite a newly acquired focus on physical health, 82
addressing smoking was still a marginalised issue and not integrated into care
pathways or standard procedures and documentation. 83
6.3.2 Media campaigns
Evidence on the effect of mass media campaigns on smokers with mental
illness is limited. One Australian study of 89 patients with schizophrenia 84
found that mass media campaigns did not appear to impact on smoking
behaviour or intentions to quit in this group, and the authors suggested that
tailored approaches taking into consideration specific barriers experienced
to quitting may be more appropriate. The study also suggested that antismoking
media campaigns may be less effective in marginalised populations in
general, such as those of lower educational status and socioeconomic status,
and those who are unemployed. 84 These findings are in line with suggestions
indicating that public health campaigns to raise awareness of and prevent
sudden infant death syndrome had less effect in people with mental disorders
than in the general population, and implying that targeted approaches may be
needed. 85
6.3.3 Health warnings, advertising and sponsorship
We are not aware of any studies that have explored the effectiveness of health
warnings, or relative impact of prohibition of advertising and sponsorship, in
subpopulations of people with mental disorders.
6.3.4 Price and illicit supply
A US empirical modelling study suggests that mental disorders increase
participation in the consumption of addictive goods but does not have
substantive effects on price elasticity, and therefore that increasing the price of
tobacco through tax is likely to be an effective means of influencing behaviour
among mental health populations. 86 We are not aware of any British studies of
this effect. Prevention of illicit supply of tobacco, which undermines tax
measures, is likely to be effective because the most disadvantaged smokers, who
© Royal College of Physicians 2013 119