Smoking and mental health - NCSCT

Smoking and mental health
dependent, almost two-thirds (63%) had a drug dependency, 35% had a
diagnosed severe mental disorder, and undiagnosed and untreated anxiety and
depression were highly prevalent. 104 A study of homeless people aged 16–21
years revealed that over 60% met diagnostic criteria for post-traumatic stress
disorder, and that over a third had made at least one suicide attempt at some
point in their lives. 105 Other evidence suggests that mental disorders are strong
determinants of homelessness, particularly for personality disorder, which may
occur in up to 60% of the homeless population. 106
7.4.3 Smoking and homelessness
The prevalence of smoking in the homeless population is also extremely high. A
national audit of more than 700 homeless people in England identified an
overall prevalence of 77%, 107 whereas an earlier UK study found smoking rates
of 93% among homeless young people aged 16–19, and 96% in 20–24 year
olds. 108 Homeless people who smoke also tend to smoke more cigarettes, to have
started smoking at a younger age and to have smoked for longer than smokers
in the general population. 109 Smokers among homeless people are more likely to
be male, to have spent some of their childhood in care, to have dropped out of
school, to be unemployed, to have been victimised, and to be dependent on
alcohol or other drugs. 110,111 Similarly high smoking prevalence estimates have
been reported among homeless people in the USA, 110–112 where the tobacco
industry has marketed cigarettes specifically to homeless and seriously mentally
ill individuals as susceptible and vulnerable consumer groups, and in this
context has developed relationships with homeless shelters and advocacy
groups. 113
7.4.4 Excess mortality and health service use among homeless people
Homelessness is associated with substantially increased morbidity and mortality.
Homeless people in the UK make around four times more use of acute hospital
services than the general population, and eight times more use of inpatient
health services than the equivalent general population. 99 The average age at death
among those who remain homeless is 40–44 years. 99 This high morbidity and
mortality are attributable to a spectrum of health problems including alcohol
abuse, illicit drug use and mental illness; however, it includes a substantial
component of diseases caused directly by smoking, including ischaemic heart
disease, and lung and other cancers. 114 As for the general population, smoking in
homeless people is the largest single cause of premature death. Ill-health in
homeless people is further exacerbated by poor access to and uptake of health
services; homeless people in the UK are 40 times less likely than the general
population to be registered with a general practitioner. 99
144 © Royal College of Physicians 2013