Disparities in Smoking and Vaping Prevalence Among People With Mental Health Conditions in England

Background: Diseases and death from smoking are substantially higher among people with mental health conditions(MHC) than people without. Vaping can help people quit smoking, but little is known about vaping among people with MHCs. We report the prevalence and characteristics of smoking and/or vaping among those with and without a history of a single or multiple MHC diagnoses.

Methods: Data from 27,553 adults collected between 2020-2022 using representative household surveys. Multinomial regressions, adjusted for age, sex and socioeconomic status, analysed associations between history of a single or multiple MHC(s) (vs no MHCs), and smoking/vaping/dual prevalence, smoking/vaping characteristics.

Results: Smoking prevalence was higher among those with a history of multiple MHCs (26.3%, AOR=2.51,95%CI=2.28-2.75,p<.001) or a single MHC (16.6%, AOR=1.62,95%CI=1.46-1.81,p<.001) than no MHCs (12.0%). People with one or multiple MHCs were more likely to smoke roll-your-own cigarettes, smoke more cigarettes per day and smoke within 5 minutes of waking, than those without MHCs. Those with multiple MHCs were more likely to be daily smokers. Vaping prevalence was higher among those with a history of multiple MHCs (13.8%, AOR=1.66,95%CI=1.47-1.87) or a single MHC (7.9%, AOR=1.28,95%CI=1.11-1.48,p=.001), than no MHCs (5.1%). There were no associations between heaviness of vaping, nicotine concentration, device type, use of non-nicotine e-liquids and a history of MHCs. Among those who vaped and/or smoked, dual use was higher among people with a history of multiple MHCs (21.9%, AOR=1.25,95%CI=1.01-1.56; p=.042), but not with a single MHC (16.3%, AOR=1.04,95%CI=0.79-1.36,p=.790), compared to no diagnosis (15.5%).

Conclusion: Smoking was substantially higher among those with a history of MHCs, especially multiple MHCs. Those with MHCs were heavier smokers with greater dependene on smoking. Although vaping was substantially higher among those with a history of MHCs, dual use was also higher. Supporting these individuals to transition to exclusive vaping may help reduce inequalities in smoking-related morbidity and mortality.