| Summary: | Introduction
People with severe mental illness (SMI) tend to die early due to
cardiovascular and respiratory diseases, which may be linked to tobacco use.
There is limited information on tobacco use in people with SMI in low- and
middle-income countries where most tobacco users reside. We present novel data
on tobacco use in people with SMI and their access to tobacco cessation advice
in South Asia.
Methods
We conducted a multi-country survey of adults with SMI attending
mental health facilities in Bangladesh, India, and Pakistan. Using data collected
with a standardized WHO STEPS survey tool, we estimated the prevalence and
distribution of tobacco use and assessed receipt of tobacco cessation advice.
Results
We recruited 3874 participants with SMI; 46.8% and 15.0% of men and
women consumed tobacco, respectively. Smoking prevalence in men varied by
country (Bangladesh 42.8%, India 20.1% and Pakistan 31.7%); <4% of women
reported smoking in each country. Smokeless tobacco use in men also varied
by country (Bangladesh 16.2%, India 18.2% and Pakistan 40.8%); for women,
it was higher in Bangladesh (19.1%), but similar in India (9.9%) and Pakistan
(9.1%). Just over a third of tobacco users (38.4%) had received advice to quit
tobacco. Among smokers, 29.1% (n=244) made at least one quit attempt in the
past year. There was strong evidence for the association between tobacco use and
the severity of depression (OR=1.29; 95% CI: 1.12–1.48) and anxiety (OR=1.29;
95% CI: 1.12–1.49).
Conclusions
As observed in high-income countries, we found higher tobacco use
in people with SMI, particularly in men compared with rates reported for the
general population in South Asia. Tobacco cessation support within mental health
services offers an opportunity to close the gap in life expectancy between SMI
and the general population.
STUDY REGISTRATION
ISRCTN88485933; https://doi.org/10.1186/ISRCTN88485933 39
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