美国国立卫生研究院Wilson M. Compton团队研究了2006-2019年患有严重抑郁或物质使用障碍的美国成年人的吸烟流行趋势。相关论文于2022年4月26日发表在《美国医学会杂志》上。

烟草的使用高度集中于精神病患者。

研究组使用具有全国代表性的数据，评估过去一年有抑郁症、物质使用障碍（SUD）、两者都有或都没有的成年人在过去一个月的吸烟流行趋势。他们基于558960名年龄在18岁及以上、参与2006-2019年美国全国药物使用和健康调查的个人数据进行了一项探索性、系列、横断面研究。使用《精神障碍诊断和统计手册》（第四版）标准，对过去一年的重度抑郁发作（MDE）和SUD进行评估。主要结局是上个月自我报告的吸烟情况，并根据社会人口特征进行校正。

2006-2019年，成人MDE患者中过去一个月的自我报告吸烟率显著下降，从37.3%降至24.2%，年均变化率为−3.2%；在成人SUD患者中从46.5%降至35.8%，年均变化率为−1.7%；在同时患MDE和SUD的成年人中从50.7%降至37.0%，年均变化率为−2.1%。

MDE和SUD患者的各年龄、性别、种族和民族亚组的吸烟率均显著下降，但患有MDE或SUD的美洲印第安人或阿拉斯加土著成年人没有显著变化。有和没有MDE的成年人之间吸烟率差异总体上亦显著下降，从11.5%降至6.6%，年均变化率为−3.4%；男性、女性、18至25岁的人群、50岁及以上的人群、西班牙裔群体以及白人群体的年均变化率亦显著下降。

对于美洲印第安人或阿拉斯加土著成年人，在2006-2012年间，有和没有MDE的人群之间吸烟率没有显著差异，但在2013-2019年间，有MDE的人群吸烟率显著高于无MDE的人群。有SUD和无SUD的女性群体之间吸烟率差异下降，年均变化率为−1.8%。

研究结果表明，2006-2019年间，患有重度抑郁发作、药物使用障碍或两者兼有的美国成年人中，自我报告的吸烟率显著降低。但仍需继续努力将吸烟率降至更低。

附：英文原文

Title: Trends in Prevalence of Cigarette Smoking Among US Adults With Major Depression or Substance Use Disorders, 2006-2019

Author: Beth Han, Nora D. Volkow, Carlos Blanco, Douglas Tipperman, Emily B. Einstein, Wilson M. Compton

Issue&Volume: 2022/04/26

Abstract:

Importance  Tobacco use is highly concentrated in persons with mental illness.

Objectives  To assess trends in past-month prevalence of cigarette smoking among adults with vs without past-year depression, substance use disorders (SUDs), or both, using nationally representative data.

Design, Setting, and Participants  Exploratory, serial, cross-sectional study based on data from 558960 individuals aged 18 years or older who participated in the 2006-2019 US National Surveys on Drug Use and Health.

Exposure  Past-year major depressive episode (MDE) and SUD using Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) criteria.

Main Outcomes and Measures  Past-month self-reported cigarette use, adjusted for sociodemographic characteristics.

Results  Of the sampled 558960 adults, 41.4% (unweighted) were aged 18 to 25 years, 29.8% (unweighted) were aged 26 to 49 years, and 53.4% (unweighted) were women. From 2006 to 2019, the past-month self-reported cigarette smoking prevalence declined significantly among adults with MDE from 37.3% to 24.2% for an average annual percent change of 3.2 (95% CI, 3.5 to 2.8; P<.001), adults with SUD from 46.5% to 35.8% for an average annual percent change of 1.7 (95% CI, 2.8 to 0.6; P=.002), and adults with co-occurring MDE and SUD from 50.7% to 37.0% for an annual average annual percent change of 2.1 (95% CI, 3.1 to 1.2; P<.001). The prevalence declined significantly for each examined age, sex, and racial and ethnic subgroup with MDE and with SUD (all P<.05), except for no significant changes in American Indian or Alaska Native adults with MDE (P=.98) or with SUD (P=.46). Differences in prevalence of cigarette smoking between adults with vs without MDE declined significantly for adults overall from 11.5% to 6.6%, for an average annual percent change of 3.4 (95% CI, 4.1 to 2.7; P<.001); significant average annual percent change declines were also seen for men (5.1 [95% CI, 7.2 to 2.9]; P<.001); for women (2.7 [95% CI, 3.9 to 1.5]; P<.001); for those aged 18 through 25 years (5.2 [95% CI, 7.6 to 2.8]; P<.001); for those aged 50 years or older (4.7 [95% CI, 8.0 to 1.2]; P=.01); for Hispanic individuals (4.4 [95% CI, 8.0 to 0.5]; P=.03), and for White individuals (3.6 [95% CI, 4.5 to 2.7]; P<.001). For American Indian or Alaska Native adults, prevalence did not significantly differ between those with vs without MDE during 2006-2012 but was significantly higher for those with MDE during 2013-2019 (difference, 11.3%; 95% CI, 0.9 to 21.7; P=.04). Differences among those with vs without SUD declined for women for an average annual percent change of 1.8 (95% CI, 2.8 to 0.9; P=.001).

Conclusions and Relevance  In this exploratory, serial, cross-sectional study, there were significant reductions in the prevalence of self-reported cigarette smoking among US adults with major depressive episode, substance use disorder, or both, between 2006 and 2019. However, continued efforts are needed to reduce the prevalence further.

DOI: 10.1001/jama.2022.4790

Source: https://jamanetwork.com/journals/jama/article-abstract/2791406