Smoking: Analyzing the Effects on the Physical Health of Adults with Mental Illness

Smoking: Analyzing the Effects on the Physical Health of Adults with Mental Illness

The smoking of tobacco has consistently continued to be a major issue among adults with mental illness. Tobacco smoking has recently been identified as one of the greatest causes of preventable illness and premature deaths in the UK (DH, 2015). The review of current literature on smoking among adults with mental illness has revealed a significant concern affecting public health (relevant to Mental Health Nursing) and to identify areas for service improvement. According to the World Health Organisation’s (WHO) definition of Public Health, it refers to all standardized measures intended to prevent diseases, promotes health and prolongs life of the population (WHO, 2016). It is concerned with threats to health based on population analysis.

This alongside public health promotion supports the notion that upholding the well-being of the public is vital for the public to enjoy good health. A literature review, on the other hand, can be defined as a critical synopsis of research studies and other works, which offer insights into the research problem and help to put it in context (Coughlan et al., 2013). This academic task is now considered an important aspect of nursing training as it helps nurses to acquire the skills of interpreting research findings. As a result, this literature review was undertaken with the aim of investigating the most consistent evidence to improve understanding and to provide an answer to the key Public Health question “Does smoking have any effect on the physical health of adults with mental illness?” The aim was to study the evidence to establish how smoking cigarette affects the physical health of adults with mental illness. The Department of Health (DH) and the World Health Organisation (WHO) as a public health issue have recognized the impact of tobacco smoking.

Research Objective

The main aim of this research is to find out the last relationship between mental illness and smoking habits. The study also seeks to find out better ways in which to deal with the mental illness issue regarding smoking habits. It intends to pay much attention to the methods that can be used effectively to combat the mental diseases that are brought about by smoking. The paper seeks to find better answers and explainable solutions to the issue of mental illness. In addition, the paper also intends to find better ways in which to distribute the information on the health hazards that smoking causes especially on the mental conditions of a person. This paper also intends to find the best suitable method to mobilize the public in general to spread the news on better healthy habits, in particular for the mentally ill, that will help them in maintaining their health status and helping them to avoid smoking as well. This will promote the socio-economic conditions of the individuals and the society as a whole.
The recent publication of the Public Health White Paper Healthy Lives, Healthy People: Our strategy for public health (DH, 2011) recognizes the devastating impact the use of tobacco has on public health in the communities. WHO (2016) acknowledges the use of tobacco among adults as one of the leading risk factors for some chronic diseases like cardiovascular disease, lung disease, and some cancers. This has prompted some countries including the UK to pass laws limiting its advertisement, regulating who buys it as well as where it can be smoked.

The risks associated with smoking tobacco has been acknowledged by WHO as an epidemic and one of the biggest public health threats ever witnessed in the world (WHO, 2016). In the UK it is estimated that 19% of adults representing one in five adults were smokers in 2013 (OLS, 2013) and was more prevalent among adults with mental illness (ASH, 2016). There are approximately 3 million smokers in the UK with mental health a condition (ASH, 2016) and nearly half are expected to die from a smoking related illness (DH,2015). The introduction of laws in 2008 to make all mental health facilities in England smoke-free buildings acknowledges the risks associated with and the need for smoking to be addressed as a public health issue.

The rationale for choosing the subject was based on several observations made by the author. First, the general acknowledgment that smoking-related illnesses and diseases have led to an increase in the total health cost of the National Health Service in England (HSCIC, 2016). The cost of treating smoking-related illnesses among people with mental health conditions in primary and secondary care is estimated to cost the NHS around £720m per year (ASH, 2016). The cost to the NHS arises from GP consultations, prescriptions for drugs and various cost related to treating smoking-attributable diseases.

A further rationale for the choice of subject arose from the fact that people suffering with mental disorders tend to experience shorter life span than the general population. On average, it is estimated that people with schizophrenia can expect to live for ten years less than someone without a mental health problem (Brown et al, 2010) as death from poor physical health remains a common cause. Higher smoking rates among people with severe mental illness result in increased levels of morbidity and premature mortality.
Finally, the experience of working with people suffering from the severe mental illness from my community placement left a lasting impression on my mind. During this time, I realized almost all the patients we dealt with in the community had the habit of smoking cigarette regularly and kept wondering whether the smoking had any link with their mental health. Further interactions with some of the patients revealed that they all seemed to have started smoking at a very early age and have never thought of giving up smoking despite all the education they receive on the dangers of smoking cigarette from the health professionals.

Because of this experience, I was left with looking for answers to questions such as: Why do most patients smoke a cigarette? Does smoking Cigarette affect their mental health? How does smoking impact on their physical health? How best can smoking be reduced among adults with mental illness? Answers to some of these questions will be reached after reviewing the current literature on the topic.

The National Mental Health Strategy, No health without mental health, has as one of its objectives, for people suffering from mental health problems to enjoy good physical health. The strategy recognizes smoking to be responsible for most of the excess mortality of people with severe mental health problems and seeks to see fewer people with mental disorders dying prematurely.

Governments have a responsibility for health promotion and preventative action from a societal level to a community level (DoH, 2011). As a result, Governments, National Institute for Health and Care Excellence (NICE), and providers of health care are confronted with a vast responsibility of working alongside each other and providing effective evidence-based interventions. These are used to address the challenges that smoking among adults with mental illness brings to our health care system (NICE 2005, DoH 2011).

Research Methodology

The research involved an extensive and broad analysis of electronic literature search to assess the breadth and the depth of the writing as well as to identify any consistent key themes that could emerge. Several titles, as well as abstracts, were also reviewed for relevance and all the abstracts that were unavailable or incomplete with the title of the paper being significant in the full article was extracted. An exploration of several databases such as Pubmed, Cinahl, and Psych articles was done in handy through inputting keywords and phrases into the search engines. Smoking and its effects on human health, depression in young people, and the psychological and physical impact of smoking, implications of smoking among many others were all reviewed from these articles.

Relevant publications from WHO, DoHand other Government websites were searched alongside policies such as Nice Guidelines for prevention and management of habitual smoking. A Google search engine was conducted using the term “effects of smoking on the physical health of adults with mental illness” After assessing the number of hits the search was narrowed for any relevant material. Research articles and peer reviews directly pertinent to the public health question was included in handy. With criteria involving reception class at adult ages. Literature that only looked at the causes of smoking at the expense of its effects on the health of adults with mental illness was thus excluded.

The research defined them as adults and for the purpose of this literature review; they will be referred to as mentally ill adults. All data was collected in an organized and structured way to identify consistencies related to the search. By drawing on the relevant publications and literature, themes began to emerge.

Qualitative research normally has no statistics or measurements. Instead, words, quotes, as well as descriptions are used to explore meaning and focus on feelings and experiences (Miller, 2010). It is, therefore, useful to remember that the objective of the qualitative research is not necessarily how much material is gathered, but also rather gaining a sound knowledge base and increased understanding of the research matter (Sandelowski, 2003).

On the contrary, quantitative methods use highly controlled approaches that typically contain “hard” statistics, numbers and secure structured data that are usually considered invaluable when it comes to measuring a person’s behaviors, attitudes, and ways of thinking (Shields and Twycross 2003).

Literature Review: Analysis of Smoking among Mentally Ill Patients. Prevalence

The first theme emerging was the prevalence of smoking and its effects. Globally, either directly or indirectly affect an estimated 120 million adults, as well as young people, are said by habitual smoking (WHO, 2012). Adulthood tobacco use and its effects have severe complications on mental and physical wellbeing creating overwhelming feelings of hopelessness among people.

It is estimated that in the United Kingdom 37,000 cases of mental illness results from smoking behavior (NICE, 2005). In England, nausea, as well as brain damage, is commonly measured by using British 1990 Growth Reference Charts recommended. The chart was recommended by NICE (2006), and it takes into account gender and age of the affected population (McPherson et al., 2007). An individual is classed as smoker when the blood nicotine content exceeds the 34th percentile (McPherson et al., 2007)

DSM-IV Depression and brain development criteria include any of the following three symptoms, which can cause significant distress or impairment in the functioning of the mind and must be present over a two-week period; depressed mood, fatigue as well as a lack of energy, feelings of guilt senseless and worthlessness. Recurrent suicidal ideas and several variations in sleep patterns as well changes in the appetite of the smoker. Diagnosis is frequently confirmed based on one criterion that must consist of depressed or high blood nicotine content (Diagnostic and Statistical Manual of Mental Disorders, 2013).

Results from the National Child Measurement Programme (NCMP) (2011) reported that almost 56% of schoolchildren aged 10-17 and nearly 51% of adults aged 18-38 experiences severe problems related to smoking. Without any positive intervention, these figures are highly likely to increase. It is estimated nationally that by 2020, nearly 70% of adult people will be smokers should the present trend remains prevalent (McPherson et al., 2007).Current evidence from the Millennium Cohort Study suggests that smoking during the adulthood, childhood as well as young ages is responsible for mental health problems and represents a significant risk for developing low self-esteem, reasoning disorders, body dissatisfaction as well as depressive symptoms (Griffiths et al., 2011).

More so, several longitudinal studies conducted by Luppino (2010) reported that adulthood smoking are closely related to several physical health problems including hypertension, diabetes, heart as well as lung diseases (NICE, 2009). In support of these findings, quantitative studies in the Journal of Pediatrics concluded significantly that smoking persons have high chances of developing high blood pressure and lung cancer, both of which presented as significant risks for CVD (Freedman et al., 2007). Furthermore, it has been estimated that at least 68% of smokers carried a risk factor for CVD whilst nearly 32% had at least two (Freedman et al., 2007). Nice guidelines suggest that individuals suffering from a chronic physical illness such as diabetes or CVD are identified early and prioritized for the screening of hypertension (NICE, 2009). The National Smoking and Drug consumption Observatory (2011) reported that in 2008 direct costs to the NHS for treating lung cancer including the related morbidities were in the region of £5.7 billion, which equates to around 8% of the NHS Budget.

Due to rapid increases in the number of adult smokers who present as notorious smokers and the co-morbidities that accompany this problem, smoking is now thought to be one of the greatest challenges to public health in the 21st century (WHO, 2009). Substantial evidence suggests there is a high risk of the related behavioral and psychological problems including poor self-worth, anxiety and depression continuing into adulthood (Nice, 2006; NOO, 2011; Griffiths et al., 2011). On the other hand, adulthood symptoms may increase the risk of becoming a smoker at a later stage (Markowitz et al., 2008; Liem et al., 2008; Ternouth, 2009). In a report published by WHO (2008) depression was branded the top cause of disability in the USA and the third largest in Europe, falling behind to CVD and stroke (WHO, 2008).

There are limitations to the research on the prevalence of smoking habits, and the way growth charts measure it. Although it is a commonly used method in the UK, it is worth noting that it does not take into account health status of the smoker hence the measures may not be much accurate (Centre for Disease Control, 2013). Moreover, the correlation between smoking and health differs with age, race and ethnicity(CDC, 2013).It would appear that to calculate the smoking effects accurately; several case studies and points should be included to reflect the variables in the different cultures would be highly useful (Madden, 2013).

Effects of Smoking on Physical Health of Adults with Mental Illness

Several pieces of evidence from the literature searches suggests that adult smokers are faced with acute reductions in the quality of the life that they live and consequently suffer the health consequences initiated by negative stereotyping, associations as well as teasing from peers around them.(Koplan et al., 2005; Calamaro and Waite, 2009). A population-based study by Sjoberg et al., (2005) investigated smoking and its relationship with the health of the individual smoker especially in the context of mental fitness in a mixed gender school aged children and adult school consecutively. Being undertaken on a large cohort sample of 500 adults who were aged 18-28, the study considered the self-reported mental status and functioning of the smoking individuals.

The study found that adult people do not feel stigmatized and embarrassed when smoking as compared to the adolescent and young group of persons. In addition, the category of adults was with such smoking characteristics were duly excluded from activities with peers and left feeling socially isolated and lonely. Furthermore, they often felt rejected for their low economic status, leading to feelings of guilt and shame.

Although this evidence has the advantage of a larger sample size, weaknesses are surrounding the self- reporting of smoking impacts which trusted the adult smokers’ perceptions of whether they thought they were smokers in reality or not. This could have led to over reporting or under reporting of smoking behavior. Furthermore, it did not make allowances for those who were already diagnosed with effects of smoking or suffering various episodes as well as those who consequently could have responded to the questions with more negativity on their minds. This could have produced flaws in the results and overestimation of impacts amongst the population that was being studied. Other research reports how smoking linked to social deprivation is and that the health of the smokers, both active and passive being exposed to poor environments is often associated with social exclusion and teasing, causing low living standards as well as heightened symptoms (McCullough et al., 2009). Likewise, similar findings suggest that for smoking adult persons at a social and economic disadvantage, this promotes derogatory remarks and torment from others, which can make them feel like victims while exposing them to the emotional scars of verbal and physical abuse (Janssen et al., 2004).

Similarly, a study by Doutre and Mansfield (2010) looked at children’s views towards smoking through identification of influences and mediating factors that affected mental well-being. The preferred method of research was in the form of semi-structured interviews. Areas with high levels of poverty were chosen as those who presented with a low social and economic status were linked to increased prevalence rates of smoking (Parsons, 2006). Applicants were between 9 and ten years of age and selected from families who gave written permission for their child to take part. From the 40 individual letters that were sent to parents, only 13 expressed an interest in allowing their child to participate. This could have been down to the shame of the subject matter and the sensitivity surrounding the topic meaning parents may have been reluctant to let their children get involved. The Interview was structured over 25 minutes and comprised of 15 questions that were simple.

The participants consisted of four boys and eight girls who all felt they had experienced functional issues and negative emotional consequences related to their weight. They recognized that hypertension and lung cancer associated with smoking, teasing, and negative attitudes had an impact on their mental well-being and resulted in low self-esteem, feelings of sadness, loneliness, and depression. Furthermore, limited friendship opportunities left them feeling unhappy and socially isolated. Girls experienced negative feelings such as body dissatisfaction, anxiety, and depression while boys experienced worry and unhappiness (Doutre and Mansfield, 2010).

The study presents with limitations due to its small sample size and characteristics and therefore it cannot be assumed that these findings apply to all smokers globally. Furthermore, some of the questions asked such as “measured on a scale of 1-5 how much of a problem do you think being a smoker is for children” could have been a leading question implying that smoking is problematic. In turn, this may have influenced any decisions with synthesized replies especially if the child did not see smoking as a problem before the study. More research involving a broader scope of schools, populations and ages would be useful to make comparisons between the variables.

The study only included children at a social and economic disadvantage and did not take into account other populations or backgrounds. Evidence suggests that parents who support their child and show an acceptance of smoking problems will produce benefits for their child’s mental well-being (Davidson and Birch, 2010; Spear et al., 2007).Findings by Ells (2009) suggest rather than targeting individuals alone without much success; it may be beneficial to provide intervention strategies that include family members, careers, and peers who suffer from similar physical and mental health problems.


Smoking has a broad range of health hazards, especially for the mentally ill patients. A habit that has mostly been associated with mental illnesses includes anxiety, depression, and even schizophrenia. People with a smoking habit often have a great difficulty with and are often exposed to risks of dying of respiratory illnesses, cancer, and other cardiovascular diseases. This is a significant threat to the health of those individuals with a smoking habit since most of them often do not seek medical attention for such conditions. Therefore, in this research, we intend to try to know the relationship between the mental illnesses and smoking habits among the adult population survey.
Mental illness is an ultimate diagnosis that involves a greater degree of judgment that is strongly influenced by cultural, political, and social values. In general, the physical fitness and physical illness are entirely different for those people with Mental illnesses. The general health of individuals with mental illness is worse than that of people with normal mental conditions. Most of those adults with mental conditions and have a smoking addiction often suffer from diabetes, heart diseases, stroke, cancer, arthritis, asthma among other health complications. Individuals who suffer from severe mental conditions often experience a higher heart rate that is above normal. Similarly, those people with schizophrenia have a high rate of chronic obstructive lung illness.


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