Ever smoking prevalence and duration of abstinence as a function of mental health and psychological distress: population surveys in Great Britain

Introduction It is important to investigate whether declines in smoking initiation with age are less pronounced among people with mental health problems than among those without. If smoking is used to cope with new mental health symptoms, initiation may occur at older ages in this group. Methods Using cross-sectional data from 29 845 adults aged 16-45 in Great Britain (surveyed October 2020–June 2023), we examined whether associations between age and i) ever smoking prevalence and ii) length of abstinence (among those who quit >1 year ago; n = 4315) differed by past-month psychological distress or history of a mental health condition (MHC). Results Approximately half of those reporting distress (46.5% [95%CI = 45.5-47.5]) or history of a MHC (52.2% [51.1-53.2]) had ever smoked, compared with one-third of those without (35.1% [34.2-35.9] and 32.6% [31.8-33.4], respectively). Ever smoking prevalence was higher among those with mental health problems across all ages and increased more steeply between ages 16-25 among those reporting distress before plateauing. Among former smokers, mean abstinence was shorter with distress (6.8 [SD = 5.5]) or history of a MHC (7.1 [5.6]) than without (8.0 [5.9] and 7.9 [5.9], respectively), though age-related increases in abstinence duration were similar. Conclusions Ever smoking prevalence was consistently higher in people with mental health problems and may have increased more steeply in early adulthood among those with past-month distress. Age-related abstinence patterns were similar, but those with mental health problems had shorter average abstinence durations. Patterns may reflect higher initiation rates earlier in life and greater relapse, rather than later initiation. Implications Smoking prevention and cessation efforts in Great Britain should prioritize people with mental health problems, among whom smoking remains more prevalent and durations of abstinence are shorter. The concentration of smoking initiation before age 30 underscores the importance of interventions during young adulthood, and the potential for the smoke-free generation policy to reduce the burden of smoking in this priority group.