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Schizophrenia Bulletin Advance Access first published online on November 5, 2007
This version published online on February 19, 2008
Schizophrenia Bulletin, doi:10.1093/schbul/sbm117
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© The Author 2007. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org.

Tobacco Use Among Individuals With Schizophrenia: What Role Has the Tobacco Industry Played?

Judith J. Prochaska1,2, Sharon M. Hall2 and Lisa A. Bero3
2 Department of Psychiatry, University of California, San Francisco
3 Department of Clinical Pharmacy and Institute for Health Policy Studies, University of California, San Francisco

1 To whom correspondence should be addressed; University of California, San Francisco, 401 Parnassus Avenue, TRC 0984, San Francisco, CA 94143-0984; tel: 415-476-7695, fax: 415-476-7719, e-mail: JProchaska{at}ucsf.edu.

Rates of tobacco use among individuals diagnosed with schizophrenia have been estimated as high as 80%. A variety of hypotheses have been proposed to explain the high rate of tobacco use among this vulnerable group. This study examined the tobacco industry's efforts to establish and promulgate beliefs about schizophrenic individuals’ need to smoke and the hazards of quitting. The current study analyzed previously secret tobacco industry documents. The initial search was conducted during January–July 2005 in the Legacy Tobacco Documents Library. The search yielded 280 records dating from 1955 to 2004. Documents indicate the tobacco industry monitored or directly funded research supporting the idea that individuals with schizophrenia were less susceptible to the harms of tobacco and that they needed tobacco as self-medication. The tobacco industry promoted smoking in psychiatric settings by providing cigarettes and supporting efforts to block hospital smoking bans. The tobacco industry engaged in a variety of direct and indirect efforts that likely contributed to the slowed decline in smoking prevalence in schizophrenia via slowing nicotine dependence treatment development for this population and slowing the rate of policy implementation vis-à-vis smoking bans on psychiatric units.

Keywords: nicotine / smoking / cigarettes / psychiatry / mentally ill / tobacco companies

Citation #77 under "Funded External Research" has been deleted and the citation numbering has been updated.


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