Smoking among patients in substance use disorders treatment: Associations with tobacco advertising, anti-tobacco messages, and perceived health risks.

Although tobacco control efforts have contributed to an overall decline in smoking, individuals with substance use disorders (SUDs) continue to smoke at high rates and remain targets of advertising to vulnerable groups, including those with mental health disorders and SUDs. This study examined associations of tobacco advertising exposure and receptivity, anti-tobacco messages awareness, and health-risk perception with smoking status and cigarettes-per-day (CPD) in a national sample of SUD treatment patients. The patients (N=1,113) in 24 programs chosen randomly, stratified by program type, from among publicly funded adult treatment programs within the National Drug Abuse Treatment Clinical Trials Network completed surveys of smoking, advertising exposure and receptivity, anti-tobacco message awareness, and perceived health risks.

Current smokers (77.9% of the sample) smoked a daily median of 10 cigarettes (IQR = 13). The participants reporting daily advertising exposure were 1.41 times more likely to be smokers (p=0.019) than others. Those highly receptive to advertising were 2.34 times more likely to be smokers (p < 0.001) than those with low/moderate receptivity. Higher perceived health risk was associated with lower odds of smoking (OR = 0.99, 95% CI: 0.98–0.99, p < 0.001). CPD for smokers highly receptive to advertising was 11.1% (95% CI: 2.8%–20.0%) higher than for smokers with low-moderate advertising receptivity. Anti-tobacco message awareness was not associated with smoking status or CPD.

Conclusions: This study is the first to examine associations of tobacco advertising and anti-tobacco messaging with smoking in a large, national sample of SUD patients, a vulnerable, high-smoking population. The high rate of smoking among SUD patients is associated with daily exposure and high receptivity to tobacco advertising and lower perception of health-related smoking risks. Tobacco control efforts should target this vulnerable population. Finally, these results support the intent of the Tobacco Control Act to further restrict tobacco advertising, and make it clear that tobacco-use assessment and cessation treatment should be standard practices in SUD treatment programs.