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Friends who were former smokers are an important element in helping people with serious mental illness quit smoking.

People with serious mental illness are more likely than the general population to initiate smoking and become addicted, they are also less likely to quit despite many people with serious mental illness being motivated to reduce or stop smoking.

Now, a study from Dartmouth College and Harvard Medical School has found that mentally ill people who underwent treatment to help them stop smoking are more likely to succeed in quitting if they had a former smoker in their social circle. They were also more likely to fit if they had a friendship group that was very close.

“Most smokers with mental illness do not engage in cessation treatment, and quit attempts without treatment are often ineffective. We conducted this study because prior research has shown that social relationships can have a major influence on people’s smoking behaviors, for better and for worse.  It can be hard to quit smoking when everyone around is smoking too.  On the other hand, someone who feels supported is more likely to quit for good,” Kelly Aschbrenner, PhD, lead author and Assistant Professor at The Dartmouth Institute for Health Policy and Clinical Practice, tolf Theravive.

Those with a serious mental illness have a reduced life expectancy, up to 25 years less than the general population. Smoking plays a big role in this gap. 18 per cent of adults among the general population smoke, whilst 53 per cent of those with a serious mental illness like major depression, schizophrenia and bipolar disorder smoke cigarettes.

The researchers were aware from previous studies that those with serious mental illness want to quit smoking, they are less likely to use smoking cessation programs and are less likely to quit. 

In order to determine the role social relationships play in successfully quitting smoking, the researchers asked 41 people with serious mental illness who underwent treatment in smoking cessation programs to categorise their social relationships, including identifying who they spent the most time with during an average week. The participants also named no more than five people who had done anything to influence the participant’s smoking over the past year.

Social contacts listed including romantic partners, coworkers, family members and roommates. The participants were then asked to detail how strong the relationship was and how frequently they had smoked with the relation during the past 12 months. They also identified whether the relation had never smoked, was a current or former smoker and whether they has ever assisted in or hampered the participants efforts to quit smoking in the past.

The researchers found that participants who had someone in their social network who were former smokers decreased the odds that the participant would still be a smoker at the end of a cessation treatment program. As well as this, those who had a friend group considered to be close-knit or tightly connected were more likely to continue abstaining from smoking after they finished treatment.

Having a former smoker in a social circle may be particularly advantageous for those with serious mental illness, who are more vulnerable and more likely to be exposed to situation where there is a higher acceptability of smoking when compared with the general population.

“Social relationships can have a big impact on our health and health behaviors.  Most health care services and treatments are oriented toward the individual with little attention given to how social relationships influence access and adherence to treatments and health outcomes.  Engaging support for quitting smoking from friends and families of persons with mental illness who smoke could dramatically shift engagement and outcomes for this high-risk group of smokers,” Aschbrenner told Theravive.

She says that investigating social networks and their influence on health behaviours and outcomes was essential for designing more effective public health programs and policies aimed at addressing public health concerns like smoking or obesity.

By applying the findings that those with serious mental illness are more likely to quit if they have a former smoker in their social network, Aschbrenner says future cessation treatment programs could be designed more effectively. She says that future programs could teach those experiencing serious mental illness important skills to seek support in quitting from those in their social circles. This would increase their chances of success following the conclusion of treatment programs.

“We believe based on our research and research by others that many people who smoke may benefit from having a friend or family member who is a former smoker who can give advice on how to quit and be a good role model for staying quit. Many people who quit smoking say it is one of the hardest things they have ever done. It is possible that having a highly connected friend group provides a strong support system that helps a person seek help to quit smoking, use cessation treatment and successfully quit,” she said.