Automobile Maintenance, Smoking and Health Equity

Mechanic with Client

Let’s talk about cars for a bit. Many of us rely pretty heavily on our car and it’s important to us that they stay in good working condition. We bring them in for regular maintenance, oil changes, rotate the tires… all that stuff to get as many years of good driving out of them that we can. Now imagine you brought your car to the garage for an oil change and they noticed something really wrong with it. Something that could severely compromise the car’s performance and take years off its life. You’d expect them to ask you if you wanted it fixed, right?

Okay, now let’s change gears (bad pun definitely intended). As most of us know, smoking is very bad for one’s health. So bad, that it consistently earns the designation of being the number one cause of preventable death. It affects every system of the body and half of long-term smokers will die from it. Quitting comes with substantial benefits, but many people have trouble doing it on their own. Odds of quitting successfully are greatly increased when supported by a health care provider who can assist with making a quit plan or refer them on to other quit supports. So it is very important for health care providers to ask patients about their smoking, and support them in quitting. I think we can all agree on that.

Now consider a group of people who are more likely to carry a significant burden of illness than the general population. Those with mental illness and/or addictions are 2-4 times more likely to smoke. They also smoke more cigarettes per day and are more heavily addicted than the average smoker. Despite this, in a survey of nearly 800 mental health providers, 88% thought clients can decide for themselves about quitting, and 82% believed their clients had more pressing issues. But about half of people diagnosed with mental illness (such as schizophrenia, bipolar disorder, or depression) die from a tobacco-related disease. That is to say, more often than not, that it is the smoking that kills them, rather than another substance use disorder or mental illness.

So why is it that smokers being treated for mental illness and other addictions are not also offered treatment for their smoking addiction? Smoking is so often associated with mental illness and other addictions that it is often dismissed. Rationale is often given that it is their one pleasure, not wanting to add to their burden, or dealing with “one thing at a time." Studies show, however, that they want to quit too! This population does often require more intensive support over a longer duration, but the cessation outcomes are significant and well worth the effort.

Consider that many within marginalized groups do not have regular interactions with health care providers, such as a yearly physical, dentist visit, etc. So it is absolutely imperative that when they do have contact with a health care provider, they are asked about their smoking and offered help to quit. It is a matter of health equity: every person deserves a fair chance at reaching their full health potential, without being disadvantaged by other social or environmental conditions. Simply put, some people need more help than others to have the same opportunity for good health.

Now here’s some good news. Not only is it possible to quit more than one addiction at a time, or with a mental illness, but it can actually be helpful to the treatment process. Nicotine addiction can interfere with other medications making them less effective, so those who quit often need less of their other meds. And smoking interventions provided during addictions treatment are associated with an increased likelihood of long-term abstinence from alcohol and illicit drugs. So to those health care providers who do not want to add to a person’s problems by bugging them about their smoking: just ask them. It could be that you’re just the person that they have been waiting for.