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An online survey of tobacco use, intentions to quit, and cessation strategies among people living with bipolar disorder


  • The authors of this paper do not have any commercial associations that might pose a conflict of interest in connection with this manuscript.

  • Portions of this study were presented at the annual meeting of the Society for Research on Nicotine and Tobacco, Toronto, Canada, February 18, 2010.

Corresponding author:
Judith J. Prochaska, PhD, MPH
Department of Psychiatry
University of California, San Francisco
401 Parnassus Avenue, TRC 0984
San Francisco, CA 94143-0984, USA
Fax: 415-476-7053


Prochaska JJ, Reyes RS, Schroeder SA, Daniels AS, Doederlein A, Bergeson B. An online survey of tobacco use, intentions to quit, and cessation strategies among people living with bipolar disorder.
Bipolar Disord 2011: 13: 466–473. © 2011 The Authors. Journal compilation © 2011 John Wiley & Sons A/S.

Objectives:  Tobacco use is prevalent among people living with bipolar disorder. We examined tobacco use, attempts to quit, and tobacco-related attitudes and intentions among 685 individuals with bipolar disorder who smoked ≥ 100 cigarettes in their lifetime.

Methods:  Data were collected online through the website of the Depression and Bipolar Support Alliance, a mood disorder peer-support network.

Results:  The sample was 67% female, 67% aged 26 to 50, and 89% Caucasian; 87% were current smokers; 92% of current smokers smoked daily, averaging 19 cigarettes/day (SD = 11). The sample began smoking at a mean age of 17 years (SD = 6) and smoked a median of 7 years prior to bipolar disorder diagnosis. Among current smokers, 74% expressed a desire to quit; intent to quit smoking was unrelated to current mental health symptoms [χ2(3) = 5.50, p = 0.139]. Only 33% were advised to quit smoking by a mental health provider, 48% reported smoking to treat their mental illness, and 96% believed being mentally healthy was important for quitting. Ex-smokers (13% of sample) had not smoked for a median of 2.7 years; 48% quit ‘cold turkey.’ Most ex-smokers (64%) were in poor or fair mental health when they quit smoking. At the time of the survey, however, more ex-smokers described their mental health as in recovery than current smokers [57% versus 40%; χ2(3) = 11.12, p = 0.011].

Conclusions:  Most smokers living with bipolar disorder are interested in quitting. The Internet may be a useful cessation tool for recruiting and potentially treating smokers with bipolar disorder who face special challenges when trying to quit and rarely receive cessation treatment from their mental health providers.