Unfair and Unjust Practices and Conditions Harm People With Behavioral Health Conditions and Drive Health Disparities

At a glance

  • Tobacco companies have created marketing plans that target population groups, including people who use illicit substances.
  • The tobacco industry targets people with behavioral health conditions with marketing and advertising.
Patient and therapist in a counseling session

Overview

People with behavioral health conditions are subject to more negative judgments and stigmatization than people with physical health conditions.1

People with behavioral health conditions have also been harmed by unjust practices related to the sale of commercial tobacco.A2

Tobacco companies funded research to support ideas that have been proven to be untrue. Such ideas include the hypothesis that people with schizophrenia could not develop lung cancer, and the idea that people with mental health conditions need cigarettes to treat their symptoms.3 Tobacco industry lobbyists have cited this disproven research to resist efforts to promote smokefree policies in psychiatric hospitals.4 Misperceptions that smoking could alleviate symptoms of mental health conditions may affect mental health providers' willingness to offer smoking cessation treatments to people with behavioral health conditions.5

Couple looking concerned.
People with behavioral health conditions have also been harmed by unjust practices related to the sale of commercial tobacco.

Tobacco companies have created marketing plans that target population groups, including people who use illicit substances. One example was "Project SCUM" (Sub-Culture Urban Marketing). This was a 1990s marketing strategy that attempted to co-brand tobacco as part of drug culture through product placement in shops that sold related paraphernalia.4

People with behavioral health conditions have also experienced discrimination and harm from systems meant to protect and improve health and well-being, including health care and medical science.

  • Until the passage of the Education for All Handicapped Children Act in 1975, it was legal to exclude children with behavioral health conditions from schools. Before the passage of the law, Congress found that 4 million children with disabilities were either excluded from public school services or served inappropriately.6
  • The Americans with Disabilities Act—passed in 1990—did not fully or evenly protect people with behavioral health conditions from workplace discrimination until clarifications were adopted in 2008.67
  • Health insurance coverage for behavioral health conditions has historically been less generous than coverage for medical care. Protections have expanded over time, starting with the Mental Health Parity Act of 1996 and the Mental Health Parity and Addiction Equity Act of 2008. There was no requirement that all insurance plans cover behavioral health conditions until the Patient Protection and Affordable Care Act of 2010.68

There are also current reasons—like the ones explored below—that help explain why commercial tobacco affects the health of people with behavioral health conditions.

The tobacco industry targets people with behavioral health conditions using marketing and advertising

Marketing plays a big role in whether people try or use commercial tobacco products. Commercial tobacco ads make smoking seem more appealing and increase the chance that someone will try smoking for the first time or start using commercial tobacco products regularly.9101112

Tobacco companies spend billions of dollars each year to aggressively market their products. They also target specific populations, including people who have behavioral health conditions, with commercial tobacco advertising.4 For example:

  • Advertisements for commercial tobacco products often incorporate images of carefree people who are smoking, socially engaged, and free from stress and anxieties.4
  • In one study of a large metropolitan area, people who had a serious mental health condition were twice as likely as those without a serious mental health condition to live in a neighborhood with more tobacco retailers and more advertisements for commercial tobacco product.13
  • Commercial tobacco brands use donations to civic groups as a way of generating influence and bolstering their public image. The industry has a history of making financial contributions to organizations that work with people with behavioral health conditions and have given free or discounted cigarettes to psychiatric facilities.34
A sign for a Tobacco & Cigarette Outlet and Vapor Shop
Tobacco companies market and advertise tobacco products to people with behavioral health conditions.

To help protect people with behavioral health conditions from tobacco marketing and discourage tobacco use, states and communities could consider the following:14

  • increasing prices.
  • prohibiting price discounts.
  • prohibiting the sale of flavored tobacco products.
  • either allowing fewer stores in a neighborhood to sell commercial tobacco products or prohibiting tobacco product sales altogether.
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Content Source:
National Center for Chronic Disease Prevention and Health Promotion; Office on Smoking and Health
  1. "Commercial tobacco" means harmful products that are made and sold by tobacco companies. It does not include "traditional tobacco" used by Indigenous groups for religious or ceremonial purposes.
  1. Centers for Disease Control and Prevention, Substance Abuse and Mental Health Services Administration, National Association of County Behavioral Health & Developmental Disability Directors, National Institute of Mental Health, The Carter Center Mental Health Program. Attitudes Toward Mental Illness: Results from the Behavioral Risk Factor Surveillance System. Centers for Disease Control and Prevention; 2012. Accessed February 25, 2022. https://stacks.cdc.gov/view/cdc/22179
  2. Richter KP, Arnsten JH. A rationale and model for addressing tobacco dependence in substance abuse treatment. Subst Abuse Treat Prev Policy. 2006;1:23.
  3. Prochaska JJ, Hall SM, Bero LA. Tobacco use among individuals with schizophrenia: what role has the tobacco industry played? Schizophr Bull. 2008;34(3):555–567.
  4. Prochaska JJ, Das S, Young-Wolff KC. Smoking, mental illness, and public health. Annu Rev Public Health. 2017;38: 165–185.
  5. Lawn S, Pols R. Smoking bans in psychiatric inpatient settings? a review of the research. Aust N Z J Psychiatry. 2005;39(10):866–885.
  6. Cummings JR, Lucas SM, Druss BG. Addressing public stigma and disparities among persons with mental illness: the role of federal policy. Am J Public Health. 2013;103(5):781–785.
  7. Senate Labor and Human Resources Committee. Americans with Disabilities Act of 1990, Pub. L. No. 101-336, 104 Stat. 327. United States Congress. Accessed February 25, 2022. https://www.congress.gov/bill/101st-congress/senate-bill/933
  8. Goodson JD. Patient Protection and Affordable Care Act: promise and peril for primary care. Ann Intern Med. 2010;152(11):742–744.
  9. Carson NJ, Rodriguez D, Audrain-McGovern J. Investigation of mechanisms linking media exposure to smoking in high school students. Prev Med. 2005;41(2):511–520.
  10. Charlesworth A, Glantz SA. Smoking in the movies increases adolescent smoking: a review. Pediatrics. 2005;116(6):1516–1528.
  11. U.S. Dept of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. U.S. Dept of Health and Human Services; 2014. Accessed April 28, 2022. https://www.ncbi.nlm.nih.gov/books/NBK179276/
  12. National Cancer Institute. The Role of the Media in Promoting and Reducing Tobacco Use. Tobacco Control Monograph No. 19. U.S. Dept of Health and Human Services; 2008. Accessed April 28, 2022. https://cancercontrol.cancer.gov/brp/tcrb/monographs/monograph-19
  13. Young-Wolff KC, Henriksen L, Delucchi K, Prochaska JJ. Tobacco retailer proximity and density and nicotine dependence among smokers with serious mental illness. Am J Public Health. 2014;104(8):1454–1463.
  14. Robertson L, McGee R, Marsh L, Hoek, J. A systematic review on the impact of point-of-sale tobacco promotion on smoking. Nicotine Tob Res. 2015;17(1):2–17.