Austin/Travis County Addresses Disproportionate Effects of Smoking among People with Mental Illness


that people with mental illness die disproportionately from smoking-related illness

a tobacco-cessation initiative (TCI), resulting in 44 smoke-free facilities and the availability of effective antismoking resources for clients and staff

the importance of having a continuous anti-smoking dialogue with fellow mental health facilities, clients, and practitioners

other mental health facilities replicate the TCI curriculum and promote tobacco-free mental health facilities statewide

Smoking is much more common among adults with mental illness than other adults, resulting in disproportionate rates of illness and death. Individuals with mental illness and/or substance abuse disorders smoke 44% of all cigarettes and account for nearly 47% of all tobacco-related deaths in the United States (Annual Review of Public Health 2010External). Nearly 17 percent of Texas adults smoke, including one in five Texans aged 14–18 years. Research shows that smokers with mental illness are interested in quitting, are able to quit, and have a better chance of quitting successfully when they have access to proven stop-smoking treatments.

Overall, people with mental illness have a life expectancy 25 years shorter than other adults and a much higher risk for chronic disorders such as heart disease, cancer, or stroke, due, in part, to tobacco use (Annual Review of Public Health 2010External). Nicotine can also compromise the effectiveness of mental health treatment by inhibiting absorption of psychiatric medications.

Until recently, mental health practitioners have been reluctant to address nicotine addiction in conjunction with mental health treatment. In Texas, as in mental health facilities across the nation, allowing clients to smoke has historically been used as a calming mechanism or a reward for complying with treatment.


What We Did

In 2011, Austin Travis County Integral Care (ATCIC)—a nonprofit agency with 44 facilities that addresses mental illness, substance abuse, and intellectual developmental disabilities—used a Communities Putting Prevention to Work (CPPW) grant to start a tobacco-cessation initiative (TCI). As a result, ATCIC—

  • Created the TCI curriculum based on the CPPW grant report and guidance from ATCIC staff. The curriculum provides a model for developing a tobacco-free workplace and implementing a TCI within a mental health facility.
  • Surveyed clients and staff about ATCIC’s culture regarding tobacco and opinions about having a tobacco-free policy.
  • Held staff and client focus groups, using feedback to shape the initiative and enhance ATCIC’s Intranet with anti-smoking resources.
  • Ensured that within six months of implementation, more than 80 percent of staff received training on nicotine replacement therapy, anti-smoking policies, and engaging clients to quit.
  • Provided clients and staff with counseling, access to free quitlines, and free nicotine replacement therapy.
What We Accomplished

As a result of the initiative, within one year, more than 46 percent of ATCIC clients had either quit smoking, decreased their use of tobacco, remained former smokers, or remained nonsmokers. In addition, ATCIC—

  • Implemented a policy change to make all 44 ATCIC facilities smoke free
  • Promoted the TCI via internal focus groups and collaboration with tobacco-control agencies throughout Texas
  • Added smoking-cessation training to new-employee orientations
  • Incorporated yearly tobacco-use assessments into client electronic medical records
  • Reinforced the significance of effective evaluation methods to help track success rates, such as biennial staff surveys, periodic client surveys, and assessment of tobacco use recorded in client health records

ATCIC was able to sustain the tobacco-cessation initiative via general funds available through its Health Promotion and Wellness Program. The TCI continues to receive strong support from ATCIC clients and staff.

Publication date: 04/19/2013

More Information
For story information, contact
Austin Travis County Integral Care
Dale S. Mantey, BA, QMHP
Tobacco Cessation Coordinator
Telephone: 512-445-7741
For product information, contact
Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333

The information in Public Health Practice Stories from the Field was provided by organizations external to CDC. Provision of this information by CDC is for informational purposes only and does not constitute an endorsement or recommendation by the US government or CDC.

Page last reviewed: October 5, 2018