Purpose: A key area that affects smoking prevention and quitting efforts is the extent to which an association between smoking and mental health problems exists. While some research demonstrates a link between tobacco use and psychiatric disorders, little has been done to examine mental health and smoking among diverse ethnic groups in the general population, and whether health disparities exist. To investigate the connection between smoking and perceived need for mental health services and use of those services among California's diverse adult population, we analyzed whether smoking and mental health needs vary cross-culturally, specifically by racial/ethnic group, language, immigration status, gender, and poverty level.

Methods: We compare data from two surveys -- the 2001 and 2003 population-based California Health Interview Surveys (2001 CHIS; 2003 CHIS). Each survey has the same questions about smoking status, but different questions on mental health. The CHIS 2001 asks a series of mental health questions (referred to as the SF-12), while the CHIS 2003 asks one question about mental health distress (referred to as the health-related quality of life [HRQOL] mental health measure (frequent mental distress). Only the CHIS 2001 asked questions about need for and use of mental health services. The 2001 CHIS asked questions of 55,428 adults; CHIS 2003 has a sample size of 42,043 adults. Bivariate analyses were utilized to examine mental health measures and smoking status relationships overall and for specific population subgroups, using the Chi-square test, confidence intervals or Student's t-test for interval data.

Findings: Current smokers were significantly more likely to report needing mental health counseling (21.3%) compared to non-smokers (13.9%). They also were more likely to see a health professional for their mental health problems (10.5% vs. 6.9%). Among smokers, perceived need for mental health services differed by ethnicity; White, Latino and African American smokers were significantly more likely to report a need for mental health services compared to Asian smokers. American Indians were the group most likely to report smoking (30.2%) at significantly higher rates than all other racial/ethnic groups. Male smokers (16.4%) were less likely to need emotional health services compared to female smokers (28.1%); both were more likely to need counseling compared to same gender nonsmokers. Current smokers were significantly more likely to report frequent days of poor health compared to nonsmokers (45.1% vs. 26.4% reporting 21 or more days of poor health in the past 30 days). Languages spoken at home did not appear to impact mental health need. Regarding citizenship, non-citizen smokers (3.2%) were more apt to obtain mental health counseling compared to non-citizen non-smokers (2.4%), although the difference was not significant.

Implications: Uncovering whether cultural and health disparities exist among diverse groups of smokers due to their mental health needs, status and utilization will help policymakers and service providers in their efforts toward eliminating barriers to accessing mental and health care and assisting smokers in their efforts to quit.

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