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Reframing "Wellness": The Social Construction of Tobacco Use in the Mental Health Community


While the rates of smoking in the general population have declined substantially over the last several decades, the prevalence of smoking among people with mental illness remains alarmingly high. For example, various estimates suggest that 50-90% of people with serious mental illness smoke, and nearly half of tobacco-related deaths each year occur among people with mental illness. Moreover, 70% or more of people with mental illness want to quit smoking, yet there often exist considerable barriers to access for cessation support. This research project is an attempt to understand the development and emergence of initiatives based on collaborative efforts between the mental health community and the smoking cessation field to raise awareness about and address the high rates of smoking among people with mental illness and the resulting health disparities that exist for this population. Research methods included: (1) individual in-person and telephone interviews with 26 national leaders in smoking cessation and mental health, (2) focus group interviews with 26 mental health consumers of various smoking statuses in California, (3) participant observation and fieldwork, and (4) a frames analysis of articles on this topic published in the last 10 years from six leading U.S. newspapers. Data were collected and analyzed using grounded theory methods. Overall, this research describes how collaborative efforts between the mental health and smoking cessation fields have resulted in the recognition of the high rates of smoking among people with mental illnesses as a social problem. This awareness has come from a shift in the social construction of tobacco use to one in which cessation is considered integral to overall wellness. The effort to address the disproportionate use of tobacco in the mental health community has allowed for the collective mobilization of the mental health and smoking cessation arenas, fields that have long been divided. This dissertation explores the enactment of and the possibilities for messages and actions to effectively and sensitively lower the rates of smoking among people with mental illness to reduce tobacco-related diseases, increase quality of life and life expectancy, and expand possibilities for recovery.

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