Prevalence of bereavement among current smokers in a state-wide cross-sectional surveillance survey.

Introduction: Research consistently shows that bereavement is associated with subsequent poor self-rated health. In a separate line of research, smoking is common among persons with a mental illness diagnosis. In a population-based survey, the following three hypotheses are tested: 1) Compared to non-smokers, smokers are not more likely to report bereavement; 2) Among the bereaved, demographic factors - gender, race, and age - do not influence the likelihood of being a current smoker; and 3) Smoking does not influence or mediate the effect of bereavement on poor self-rated health.

Methods: The sample consisted of 7354 respondents to the annual 2019 Georgia Behavioral Risk Factor Surveillance Survey (BRFSS). Multiple imputation, descriptive analysis, ordered logistic regression, and mediation models were used.

Results: With imputed datasets, we found that bereavement rates were higher among every day (52.2%) compared to former smokers (46.4%) and never smokers (43.3%). Bereaved persons who smoke are also more likely to report heavy drinking: females (OR=3.92; 95% CI: 2.96-5.18) and males (OR=3.64; 95% CI: 2.72-4.86). Bereavement rates are highest among males who report smoking some days (OR=52.7; 95% CI: 44.4-61.0) and among females who report smoking every day (OR=56.77; 95% CI: 50.9-62.7).

Conclusions: Among all current smokers, bereavement is highly prevalent. However, gender, smoking and grief have a complex association. Bereaved female smokers typically smoke every day while bereaved male smokers on some days. Any bereaved smoker may benefit from cessation treatment to reduce health decline after loss.