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For decades, patients in most psychiatric hospitals were allowed—even encouraged—to smoke. Now state and federal health officials are changing course, and banning smoking in a growing number of these facilities, according to The New York Times.

Psychiatric hospitals often provided cigarettes as incentives or rewards to patients for taking medicine, attending therapy or following rules, the article notes. Advocates for people with mental illness, and family members, supported these rules, saying cigarettes were one of the few pleasures patients could enjoy.

A study released this week by the Centers for Disease Control and Prevention (CDC) finds the rate of smoking for adults with some form of mental illness is 70 percent higher, compared with those without a mental health issue. Among adults with a mental illness, 36 percent smoke cigarettes, compared with 21 percent of adults without a mental illness.

According to William Riley, Chief of the Science of Research and Technology Branch at the National Cancer Institute, smoking can be especially harmful for people with mental illness. They are often “smoking heavier, their puffs are longer and they’re smoking it down to the end of the cigarette,” he told the newspaper.

The National Association of State Mental Health Program Directors says people with the most serious mental illness die an average of 25 years earlier than the general population, many of them from smoking-related conditions such as lung or heart disease. The organization conducted a survey in 2012 that found about one-fifth of state hospitals are not smoke free. Those that allow smoking usually do so outside on their grounds during scheduled periods.

According to the CDC, people with mental illness are more likely to have stressful living conditions, be low income, and lack access to health insurance, health care, and getting help to quit. All of these factors make it more challenging to quit.

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