In addition to the high prevalence of smoking among persons with AMI, data also indicate that these persons smoke more cigarettes per month and are less likely to have stopped smoking, compared with persons without AMI. There are several possible explanations for these findings. First, because nicotine is a central nervous system stimulant with mood-altering effects, it can temporarily mask negative affect and symptoms associated with mental illness (3). Second, research indicates that other constituents of tobacco smoke can accelerate the metabolism of some mental health medications, thus possibly reducing their effective blood levels (13) and potentially resulting in increased compensatory nicotine intake (13). Third, given that >80% of adult smokers begin smoking during adolescence,§§ those with AMI who smoke also likely started during youth. Factors that might predict the onset of dependence among youths include depressed mood and familiarity with tobacco advertisements (14); adolescents with depressive symptoms might experience increased receptivity to tobacco advertisements, making them more likely to smoke (15). Fourth, the tobacco industry has marketed cigarettes to populations with AMI (16), funded research to show that persons
