Psychological distress and unmet mental health needs of low-income food assistance recipients who smoke.

Food assistance recipients have high smoking rates. Mental health factors that may affect their smoking are understudied. This study examined psychological distress and mental health service use among food assistance recipients enrolled in a smoking cessation trial. The trial sample comprised N = 352 adults aged ≥18, earning below 200% of the federal poverty level, smoking ≥5 cigarettes daily, and receiving public food assistance (e.g. SNAP). Psychological distress was assessed via the Kessler-6. Recent mental health service use (yes/no), therapeutic satisfaction (scale of 1-10), and potential usefulness of mental health services (scale of 1-10) were also assessed. Overall, 23% of participants had severe distress, 53% moderate distress, and 24% no/mild distress. Severe psychological distress was associated with younger age, high levels of financial stress, and food insecurity, but not with tobacco behaviors or motivations. Recent mental health service use was more common among individuals with severe distress, while therapeutic satisfaction was high across all distress levels. Participants who had not received mental health services reported a high level of potential usefulness if they were to receive services, especially among participants with severe distress. Results suggest that food assistance recipients who smoke may have unmet mental health care needs.