Betty Williams says giving up crack cocaine was easier than her ongoing struggle to quit cigarettes. “A cigarette is a friend,” said Williams, who lives with schizophrenia and chronic obstructive pulmonary disease. People with mental illness account for 44% of the cigarette purchases in the United States, and they are less likely to quit than other smokers. High smoking rates among people with mental illness contribute to poorer physical health and shorter lifespans, generally 13 to 30 years shorter than the population as a whole. About 37% of men and 30% of women with mental illness smoke.