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Cho A, Scollo M, Chan G, Driezen P, Hyland A, Shang C, Gartner CE. The impact of tobacco tax increases on cost-minimising behaviours and subsequent smoking cessation in Australia: an analysis of the International Tobacco Control Policy Evaluation Project. Tob Control 2024:tc-2024-058776. [PMID: 39191503 DOI: 10.1136/tc-2024-058776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 08/05/2024] [Indexed: 08/29/2024]
Abstract
OBJECTIVE We examined the relationship in Australia from 2007 to 2020 between tobacco tax increases and use of cost-minimising behaviours (CMBs) when purchasing tobacco and: (1) tobacco expenditure and (2) smoking cessation attempts and quit success. METHODS We used data collected from adults who smoked factory-made and/or roll-your-own (RYO) cigarettes in nine waves (2007-2020) of the International Tobacco Control Policy Evaluation Project Australia Survey (Nsample=4975, Nobservations=10 474). CMBs included buying RYO tobacco, cartons, large-sized packs, economy packs, or tax avoidance/evasion, smoking reduction and e-cigarette use. Logistic regression, fit using generalised estimating equations, estimated the CMB-outcome association for quit attempts and quit success at the next wave follow-up (Nsubsample=2984, Nobservations=6843). RESULTS Over half of respondents used a CMB for tobacco purchase (P-CMB) at baseline (57.1% in 2007-2008), increasing to 76.8% (2018) post-tax increases. Participating in any P-CMB was associated with having higher weekly tobacco expenditure. Engaging in any P-CMB was negatively associated with attempting to quit (aOR=0.82, 95% CI 0.69-0.98). Purchasing RYO tobacco or cartons was associated with making no quit attempts (aOR=0.66, 95% CI 0.52-0.83; aOR=0.72, 95% CI 0.59-0.89, respectively). Among respondents smoking cigarettes who made quit attempts, there were no significant associations between all P-CMBs and quit success. Neither smoking reduction nor vaping were significantly associated with quit attempts. CONCLUSION P-CMBs are associated with reduced smoking cessation. Reducing opportunities for industry to promote purchasing-related CMB options, such as by standardising pack sizes and reducing the price differential between RYO and manufactured cigarettes could increase the effectiveness of tax increases.
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Affiliation(s)
- Ara Cho
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- The NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Michelle Scollo
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Gary Chan
- Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, Queensland, Australia
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Ce Shang
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Coral E Gartner
- The NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Herston, Queensland, Australia
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2
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Jones SMW, Ton M, Heffner JL, Malen RC, Cohen SA, Newcomb PA. Association of financial worry with substance use, mental health, and quality of life in cancer patients. J Cancer Surviv 2023; 17:1824-1833. [PMID: 36595185 DOI: 10.1007/s11764-022-01319-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/09/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE Financial worry is an under-appreciated negative effect of cancer. The relationship of financial worry and health behaviors in cancer is poorly characterized and has important clinical implications. This study examined the association of financial worry with substance misuse, mood, and quality of life. METHODS People with cancer (n = 1473; 6 to 20 months after diagnosis) were recruited from a SEER cancer registry in the Pacific Northwest. Participants completed an online survey assessing financial worry; misuse of cannabis, alcohol, and prescription drugs; tobacco smoking status; quality of life (physical and mental dimensions); anxiety; and depression. Multivariable regressions tested the association of financial worry to each health indicator and outcome. RESULTS In adjusted analyses, financial worry was associated with being a current vs. never smoker (odds ratio (OR) = 1.91, 95% confidence interval (CI): 1.01, 3.60), and a positive screen for an anxiety (OR = 3.01, 95% CI: 1.93, 4.68) and depressive (OR = 3.08, 95% CI: 1.89, 5.00) disorder. Financial worry was not associated with cannabis, alcohol, or prescription drug misuse (all ps > 0.05), but was associated with a decrease in physical (β = - 2.97, 95% CI: - 4.15, - 1.79) and mental (β = - 5.27, 95% CI: - 6.59, - 3.96) quality of life. CONCLUSION Financial worry among cancer survivors is associated with anxiety, depression, and worse quality of life. Of the evaluated substances, there was only an increased odds of current tobacco use with financial worry. Future longitudinal studies should inform the relationships between these factors. IMPLICATIONS FOR CANCER SURVIVORS Financial worry and material hardship may both need to be addressed in cancer survivorship.
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Affiliation(s)
- Salene M W Jones
- Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA.
| | - Mimi Ton
- Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
- School of Public Health, University of Washington, Seattle, WA, USA
| | - Jaimee L Heffner
- Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
| | - Rachel C Malen
- Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
| | - Stacey A Cohen
- Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Polly A Newcomb
- Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
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3
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Adinkrah E, Najand B, Rahmani A, Maharlouei N, Ekwegh T, Cobb S, Zare H. Social Determinants of Mental, Physical, and Oral Health of Middle-Aged and Older African Americans in South Los Angeles. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16765. [PMID: 36554645 PMCID: PMC9779480 DOI: 10.3390/ijerph192416765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/10/2022] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND A growing body of research suggests that financial difficulties could weaken the protective effects of socioeconomic status (SES) indicators, including education and income, on the health status of marginalized communities, such as African Americans. AIM We investigated the separate and joint effects of education, income, and financial difficulties on mental, physical, and oral self-rated health (SRH) outcomes in African American middle-aged and older adults. METHODS This cross-sectional study enrolled 150 middle-aged and older African Americans residing in South Los Angeles. Data on demographic factors (age and gender), socioeconomic characteristics (education, income, and financial difficulties), and self-rated health (mental, physical, and oral health) were collected. Three linear regression models were used to analyze the data. RESULTS Higher education and income were associated with a lower level of financial strain in a bivariate analysis. However, according to multivariable models, only financial difficulties were associated with poor mental, physical, and oral health. As similar patterns emerged for all three health outcomes, the risk associated with financial difficulties seems robust. CONCLUSIONS According to our multivariable models, financial strain is a more salient social determinant of health within African American communities than education and income in economically constrained urban environments such as South Los Angeles. While education and income lose some protective effects, financial strain continues to deteriorate the health of African American communities across domains.
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Affiliation(s)
- Edward Adinkrah
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Babak Najand
- Marginalization-Related Diminished Returns (MDRs) Center, Los Angeles, CA 90059, USA
| | - Arash Rahmani
- Marginalization-Related Diminished Returns (MDRs) Center, Los Angeles, CA 90059, USA
| | - Najmeh Maharlouei
- Marginalization-Related Diminished Returns (MDRs) Center, Los Angeles, CA 90059, USA
| | - Tavonia Ekwegh
- Mervyn M. Dymally School of Nursing, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Sharon Cobb
- Mervyn M. Dymally School of Nursing, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- School of Business, University of Maryland Global Campus (UMGC), Adelphi, Garden City, NY 20783, USA
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4
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SATO TOMOYO, MAEDA MITSUYA, KAWATA YUMI, MARUYAMA KOUTATSU, WADA HIROO, IKEDA AI, TANIGAWA TAKESHI. Association of Sources of Worry and Stress with Smoking in Japan: Findings from the Comprehensive Survey of Living Conditions 2010. JUNTENDO IJI ZASSHI = JUNTENDO MEDICAL JOURNAL 2022; 68:613-621. [PMID: 39081388 PMCID: PMC11284292 DOI: 10.14789/jmj.jmj20-oa18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 11/01/2022] [Indexed: 08/02/2024]
Abstract
Objectives The purpose of this study is to examine which sources of worry and stress are associated with smoking behavior and if these associations are varied by gender. Methods The anonymous data of 28,588 men and 30,813 women aged 20-79 years old in Japan were analyzed. We defined the subjects who chose "smoking everyday" as "smokers." We also assessed 20 sources of worry and stress. Multivariable odds ratios (ORs) and 95% confidence intervals (CIs) of smoking for each source of worry and stress were calculated using logistic regression analysis. Results We found significant association of financial stress with smoking behavior in both genders. The multivariable OR (95% CI) of smoking according to stress from financial stress was 1.22 (1.15-1.31) in men and 1.66 (1.53-1.80) in women. Moreover, the OR of smoking according to stress from human relationships and job affairs was significantly higher for women. Conclusion We found that some sources of worry and stress were related to smoking behavior and these associations were found to be gender-specific.
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Affiliation(s)
| | | | | | | | | | - AI IKEDA
- Corresponding author: Ai Ikeda, Department of Public Health, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan, TEL: +81-3-5802-1049 FAX: +81-3-3814-0305 E-mail: , Corresponding author: Takeshi Tanigawa, Department of Public Health, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan, TEL: +81-3-5802-1049 FAX: +81-3-3814-0305 E-mail:
| | - TAKESHI TANIGAWA
- Corresponding author: Ai Ikeda, Department of Public Health, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan, TEL: +81-3-5802-1049 FAX: +81-3-3814-0305 E-mail: , Corresponding author: Takeshi Tanigawa, Department of Public Health, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan, TEL: +81-3-5802-1049 FAX: +81-3-3814-0305 E-mail:
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5
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Lal A, Mohebi M, White SL, Scollo M, McCaffrey N. Household expenditure of smokers and ex-smokers across socioeconomic groups: results from a large nationwide Australian longitudinal survey. BMC Public Health 2022; 22:1706. [PMID: 36076210 PMCID: PMC9461138 DOI: 10.1186/s12889-022-14083-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Countries with best practice tobacco control measures have experienced significant reductions in smoking prevalence, but socioeconomic inequalities remain. Spending on tobacco products, particularly by low-income groups can negatively affect expenditure on other goods and services. This study aims to compare the household expenditure of adults who smoke tobacco products and those who formerly smoked across socioeconomic groups. METHODS Daily smokers and ex-smokers were compared using the Household, Income and Labour Dynamics in Australia Survey, over 7 waves. Adults who never smoked were not included. Participants were continuing sample members across waves. Mean number of participants per wave was 2505, 25% were smokers and 75% ex-smokers. The expenditure variables investigated included tobacco products, alcohol, motor vehicle fuel, health practitioners, insurance, education, and meals eaten out. Regression models using the generalized estimating equation technique were employed to compare expenditure data aggregated across the waves by Socioeconomic Index for Areas (SEIFA) quintiles of relative socio-economic advantage/disadvantage while accounting for within-participant autocorrelation. Quintiles are ranked by information such as the income, occupation and access to material and social resources of the residents. RESULTS Smokers from all quintiles spent significantly less per year on meals out, education and insurance than ex-smokers (p < 0.001). Smokers from quintiles 2-5 spent less on groceries, medicines, and health practitioners (p < 0.01). Smokers from quintiles 1 and 2 (most disadvantaged), spent less on motor vehicle fuel than ex-smokers ($280;95%CI: $126-$434), ($213;95%CI: $82-$344). Smokers from quintiles 2 and 3 spent more on alcohol ($212;95%CI: $86-$339), ($231.8;95%CI: $94-$370) than ex-smokers. Smokers from the least disadvantaged groups spent less on clothing than ex-smokers ($348;95%CI: $476-$221), ($501; 95%CI: $743-$258). Across the whole sample, smokers spent more than ex-smokers on alcohol ($230;95%CI:$95-$365) and less on meals out ($361;95%CI:$216-$379), groceries ($529;95%CI:$277-$781), education ($456;95%CI:$288-$624), medicine ($71;95%CI:$38-$104), health practitioners ($345;95%CI:$245-$444) and insurance ($318;95%CI:$229-$407). CONCLUSIONS Smoking cessation leads to reallocation of spending across all socioeconomic groups, which could have positive impacts on households and their local communities. Less spending on alcohol by ex-smokers across the whole sample could indicate a joint health improvement associated with smoking cessation.
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Affiliation(s)
- Anita Lal
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia.
| | - Mohammadreza Mohebi
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Australia
| | | | - Michelle Scollo
- Quit, Cancer Council Victoria, Melbourne, Australia
- Cancer Council Victoria, Melbourne, Australia
| | - Nikki McCaffrey
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
- Cancer Council Victoria, Melbourne, Australia
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6
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Paul CL, Warren G, Vinod S, Meiser B, Stone E, Barker D, White K, McLennan J, Day F, McCarter K, McEnallay M, Tait J, Canfell K, Weber M, Segan C. Care to Quit: a stepped wedge cluster randomised controlled trial to implement best practice smoking cessation care in cancer centres. Implement Sci 2021; 16:23. [PMID: 33663518 PMCID: PMC7934502 DOI: 10.1186/s13012-021-01092-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cigarette smoking in people with cancer is associated with negative treatment-related outcomes including increased treatment toxicity and complications, medication side effects, decreased performance status and morbidity. Evidence-based smoking cessation care is not routinely provided to patients with cancer. The purpose of this study is to determine the effectiveness of a smoking cessation implementation intervention on abstinence from smoking in people diagnosed with cancer. METHODS A stepped wedge cluster randomised design will be used. All sites begin in the control condition providing treatment as usual. In a randomly generated order, sites will move to the intervention condition. Based on the Theoretical Domains Framework, implementation of Care to Quit will include (i) building the capability and motivation of a critical mass of key clinical staff and identifying champions; and (ii) identifying and implementing cessation care models/pathways. Two thousand one hundred sixty patients with cancer (diagnosed in the prior six months), aged 18+, who report recent combustible tobacco use (past 90 days or in the 30 days prior to cancer diagnosis) and are accessing anti-cancer therapy, will be recruited at nine sites. Assessments will be conducted at baseline and 7-month follow-up. The primary outcome will be 6-month abstinence from smoking. Secondary outcomes include biochemical verification of abstinence from smoking, duration of quit attempts, tobacco consumption, nicotine dependence, provision and receipt of smoking cessation care, mental health and quality of life and cost effectiveness of the intervention. DISCUSSION This study will implement best practice smoking cessation care in cancer centres and has the potential for wide dissemination. TRIAL REGISTRATION The trial is registered with ANZCTR (www.anzctr.org.au): ACTRN ( ACTRN12621000154808 ) prior to the accrual of the first participant and will be updated regularly as per registry guidelines.
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Affiliation(s)
- Christine L Paul
- University of Newcastle Priority Research Centre for Cancer Research, Innovation and Translation, Callaghan, Australia. .,University of Newcastle School of Medicine and Public Health, Callaghan, NSW, Australia. .,Level 4 West, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, Newcastle, NSW, Australia. .,Hunter Cancer Research Alliance, John Hunter Hospital, New Lambton Heights, Newcastle, NSW, Australia.
| | - Graham Warren
- Department of Radiation Oncology, Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, SC, USA
| | - Shalini Vinod
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia.,South Western Sydney Clinical School and Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Bettina Meiser
- Prince of Wales Clinical School, University of New South Wales, Kensington, NSW, 2052, Australia
| | - Emily Stone
- St Vincent's Hospital Sydney, Kinghorn Cancer Centre, University of NSW, Kensington, Australia
| | - Daniel Barker
- University of Newcastle School of Medicine and Public Health, Callaghan, NSW, Australia
| | - Kate White
- Faculty of Medicine and Health, University of Sydney, CNRU Sydney Local Health District, Sydney, Australia
| | - James McLennan
- St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - Fiona Day
- University of Newcastle School of Medicine and Public Health, Callaghan, NSW, Australia.,Hunter Cancer Research Alliance, John Hunter Hospital, New Lambton Heights, Newcastle, NSW, Australia.,Calvary Mater Newcastle, Hunter Region Mail Centre, Waratah, NSW, Australia
| | - Kristen McCarter
- University of Newcastle Priority Research Centre for Cancer Research, Innovation and Translation, Callaghan, Australia.,University of Newcastle School of Medicine and Public Health, Callaghan, NSW, Australia.,Level 4 West, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, Newcastle, NSW, Australia.,Hunter Cancer Research Alliance, John Hunter Hospital, New Lambton Heights, Newcastle, NSW, Australia
| | - Melissa McEnallay
- University of Newcastle Priority Research Centre for Cancer Research, Innovation and Translation, Callaghan, Australia.,University of Newcastle School of Medicine and Public Health, Callaghan, NSW, Australia.,Level 4 West, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, Newcastle, NSW, Australia.,Hunter Cancer Research Alliance, John Hunter Hospital, New Lambton Heights, Newcastle, NSW, Australia
| | - Jordan Tait
- University of Newcastle School of Medicine and Public Health, Callaghan, NSW, Australia.,Level 4 West, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, Newcastle, NSW, Australia.,Hunter Cancer Research Alliance, John Hunter Hospital, New Lambton Heights, Newcastle, NSW, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Marianne Weber
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia.,Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Catherine Segan
- Cancer Council Victoria, Melbourne, VIC, Australia.,Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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7
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Assari S, Cobb S, Saqib M, Bazargan M. Economic Strain Deteriorates While Education Fails to Protect Black Older Adults Against Depressive Symptoms, Pain, Self-rated Health, Chronic Disease, and Sick Days. ACTA ACUST UNITED AC 2020; 4:49-62. [PMID: 32724902 DOI: 10.29245/2578-2959/2020/2.1203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background A large body of empirical evidence on Minorities' Diminished Returns (MDRs) suggests that educational attainment shows smaller health effects for Blacks compared to Whites. At the same time, economic strain may operate as a risk factor for a wide range of undesired mental and physical health outcomes in Black communities. Aim The current study investigated the combined effects of education and economic strain on the following five health outcomes in Black older adults in underserved areas of South Los Angeles: depressive symptoms, number of chronic diseases, pain intensity, self-rated health, and sick days. Methods This cross-sectional study included 619 Black older adults residing in South Los Angeles. Data on demographic factors (age and gender), socioeconomic characteristics, economic strain, health insurance, living arrangement, marital status, health behaviors, depressive symptoms, pain intensity, number of chronic diseases, sick days, and self-rated health were collected. Five linear regressions were used to analyze the data. Results Although high education was associated with less economic strain, it was the economic strain, not educational attainment, which was universally associated with depressive symptoms, pain intensity, self-rated health, chronic diseases, and sick days, independent of covariates. Similar patterns emerged for all health outcomes suggesting that the risk associated with economic strain and lack of health gain due to educational attainment are both robust and independent of type of health outcome. Conclusion In economically constrained urban environments, economic strain is a more salient social determinant of health of Black older adults than educational attainment. While education loses some of its protective effects, economic strain deteriorates health of Black population across domains. There is a need for bold economic and social policies that increase access of Black communities to cash at times of emergency. There is also a need to improve the education quality in the Black communities.
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Affiliation(s)
- Shervin Assari
- Departments of Family Medicine, Charles R Drew University of Medicine and Science
| | - Sharon Cobb
- School of Nursing, Charles R Drew University of Medicine and Science, Los Angeles, CA, United States
| | - Mohammed Saqib
- University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Mohsen Bazargan
- Departments of Family Medicine, Charles R Drew University of Medicine and Science.,Departments of Family Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, United States
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8
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Substance Use among Economically Disadvantaged African American Older Adults; Objective and Subjective Socioeconomic Status. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101826. [PMID: 31126049 PMCID: PMC6572418 DOI: 10.3390/ijerph16101826] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/11/2019] [Accepted: 05/17/2019] [Indexed: 12/17/2022]
Abstract
Purpose. This study investigated the effects of objective and subjective socioeconomic status (SES) indicators on two health behaviors, cigarette smoking and alcohol drinking, among African American older adults. Methods. This community-based study recruited 619 economically disadvantaged African American older adults (age ≥ 65 years) residing in South Los Angeles. Structured face-to-face interviews were conducted to collect data. Data on demographic factors (age and gender), subjective SES (financial difficulties), objective SES (educational attainment), living arrangement, marital status, healthcare access (insurance), and health (number of chronic medical conditions, self-rated health, sick days, depression, and chronic pain) and health behaviors (cigarette smoking and alcohol drinking) were collected from participants. Logistic regressions were used to analyze the data. Results. High financial difficulties were associated with higher odds of smoking cigarettes and drinking alcohol, independent of covariates. Educational attainment did not correlate with our outcomes. Similar patterns emerged for cigarette smoking and alcohol drinking. Conclusion. Subjective SES indicators such as financial difficulties may be more relevant than objective SES indicators such as educational attainment to health risk behaviors such as cigarette smoking and alcohol drinking among African American older adults in economically constrain urban environments. Smoking and drinking may serve as coping mechanisms with financial difficulty, especially among African American older adults. In line with the minorities' diminished returns (MDR) theory, and probably due to discrimination against racial minorities, educational attainment has a smaller protective effect among economically disadvantaged African American individuals against health risk behaviors.
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9
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Siahpush M, Farazi PA, Maloney SI, Dinkel D, Nguyen MN, Singh GK. Socioeconomic status and cigarette expenditure among US households: results from 2010 to 2015 Consumer Expenditure Survey. BMJ Open 2018; 8:e020571. [PMID: 29909369 PMCID: PMC6009464 DOI: 10.1136/bmjopen-2017-020571] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 04/27/2018] [Accepted: 05/15/2018] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To examine (1) the association between household socioeconomic status (SES) and whether a household spends money on cigarettes and (2) socioeconomic variations in proportion of total household expenditure spent on cigarettes among smoking households. METHODS We pooled data from six consecutive years, 2010-2015, of the Consumer Expenditure Interview Survey. The interviews involved a structured questionnaire about household income, demographics and expenditures including expenditure on cigarettes. Households that reported cigarette expenditure in the previous 3 months were distinguished as smoking households. SES indicators were household poverty status, education and occupation of the head of household. Logistic regression was used to assess the association of household smoking status with SES. Fractional logistic regression was used to assess the association of cigarette expenditure as a proportion of total household expenditure with SES. The analysis sample size was 39 218. RESULTS The probability of spending money on cigarettes was higher among lower SES households. Households in poverty compared with those above 300% of poverty threshold had 1.86 (95% CI 1.61 to 2.16), households headed by a person with less than high school education compared with those headed by a person with at least a bachelor's degree had 3.37 (95% CI 2.92 to 3.89) and households headed by a blue-collar work compared with those headed by a person in a managerial occupation had 1.45 (95% CI 1.26 to 1.66) higher odds of spending money on cigarettes. Similarly, the proportion of total household expenditure spent on cigarettes was higher among lower SES smoking households. CONCLUSION Lower SES households are more likely to spend money on cigarettes and spend a larger proportion of their total expenditure on cigarettes. We recommend strategies effective in reducing smoking among low SES smokers.
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Affiliation(s)
- Mohammad Siahpush
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Paraskevi A Farazi
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Shannon I Maloney
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Danae Dinkel
- School of Health and Kinesiology, College of Education, University of Nebraska, Omaha, Nebraska, USA
| | - Minh N Nguyen
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Gopal K Singh
- U.S. Department of Health & Human Services, Office of Health Equity, Health Resources and Services Administration, Rockville, Maryland, USA
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10
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McKenna CS, Law C, Pearce A. Financial Strain, Parental Smoking, and the Great Recession: An Analysis of the UK Millennium Cohort Study. Nicotine Tob Res 2018; 19:1521-1525. [PMID: 27707885 PMCID: PMC5896540 DOI: 10.1093/ntr/ntw269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 10/04/2016] [Indexed: 01/26/2023]
Abstract
Introduction During the recent "Great Recession," many families in the United Kingdom experienced increased financial strain (FS). The aim of this study was to determine if increases in FS, occurring over the period of the "Great Recession," were associated with increased risks of persistent and relapsed tobacco use among parents. Methods We analyzed the Millennium Cohort Study, a longitudinal study of 18819 children born in the United Kingdom between 2000 and 2002. Surveys at 7 (T1, 2008) and 11 years (T2, 2012) spanned the "Great Recession." Three measures of increased FS were defined; "became income poor" (self-reported household income dropped below the "poverty line" between T1 and T2); "developed difficulty managing" (parental report of being "financially comfortable" at T1 and finding it "difficult to manage" at T2); "felt worse off" (parental report of feeling financially "worse off" at T2, compared to T1). Poisson regression was used to estimate risk ratios (RR), adjusted RRs (aRR), and 95% confidence intervals for three outcomes: "persistent tobacco use," "new reported tobacco use," and "relapsed tobacco use." Results Parents in households which "became income poor" over the period of the "Great Recession" were significantly more likely to report "persistent tobacco use" (aRR = 2.17 [1.83-2.57]) or "new reported tobacco use" (aRR = 1.72 [1.04-2.83]). Ninety-five percent of "new reported tobacco users" had evidence of prior tobacco use suggesting the majority were "relapsed tobacco users." Similar patterns were seen for those who "developed difficulty managing" and "felt worse off." Conclusions Increased tobacco use among financially strained families has the potential to widen inequalities and undermine the public health policies that have had positive impacts on tobacco consumption in the United Kingdom. Implications While several studies have shown that FS is associated with a higher prevalence of tobacco use, heavier smoking, and relapsed tobacco use, most of this work used cross-sectional data and none has focused on parents. We used longitudinal data from the UK Millennium Cohort Study, between 2008 and 2012, to examine the association between FS and parental smoking. We show that parents who experienced increased FS, over the period of the "Great Recession," were more likely to continue using tobacco or to relapse.
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Affiliation(s)
- Caoimhe S McKenna
- Population, Policy and Practice, Great Ormond Street Institute of Child Health, University College London (UCL), London, UK
| | - Catherine Law
- Population, Policy and Practice, Great Ormond Street Institute of Child Health, University College London (UCL), London, UK
| | - Anna Pearce
- Population, Policy and Practice, Great Ormond Street Institute of Child Health, University College London (UCL), London, UK
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Kendzor DE, Businelle MS, Waters AF, Frank SG, Hébert ET. Financial strain indirectly influences smoking cessation through withdrawal symptom severity. Drug Alcohol Depend 2018; 183:55-61. [PMID: 29227838 DOI: 10.1016/j.drugalcdep.2017.10.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 10/10/2017] [Accepted: 10/17/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Financial strain has an adverse impact on smoking cessation. However, the mechanisms through which financial strain influences cessation remain unclear. The purpose of the current study was to determine whether financial strain indirectly influenced smoking cessation through withdrawal symptom severity. METHODS Participants (N=139) were primarily Black (63.3%) and female (57.6%) adults enrolled in a smoking cessation program at a safety-net hospital. A self-report financial strain questionnaire was completed one week prior to the scheduled quit date, and the Wisconsin Smoking Withdrawal Scale (WSWS) was completed on the day after the scheduled quit date. Biochemically-verified 7-day point prevalence abstinence was assessed four weeks after the scheduled quit date. Adjusted mediation analyses were conducted using the PROCESS macro for SPSS to evaluate the indirect effects of financial strain on smoking cessation via post-quit withdrawal symptom severity. RESULTS Analyses indicated a significant indirect effect of financial strain on smoking cessation through total withdrawal symptom severity, B=0.027; 95% CI (0.003, 0.066); and specifically anger, B=0.035; 95% CI (0.008, 0.074), anxiety, B=0.021; 95% CI (0.001, 0.051), and sleep symptoms, B=0.015; 95% CI (0.005, 0.043). Greater pre-quit financial strain was associated with greater post-quit withdrawal symptom severity, which increased the likelihood of non-abstinence 4 weeks after the scheduled quit attempt. The direct effect of financial strain on smoking cessation was not significant in any of the mediation models. CONCLUSIONS Findings: suggest that withdrawal severity is an underlying mechanism through which financial strain influences smoking cessation.
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Affiliation(s)
- Darla E Kendzor
- The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Stephenson Cancer Center, Oklahoma Tobacco Research Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, USA.
| | - Michael S Businelle
- The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Stephenson Cancer Center, Oklahoma Tobacco Research Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, USA.
| | - Aaron F Waters
- Louisiana State University, Department of Psychology, 236 Audubon Hall, Baton Rouge, LA, 70803, USA.
| | - Summer G Frank
- The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Stephenson Cancer Center, Oklahoma Tobacco Research Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, USA.
| | - Emily T Hébert
- The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Stephenson Cancer Center, Oklahoma Tobacco Research Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, USA.
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12
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Twyman L, Bonevski B, Paul C, Bryant J, West R, Siahpush M, D'este C, Oldmeadow C, Palazzi K. What factors are associated with abstinence amongst socioeconomically disadvantaged smokers? A cross-sectional survey of use of cessation aids and quitting approach. Drug Alcohol Rev 2018; 37:170-179. [PMID: 28616900 DOI: 10.1111/dar.12561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 12/05/2016] [Accepted: 03/31/2017] [Indexed: 01/07/2023]
Abstract
INTRODUCTION AND AIMS This study aimed to compare current and ex-smokers' sociodemographic and psychosocial characteristics, use of cessation aids and abrupt versus gradual quitting approaches. DESIGN AND METHODS A cross-sectional survey of financially disadvantaged adults attending a community service organisation was conducted in New South Wales, Australia, between February 2012 and December 2013. Sociodemographic and psychosocial factors, use of cessation aids and gradual versus abrupt quit approach were assessed. χ2 tests and logistic regression compared characteristics of current and ex-smokers. RESULTS Of 905 individuals who completed the survey, 639 (71%) were current smokers and 107 (12%) were ex-smokers. Ex-smokers were older [odds ratio (OR) = 1.03, 95% confidence interval (CI) = 1.01, 1.05], had higher odds of being female (OR = 1.67, 95% CI = 1.06, 2.65), lower odds of being financially stressed (OR = 0.87, 95% CI = 0.76, 0.99), lower odds of anxiety and depression symptoms (OR = 0.91, 95% CI = 0.84, 0.98) and lower odds of having friends and family who were smokers (ORs ranged from 0.30-0.43). Ex-smokers had lower odds of using cessation aids and higher odds of reporting abrupt quitting during their last quit attempt (OR = 4.48, 95% CI = 2.66, 7.54). CONCLUSIONS Lower levels of disadvantage, less smoking in social networks, less use of cessation aids and abrupt (vs. gradual) quitting approaches were associated with being an ex-smoker. Lower use of evidence based methods to quit by disadvantaged ex-smokers requires further exploration. [Twyman L, Bonevski B, Paul C, Bryant J, West R, Siahpush M, D'este C, Oldmeadow C, Palazzi K. What factors are associated with abstinence amongst socioeconomically disadvantaged smokers? A cross-sectional survey of use of cessation aids and quitting approach. Drug Alcohol Rev 2017;00:000-000].
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Affiliation(s)
- Laura Twyman
- School of Medicine and Public Health, Faculty of Health and Medicine, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Billie Bonevski
- School of Medicine and Public Health, Faculty of Health and Medicine, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Christine Paul
- School of Medicine and Public Health, Faculty of Health and Medicine, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Jamie Bryant
- School of Medicine and Public Health, Faculty of Health and Medicine, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
- Priority Research Centre for Health Behaviour and Health Behaviour Research Group, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Robert West
- Health Behaviour Research Centre Department of Epidemiology and Public Health, University College London, London, UK
- Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, USA
| | - Mohammad Siahpush
- Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, USA
| | - Catherine D'este
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia
| | - Christopher Oldmeadow
- School of Medicine and Public Health, Faculty of Health and Medicine, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
- Hunter Medical Research Institute, Newcastle, Australia
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Sheffer CE, Bickel WK, Franck CT, Panissidi L, Pittman JC, Stayna H, Evans S. Improving tobacco dependence treatment outcomes for smokers of lower socioeconomic status: A randomized clinical trial. Drug Alcohol Depend 2017; 181:177-185. [PMID: 29065390 PMCID: PMC7780926 DOI: 10.1016/j.drugalcdep.2017.09.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/08/2017] [Accepted: 09/03/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Evidence-based treatments for tobacco dependence are significantly less effective for smokers of lower socioeconomic status which contributes to socioeconomic disparities in smoking prevalence rates and health. We aimed to reduce the socioeconomic gradient in treatment outcomes by systematically adapting evidence-based, cognitive-behavioral treatment for tobacco dependence for diverse lower socioeconomic smokers. METHODS Participants were randomized to adapted or standard treatment, received six 1-h group treatment sessions, and were followed for six months. We examined the effectiveness of the adapted treatment to improve treatment outcomes for lower socioeconomic groups. RESULTS Participants (n=227) were ethnically, racially, and socioeconomically diverse. The adapted treatment significantly reduced the days to relapse for the two lowest socioeconomic groups: SES1: M=76.6 (SD 72.9) vs. 38.3 (SD 60.1) days to relapse (RR=0.63 95% CI, 0.45, 0.88, p=0.0013); SES2: M=88.2 (SD 67.3) vs. 40.1 (SD 62.6 days to relapse (RR=0.57 95% CI, 0.18, 0.70, p=0.0024). Interactions between socioeconomic status and condition were significant for initial abstinence (OR=1.26, 95% CI 1.09, 1.46, p=0.002), approached significance for 3-month abstinence (OR=0.90, 95% CI 0.80, 1.01, p<0.071), and were not significant for 6-month abstinence (OR=0.99 95% CI 0.88, 1.10, p=0.795). No significant differences in long-term abstinence were observed. CONCLUSION Systematic adaption of evidence-based treatment for tobacco dependence can significantly improve initial and short-term treatment outcomes for diverse lower socioeconomic smokers and reduce inequities in days to relapse. Novel methods of providing targeted extended support are needed to improve long-term outcomes.
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Affiliation(s)
- Christine E Sheffer
- City University of New York School of Medicine, City College of New York, 160 Convent Ave, New York, NY 10031, United States.
| | - Warren K Bickel
- Advanced Recovery Research Center, Virginia Tech Carilion Research Institute, 2 Riverside Circle, Roanoke, VA 24016, United States
| | | | - Luana Panissidi
- City University of New York School of Medicine, City College of New York, 160 Convent Ave, New York, NY 10031, United States
| | - Jami C Pittman
- City University of New York School of Medicine, City College of New York, 160 Convent Ave, New York, NY 10031, United States
| | - Helen Stayna
- City University of New York School of Medicine, City College of New York, 160 Convent Ave, New York, NY 10031, United States
| | - Shenell Evans
- City University of New York School of Medicine, City College of New York, 160 Convent Ave, New York, NY 10031, United States
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14
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Siahpush M, Tibbits M, Soliman GA, Grimm B, Shaikh RA, McCarthy M, Wan N, Ramos AK, Correa A. Neighbourhood exposure to point-of-sale price promotions for cigarettes is associated with financial stress among smokers: results from a population-based study. Tob Control 2017; 26:703-708. [PMID: 28119499 PMCID: PMC5577380 DOI: 10.1136/tobaccocontrol-2016-053339] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 12/21/2016] [Accepted: 12/29/2016] [Indexed: 11/04/2022]
Abstract
AIM To examine the association between neighbourhood exposure to point-of-sale (POS) cigarette price promotions and financial stress among smokers in a Midwestern metropolitan area in the USA. METHODS Survey data from 888 smokers provided information on sociodemographic and smoking related variables. Financial stress was measured with the question: 'In the last six months, because of lack of money, was there a time when you were unable to buy food or pay any important bills on time, such as electricity, telephone, credit card, rent or your mortgage? (Yes/No).' Using audit data from 504 tobacco retailers, we estimated a score of POS price promotions for each respondent by summing the different types of promotion in each store in their neighbourhood, as defined by a 1-km roadway buffer. RESULTS Adjusted results provided strong support for an association between higher scores of neighbourhood POS cigarette price promotions and a higher probability of financial stress (p=0.007). CONCLUSION Exposure to POS cigarette price promotions is associated with financial stress. This finding, coupled with previous reports that smokers with financial stress are less likely to attempt to quit or succeed in quitting smoking, suggests that POS cigarette price promotions may act as an impediment to smoking cessation.
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Affiliation(s)
- Mohammad Siahpush
- Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Melissa Tibbits
- Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ghada A Soliman
- Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Brandon Grimm
- Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Raees A Shaikh
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Molly McCarthy
- Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Neng Wan
- Department of Geography, University of Utah, Salt Lake City, Utah, USA
| | - Athena K Ramos
- Center for Reducing Health Disparities, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Antonia Correa
- Center for Reducing Health Disparities, University of Nebraska Medical Center, Omaha, Nebraska, USA
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15
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Martire KA, Clare P, Courtney RJ, Bonevski B, Boland V, Borland R, Doran CM, Farrell M, Hall W, Iredale JM, Siahpush M, Mattick RP. Smoking and finances: baseline characteristics of low income daily smokers in the FISCALS cohort. Int J Equity Health 2017; 16:157. [PMID: 28854980 PMCID: PMC5577825 DOI: 10.1186/s12939-017-0643-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 08/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Financial stress is a barrier to successful smoking cessation and a key predictor of relapse. Little is known about the financial situation of low-income Australian daily smokers. This study aims to describe and investigate associations between the financial functioning, tobacco use and quitting behaviours of low income daily smokers. METHODS Low-income Australian adult smokers in the 'Financial Intervention for Smoking Cessation Among Low-income Smokers (FISCALS) randomised clinical trial completed a structured telephone questionnaire. RESULTS The median number of cigarettes typically smoked by the 1047 participants was 23 per day. The median spent on tobacco per week was AU$80. Three quarters (73.0%) reported some financial stress and 43.2% reported smoking-induced deprivation. Financial stress was significantly associated with deprivation (IRR: 1.23, 95% CI 1.21, 1.26, p < 0.001). There were no significant associations either between adjusted financial stress or deprivation and motivation to quit or certainty of quit success. CONCLUSIONS Financial stress and smoking induced deprivation were prevalent among low-income daily smokers, but they were not associated with motivation to quit. Smoking cessation interventions need to be responsive to the role financial stress plays in reducing quit attempts and increasing relapse. TRIAL REGISTRATION Australian and New Zealand Clinical trials Registry ACTRN12612000725864 6/07/2012.
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Affiliation(s)
| | - Philip Clare
- National Drug and Alcohol Research Centre, University of NSW, Sydney, NSW 2052 Australia
| | - Ryan J. Courtney
- National Drug and Alcohol Research Centre, University of NSW, Sydney, NSW 2052 Australia
| | - Billie Bonevski
- School of Medicine & Public Health, University of Newcastle, University Dr, Callaghan, NSW 2308 Australia
| | - Veronica Boland
- National Drug and Alcohol Research Centre, University of NSW, Sydney, NSW 2052 Australia
| | - Ron Borland
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, VIC 3004 Australia
| | - Christopher M. Doran
- Centre for Indigenous Health Equity Research, School of Human, Health and Social Sciences, Central Queensland University, Brisbane, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of NSW, Sydney, NSW 2052 Australia
| | - Wayne Hall
- Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | - Jaimi M. Iredale
- National Drug and Alcohol Research Centre, University of NSW, Sydney, NSW 2052 Australia
| | - Mohammad Siahpush
- College of Public Health, University of Nebraska Medical Centre, 42nd and Emile, Omaha, NE 68198 USA
| | - Richard P. Mattick
- National Drug and Alcohol Research Centre, University of NSW, Sydney, NSW 2052 Australia
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Financial Stress and Smoking within a Large Sample of Socially Disadvantaged Australians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14030231. [PMID: 28245612 PMCID: PMC5369067 DOI: 10.3390/ijerph14030231] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 02/05/2017] [Accepted: 02/17/2017] [Indexed: 11/16/2022]
Abstract
Financial stress is associated with fewer quit attempts and higher relapse rates. This study aimed to compare financial stress among smokers, ex-smokers and never smokers in a highly socioeconomically disadvantaged sample. The study also aimed to determine whether specific indicators of financial stress differ according to smoking status. Adult clients seeking welfare assistance from two Social and Community Service Organisation sites in New South Wales, Australia, were invited to complete a cross-sectional survey between March 2012 and December 2013. Responses to a financial stress scale, smoking status and demographics were collected. Linear and logistic regression modelling was used to examine associations between smoking status and financial stress. A total of 1463 participants completed the survey. Current smokers had significantly higher total financial stress scores than ex-smokers and non-smokers respectively. Current smokers also had higher odds of severe financial stress indicators, such as going without meals (Odds Ratio = 2.2 and 2.0), than both non-smokers and ex-smokers. Even among a highly socioeconomically disadvantaged sample with high levels of financial stress, smoking status further exacerbates experiences of deprivation. Given the relationship between financial stress, socioeconomic disadvantage and difficulty quitting, it is important to provide enhanced cessation support to smokers experiencing financial stress.
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A qualitative analysis of low income smokers' responses to tobacco excise tax increases. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 37:82-89. [PMID: 27639173 DOI: 10.1016/j.drugpo.2016.08.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/08/2016] [Accepted: 08/10/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND While increasing the excise tax applied to tobacco products reduces consumption and smoking prevalence, it may also cause hardship among smokers who do not quit. We explored how smokers living on a low income respond to increasing tobacco excise taxes. METHODS Using a social justice perspective, we explored the increasing costs of tobacco with a sample of 27 adult smokers who live below the poverty line (i.e., with an income less than 60% of the median New Zealand income). Face-to-face interviews were conducted in Dunedin, New Zealand, a city with marked income differences, and were undertaken shortly after a further tobacco excise tax increase. The interview guide explored participants' smoking practices, their perceptions of excise tax as a strategy to reduce smoking prevalence, and the strategies they used to manage their tobacco needs. RESULTS We identified three key themes: depriving the poor; tobacco as a precious commodity, and desperation. While many participants described smoking as a pleasure or coping mechanism, they also saw it as a burden that they struggled to manage. Despite trying to quit, most had failed to become smokefree and felt victimised by a punitive policy system that coerced change without supporting it. They managed financial pressure by reducing their tobacco consumption but also used increasingly desperate measures, including recycling waste tobacco; participants reported feeling demeaned by measures they saw as their only option. CONCLUSION Providing intensive cessation support for lower income smokers could avoid further alienating a group already experiencing considerable disadvantage.
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Abstract
OBJECTIVES This study examined the role of cigarette smoking beginning in adolescence and extending to the fifth decade of life on insomnia at an average age of 43 years in the Children and Adults in the Community Study. METHODS Participants were originally assessed in 1983 and came from a community-based random sample of individuals living in 2 upstate New York counties. Participants were assessed over 7 waves of data collection that spanned approximately 29 years, from mean ages 14.1 years (T2) to 42.9 years (T8). We classified the longitudinal trajectories of cigarette use. Five cigarette use trajectory groups were identified: heavy/continuous smokers, late starters, occasional smokers, quitters/decreasers, and nonsmokers. RESULTS The result of the logistic regression analysis of adult insomnia for the Bayesian posterior probability of the heavy/continuous smokers when compared with the Bayesian posterior probability of nonsmokers was statistically significant-adjusted odds ratio of 3.35 [95% confidence interval (1.06-10.56; P < 0.05)]-after adjustment for control variables. CONCLUSIONS The findings highlight the importance of heavy chronic smoking as contributing to insomnia. Clinicians should focus their efforts on smoking prevention and treatment of younger individuals, as well as promoting cessation among older adult smokers to decrease the likelihood of insomnia.
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Tucker-Seeley RD, Selk S, Adams I, Allen JD, Sorensen G. Tobacco use among low-income housing residents: does hardship motivate quit attempts? Cancer Causes Control 2015; 26:1699-707. [PMID: 26376892 PMCID: PMC4694626 DOI: 10.1007/s10552-015-0662-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 09/03/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study was to examine material hardship among smokers to determine whether such hardship was positively associated with current attempts to quit tobacco use. METHODS We analyzed cross-sectional data from the Health in Common (HIC) study, an observational study to investigate social and physical determinants of cancer risk-related behaviors among residents of low-income housing in three cities in the Boston metropolitan area. In this study, three indicators of hardship were used: food hardship, financial hardship, and material hardship (food and financial hardship combined). Logistic regression models were used to obtain the odds of currently trying to quit among current smokers in the HIC (n = 170) across hardship types experienced, adjusting for sociodemographic and psychosocial factors. RESULTS Fully adjusted models revealed no statistically significant association between trying to quit tobacco use and indicators of material hardship: food hardship and financial hardship present (OR 1.33 (0.42-4.2); food hardship and no financial hardship OR 3.83 (0.97-15.13); and financial hardship but no food hardship OR 0.5 (0.1-2.39). CONCLUSIONS These findings suggest that even in the presence of material hardship, low-income housing resident tobacco users are not more likely to quit tobacco use; therefore, cessation efforts focused on the financial benefits of quitting may be insufficient to motivate quit attempts among low-income smokers.
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Affiliation(s)
- R D Tucker-Seeley
- Center for Community-Based Research, Dana Farber Cancer Institute, 450 Brookline Ave, LW 747, Boston, MA, 02215, USA.
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - S Selk
- Center for Community-Based Research, Dana Farber Cancer Institute, 450 Brookline Ave, LW 747, Boston, MA, 02215, USA
| | - I Adams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - J D Allen
- Department of Public Health and Community Medicine, Tufts University, Boston, MA, USA
| | - G Sorensen
- Center for Community-Based Research, Dana Farber Cancer Institute, 450 Brookline Ave, LW 747, Boston, MA, 02215, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Widome R, Joseph AM, Hammett P, Van Ryn M, Nelson DB, Nyman JA, Fu SS. Associations between smoking behaviors and financial stress among low-income smokers. Prev Med Rep 2015; 2:911-5. [PMID: 26844167 PMCID: PMC4721304 DOI: 10.1016/j.pmedr.2015.10.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE Many American households struggle to bring in sufficient income to meet basic needs related to nutrition, housing, and healthcare. Nicotine addiction and consequent expenditures on cigarettes may impose extra financial strain on low-income households. We examine how cigarette use behaviors relate to self-reported financial stress/strain among low-income smokers. METHODS At baseline in 2011/12, OPT-IN recruited adult smokers age 18-64 from the administrative databases of the state-subsidized Minnesota Health Care Programs (N = 2406). We tested whether nicotine dependency, type of cigarettes used, and smoking intensity were associated with self-reported difficulty affording food, healthcare, housing, and living within one's income. All regression models were adjusted for race, education, income, age, and gender. RESULTS Difficulty living on one's income (77.4%), paying for healthcare (33.6%), paying for housing (38.4%), and paying for food (40.8%) were common conditions in this population. Time to first cigarette and cigarettes smoked per day predicted financial stress related to affording food, housing, and living within one's income (all p < 0.05). For instance, those whose time to first cigarette was greater than 60 minutes had about half the odds of reporting difficulty paying for housing compared to those who had their first cigarette within five minutes of waking (adjusted odds ratio = 0.55 [95% CI: 0.41, 0.73]). Type of cigarette used was not associated with any type of financial stress/strain. CONCLUSIONS Smoking and particularly heavy smoking may contribute in an important way to the struggles that low-income households with smokers face in paying for necessities.
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Affiliation(s)
- Rachel Widome
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA
| | - Anne M Joseph
- Department of Medicine, University of Minnesota Medical School, MN, USA
| | - Patrick Hammett
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA; Department of Medicine, University of Minnesota Medical School, MN, USA; VA HSR&D Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, MN, USA
| | - Michelle Van Ryn
- Mayo Clinic, Division of Health Care Policy & Research, Rochester, MN, USA
| | - David B Nelson
- VA HSR&D Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, MN, USA
| | - John A Nyman
- Division of Health Policy and Management, University of Minnesota School of Public Health, MN, USA
| | - Steven S Fu
- Department of Medicine, University of Minnesota Medical School, MN, USA; VA HSR&D Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, MN, USA
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Basu S, Hamad R, White JS, Modrek S, Rehkopf DH, Cullen MR. The EARN-Health Trial: protocol for a randomised controlled trial to identify health effects of a financial savings programme among low-income US adults. BMJ Open 2015; 5:e009366. [PMID: 26443663 PMCID: PMC4606428 DOI: 10.1136/bmjopen-2015-009366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 08/19/2015] [Accepted: 08/21/2015] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION A theory within the social epidemiology field is that financial stress related to having inadequate financial savings may contribute to psychological stress, poor mental health and poor health-related behaviours among low-income US adults. Our objective is to test whether an intervention that encourages financial savings among low-income US adults improves health behaviours and mental health. METHODS AND ANALYSIS A parallel group two-arm controlled superiority trial will be performed in which 700 participants will be randomised to the intervention or a wait list. The intervention arm will be provided an online Individual Development Account (IDA) for 6 months, during which participants receive a $5 incentive (£3.2, €4.5) for every month they save $20 in their account (£12.8, €18), and an additional $5 if they save $20 for two consecutive months. Both groups will be provided links to standard online financial counselling materials. Online surveys in months 0 (prior to randomisation), 6 and 12 (6 months postintervention) will assess self-reported health behaviours and mental health among participants in both arms. The surveys items were tested previously in the US Centers for Disease Control and Prevention national health interviews and related health studies, including self-reported overall health, health-related quality of life, alcohol and tobacco use, depression symptoms, financial stress, optimism and locus of control, and spending and savings behaviours. Trial data will be analysed on an intent-to-treat basis. ETHICS AND DISSEMINATION This protocol was approved by the Institutional Review Board of Stanford University (Protocol ID: 30641). The findings of the trial will be disseminated through peer-reviewed publication. TRIAL REGISTRATION NUMBER Identifier NCT02185612; Pre-results.
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Affiliation(s)
- Sanjay Basu
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Rita Hamad
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Justin S White
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Sepideh Modrek
- Department of Medicine, Stanford University, Stanford, California, USA
| | - David H Rehkopf
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Mark R Cullen
- Department of Medicine, Stanford University, Stanford, California, USA
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Reitzel LR, Langdon KJ, Nguyen NT, Zvolensky MJ. Financial strain and smoking cessation among men and women within a self-guided quit attempt. Addict Behav 2015; 47:66-9. [PMID: 25879712 DOI: 10.1016/j.addbeh.2015.03.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 03/07/2015] [Accepted: 03/29/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Financial strain, defined as an unfavorable asset-to-needs ratio, has been associated with reduced odds of smoking cessation in the context of a structured clinical study providing cessation assistance. This study reports on a secondary data analysis that assessed the association of financial strain and biochemically-verified smoking abstinence within a structured clinical study of smokers making a self-guided cessation attempt. METHODS Participants (N=58; 65.5% men) were enrolled in a study about anxiety sensitivity and smoking cessation whereby they were instructed to initiate a self-guided quit attempt. Relations between financial strain and biochemically-verified smoking abstinence on the quit day and at Days 3, 7, 14, 28, and 90 post-quit were assessed using generalized estimating equations controlling for age, sex, race, education, partner status, pre-quit cigarettes smoked per day, and time. RESULTS Associations between financial strain and abstinence in the whole sample were marginal (aOR=.94, 95% CI=.87-1.01, observations=293; p=.07). However, sex was a significant moderator: greater financial strain was associated with lower odds of abstinence for men (aOR=.90, 95% CI=.80-1.00, observations=201; p=.05), but not women (aOR=1.05, 95% CI=.91-1.21, observations=92; p=.48). CONCLUSIONS Results indicated that financial strain was associated with lower odds of cessation among men undergoing a self-guided quit attempt in the context of a structured clinical study. These data suggest that financial strain may be an important socioeconomic determinant of smoking cessation and support its relevance for better understanding socioeconomic-based smoking-related health disparities. Future work may benefit by exploring sex-specific models of financial strain in the context of smoking cessation.
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Affiliation(s)
- Lorraine R Reitzel
- The University of Houston, College of Education, Department of Psychological, Health, & Learning Sciences, 491 Farish Hall, Houston, TX 77204-5029, USA.
| | - Kirsten J Langdon
- The National Center for PTSD, Women's Health Sciences Division, VA Boston Healthcare System, Boston University School of Medicine, Boston, MA 02118, USA
| | | | - Michael J Zvolensky
- The University of Houston, College of Liberal Arts and Social Sciences, Department of Psychology, 126 Heyne Building, Suite 104, Houston, TX 77204, USA
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Courtney RJ, Bradford D, Martire KA, Bonevski B, Borland R, Doran C, Hall W, Farrell M, Siahpush M, Sanson-Fisher R, West R, Mattick RP. A randomized clinical trial of a financial education intervention with nicotine replacement therapy (NRT) for low socio-economic status Australian smokers: a study protocol. Addiction 2014; 109:1602-11. [PMID: 25040447 DOI: 10.1111/add.12669] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 03/04/2014] [Accepted: 06/16/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Reducing smoking prevalence among smokers from low socio-economic status (SES) is a preventative health priority. Financial stress (e.g. shortage of money or inability to pay bills) may be a major barrier to quitting smoking. This study evaluates the efficacy of a financial education and support programme coupled with pharmacotherapy at improving cessation rates at 8-month follow-up among Australian low SES smokers (people receiving a government pension or allowance). DESIGN A two-group parallel block randomized (ratio 1 : 1) open-label clinical trial (RCT) with allocation concealment will be conducted. Allocation will be concealed to interviewers at data collection-points. SETTING The study will be conducted primarily by telephone with baseline, follow-up interviews and telephone-based support sessions. Nicotine replacement therapy (NRT) delivery will be mail-based. PARTICIPANTS Daily smokers who are interested in quitting smoking and are currently in receipt of government benefits (n = 1046) will be recruited through study advertisements placed in newspapers, posters placed in government social assistance agencies and Quitline telephone-based cessation support services. After completion of a baseline computer-assisted telephone interview, participants will be allocated randomly to control or intervention group using a permuted block approach. INTERVENTION AND COMPARATOR Participants in both groups will receive 8 weeks of free combination NRT plus Quitline support. Participants in the intervention group will also receive four telephone-delivered financial education and support sessions. MEASUREMENTS The primary outcome measure will be prolonged abstinence (at 8-month follow-up) assessed using Russell Standard criteria and biochemically verified (urine cotinine). COMMENTS This is the first intervention study to evaluate the potential of co-managing financial stress as a means of enhancing smokers' capacity to quit smoking. Such an intervention may provide a scalable intervention to help low SES smokers to quit.
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Affiliation(s)
- Ryan J Courtney
- National Drug and Alcohol Research Centre, Medicine, University of New South Wales (UNSW), Sydney, NSW, Australia
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Harley AE, Yang M, Stoddard AM, Adamkiewicz G, Walker R, Tucker-Seeley RD, Allen JD, Sorensen G. Patterns and predictors of health behaviors among racially/ethnically diverse residents of low-income housing developments. Am J Health Promot 2014; 29:59-67. [PMID: 24359221 PMCID: PMC4425289 DOI: 10.4278/ajhp.121009-quan-492] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To examine behavioral patterns and sociodemographic predictors of diet, inactivity, and tobacco use among a diverse sample of residents from low-income housing developments. DESIGN In this cross-sectional survey study, households and residents were randomly selected using multistage cluster sampling. Setting . The study was conducted in 20 low-income housing developments in the Boston, Massachusetts, metropolitan area. SUBJECTS Subjects were 828 residents who completed the survey (response rate = 49.3%). Forty-one percent of participants were Hispanic and 38% were non-Hispanic Black. Measures . Outcomes measured were diet, inactivity, and tobacco use. Predictors measured were age, race/ethnicity, gender, education, country in which the subject was born, language spoken, and financial hardship. Analysis . Logistic regression analyses were conducted to examine the association of three health behaviors with sociodemographic factors. RESULTS Age, gender, language spoken, and financial hardship showed significant relationships with all three behaviors. For example, those who reported less financial hardship (odds ratio [OR] = 1.75) were more likely to eat healthier. Residents who spoke no English, or at least one language in addition to English, were significantly more likely to report healthier eating (OR = 2.78 and 3.30, respectively) than those who spoke English only. Men were significantly more likely to report less healthy eating (OR = 0.65) than were women. Similar trends emerged for inactivity and tobacco use. CONCLUSION Effective health promotion interventions in low-income housing developments that leverage protective factors while addressing risk factors have the potential to reduce income-related health disparities in these concentrated resource-deprived neighborhoods.
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Brook JS, Rubenstone E, Zhang C, Brook DW. Better late than never: the perceived benefits of smoking cessation among women in late midlife. J Addict Dis 2014; 33:266-73. [PMID: 25115276 DOI: 10.1080/10550887.2014.950028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The current study examined the association of smoking cessation (≥1 year without relapse) and self-reported psychosocial and physical outcomes among a community sample of women (N = 195; mean age = 63.7 years, SD = 5.7 years). Data were collected in 1985-1986 and 2009. Successful smoking cessation for ≥1 year was significantly associated with each of the outcome measures (e.g., less financial stress [adjusted odds ratio (AOR) = 0.50; 95% confidence interval (CI) = 0.25-1.00, P< 0.05), less life dissatisfaction (AOR = 0.51, 95% CI = 0.24-1.09, P< 0.05). Findings suggest that older women should be included in smoking cessation programs, and the important benefits of quitting should be used to encourage cessation.
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Affiliation(s)
- Judith S Brook
- a Department of Psychiatry , New York University School of Medicine , New York , New York , USA
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Guillaumier A, Bonevski B, Paul C, D'Este C, Doran C, Siahpush M. Paying the price: a cross-sectional survey of Australian socioeconomically disadvantaged smokers' responses to hypothetical cigarette price rises. Drug Alcohol Rev 2013; 33:177-85. [PMID: 24350887 DOI: 10.1111/dar.12103] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 11/20/2013] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS Increases in tobacco taxation can lead to reductions in tobacco consumption and prevalence of use across social groups. However, use of price-minimisation strategies to manage current and future tobacco use and the role of financial stress is less understood. This study aimed to measure the effect of cigarette price increases on price-minimisation strategy endorsement and financial stress among socioeconomically disadvantaged smokers. DESIGN AND METHODS Community service organisation welfare recipients in NSW, Australia completed a touchscreen survey. Smoking history, financial stress, highest price to quit and responses to hypothetical cigarette price increases were assessed. RESULTS Participants were 354 smokers (response rate = 79%). Most participants received income from a government pension (95%), earned <A$300/week (55%), had not completed secondary schooling (64%), were moderately or heavily nicotine-dependent (60%), reported high financial stress (66%) and spent A$56/week on tobacco. In response to 10% and 20% hypothetical price rises, significantly more participants endorsed trying to quit in response to the larger increase scenario (P < 0.001), and fewer selected no change to their smoking (P < 0.001). Numerous price-minimisation strategies (e.g. switching to cheaper brands/products) were endorsed, but remained constant across hypothetical scenarios; level of financial stress appeared to have little influence. Smokers indicating they would not change their smoking in response to price rises had higher levels of nicotine dependence. DISCUSSION AND CONCLUSIONS Socially disadvantaged smokers endorsed numerous price-minimising strategies to maintain smoking at hypothetically increased costs. Larger cigarette price rises motivated more smokers to consider quitting, while price-resistant smokers appeared to have a more entrenched smoker status.
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Affiliation(s)
- Ashleigh Guillaumier
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
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Siahpush M, Borland R, Yong HH, Cummings KM, Fong GT. Tobacco expenditure, smoking-induced deprivation and financial stress: results from the International Tobacco Control (ITC) Four-Country Survey. Drug Alcohol Rev 2012; 31:664-71. [PMID: 22404640 DOI: 10.1111/j.1465-3362.2012.00432.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS While higher tobacco prices lead to a reduction in smoking prevalence, there is a concern that paying more for cigarettes can lead to excess financial burden. Our primary aim was to examine the association of daily cigarette expenditure with smoking-induced deprivation (SID) and financial stress (FS). DESIGN AND METHODS We used data from wave 7 (2008-2009) of the International Tobacco Control (ITC) Four-Country Survey which is a survey of smokers in Canada, the USA, the UK and Australia (n = 5887). Logistic regressions were used to assess the association of daily cigarette expenditure with SID and FS. RESULTS In multivariate analyses, a one standard deviation increase in daily cigarette expenditure was associated with an increase of 24% (P = 0.004) in the probability of experiencing SID. While we found no association between daily cigarette expenditure and FS, we found that SID is a strong predictor of FS (odds ratio 6.25; P < 0.001). This suggests that cigarette expenditure indirectly affects FS through SID. Results showed no evidence of an interaction between cigarette expenditure and income or education in their effect on SID or FS. CONCLUSIONS Our results imply that spending more on tobacco may result in SID but surprisingly has no direct effect on FS. While most smokers may be adjusting their incomes and consumption to minimise FS, some fail to do so occasionally as indexed by the SID measure. Future studies need to prospectively examine the effect of increased tobacco expenditure on financial burden of smokers.
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Affiliation(s)
- Mohammad Siahpush
- Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198-4365, USA.
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Slopen N, Dutra LM, Williams DR, Mujahid MS, Lewis TT, Bennett GG, Ryff CD, Albert MA. Psychosocial stressors and cigarette smoking among African American adults in midlife. Nicotine Tob Res 2012; 14:1161-9. [PMID: 22367977 DOI: 10.1093/ntr/nts011] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Psychosocial stress is a significant risk factor for smoking, and Blacks experience higher levels of psychosocial stress relative to other racial/ethnic groups. Limited research has comprehensively examined psychosocial stressors in relation to smoking among Blacks. METHODS We examined psychosocial stressors in relation to smoking status (current, previous, and never) in middle-aged Blacks (34-85 years, n = 592) from Milwaukee, Wisconsin, a subset of the Midlife in the United States Study II (2004-2006). Eleven stressor domains were assessed, including psychological and physical work stress, work-family conflict, perceived inequality, relationship stress, neighborhood stress, discrimination, financial stress, recent problems, stressful events, and childhood adversity. We also calculated a cumulative score. Multinomial models were adjusted for age, gender, education, and income. RESULTS Seven of the 11 stressors and the cumulative score were associated with higher odds of being a current smoker compared with a never-smoker: neighborhood, financial, relationship, and psychological work stress, perceived inequality, stressful events, childhood adversity (p values <.05; ORs ranged from 1.28 to 1.77). Three stressors and the cumulative score were associated with higher odds of being a previous smoker versus a never-smoker (p < .05). Individuals who scored in the top quartile on 5 or more stressors were 3.74 (95% CI = 2.09-6.71) times as likely to be current smokers, and more than twice as likely to be previous smokers, compared with individuals with no high stressors. CONCLUSIONS These results demonstrate a strong relationship between stress and smoking among urban middle-aged Blacks and suggest that cessation programs should address modifiable individual and community-level stressors.
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Affiliation(s)
- Natalie Slopen
- Center on the Developing Child, Harvard University, 50 Church Street, 4th Floor, Cambridge, MA 02138, USA.
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Lynagh M, Bonevski B, Symonds I, Sanson-Fisher RW. Paying women to quit smoking during pregnancy? Acceptability among pregnant women. Nicotine Tob Res 2011; 13:1029-36. [PMID: 21690320 DOI: 10.1093/ntr/ntr108] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION There is growing international interest in the use of financial incentives in smoking cessation, yet little research on public opinion of the scheme. This paper reports on the acceptability of incentives for reducing smoking in pregnant women and the perceived size of incentive that would encourage smoking cessation during pregnancy. METHODS A cross-sectional survey was conducted on a convenience sample of 213 women attending the antenatal clinic of a large public hospital in Australia. Participants completed a questionnaire on their views on the use of incentives with responses measured on a 5-point Likert scale. RESULTS The majority of participants (60%) did not agree that paying pregnant smokers to quit is a good idea. Opinions regarding the likely effectiveness were mixed with 30% of respondents in agreement and 22% undecided. Most (62%) were not willing to pay smokers any amount to quit. Smokers were more likely to have more favorable views about incentives than nonsmokers (p < .0001) and considered payments of between $100 and >$1,000 acceptable as reward for quitting smoking. CONCLUSIONS Acceptability for the use of financial incentives in reducing antenatal smoking is low among pregnant women. Future research should explore views of a wider audience and continue to gather stronger evidence of the efficacy of rewards for reducing smoking in pregnancy.
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Affiliation(s)
- Marita Lynagh
- School of Medicine & Public Health, University of Newcastle, David Maddison Building, Cnr King & Watt Streets, Newcastle, NSW 2300, Australia.
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Bonevski B, Paul C, D'Este C, Sanson-Fisher R, West R, Girgis A, Siahpush M, Carter R. RCT of a client-centred, caseworker-delivered smoking cessation intervention for a socially disadvantaged population. BMC Public Health 2011; 11:70. [PMID: 21281519 PMCID: PMC3038158 DOI: 10.1186/1471-2458-11-70] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 01/31/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disadvantaged groups are an important target for smoking cessation intervention. Smoking rates are markedly higher among severely socially disadvantaged groups such as indigenous people, the homeless, people with a mental illness or drug and alcohol addiction, and the unemployed than in the general population. This proposal aims to evaluate the efficacy of a client-centred, caseworker delivered cessation support intervention at increasing validated self reported smoking cessation rates in a socially disadvantaged population. METHODS/DESIGN A block randomised controlled trial will be conducted. The setting will be a non-government organisation, Community Care Centre located in New South Wales, Australia which provides emergency relief and counselling services to predominantly government income assistance recipients. Eligible clients identified as smokers during a baseline touch screen computer survey will be recruited and randomised by a trained research assistant located in the waiting area. Allocation to intervention or control groups will be determined by time periods with clients randomised in one-week blocks. Intervention group clients will receive an intensive client-centred smoking cessation intervention offered by the caseworker over two face-to-face and two telephone contacts. There will be two primary outcome measures obtained at one, six, and 12 month follow-up: 1) 24-hour expired air CO validated self-reported smoking cessation and 2) 7-day self-reported smoking cessation. Continuous abstinence will also be measured at six and 12 months follow up. DISCUSSION This study will generate new knowledge in an area where the current information regarding the most effective smoking cessation approaches with disadvantaged groups is limited. TRIAL REGISTRATION NUMBER ISRCTN: ISRCTN85202510.
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Affiliation(s)
- Billie Bonevski
- Centre for Health Research & Psycho-oncology (CHeRP), Cancer Council NSW & University of Newcastle, Newcastle, Australia.
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de Silva V, Samarasinghe D, Hanwella R. Association between concurrent alcohol and tobacco use and poverty. Drug Alcohol Rev 2011; 30:69-73. [PMID: 21219500 DOI: 10.1111/j.1465-3362.2010.00202.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS The harm from alcohol and tobacco use in low- and middle-income countries includes substantial economic cost to the individual. Our aim was to describe the expenditure on concurrent alcohol and tobacco use in relation to family income in two districts in Sri Lanka. DESIGN AND METHODS A community-based cross-sectional study was carried out in two districts in Sri Lanka. We sampled 2684 men over 18 years of age using multistage cluster sampling. Cost of alcohol and cigarettes was calculated using the retail price for each brand and multiplying by the amount consumed. RESULTS Among current alcohol users 63.1% were also smokers. Among current smokers 61.9% were also using alcohol. Prevalence of concurrent alcohol and tobacco use in urban areas was 20.1% and in rural areas 14%. The two lowest income categories (<$US76 per month) spent more than 40% of their income on concurrent use while the next category ($US76-143 per month) spent 34.8% of their income on concurrent use. DISCUSSION AND CONCLUSIONS The poor spent less than those with higher income on alcohol and tobacco, but the expenditure constituted a much larger slice of their income thus compromising their ability to meet basic needs. In low-income countries, damaging economic consequences start at lower levels of alcohol and tobacco consumption and affect a significant proportion of the population. Defining risk levels and guidelines on safe limits based purely on individual health harm has, at best, little meaning in such settings.
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Affiliation(s)
- Varuni de Silva
- Department of Psychological Medicine, Faculty of Medicine, Colombo, Sri Lanka.
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Bonevski B, Paul C, Lorraine P, Lecathelinais C. Spending, Shopping and Saving: Ex-Smokers' Perceptions About Material Gains Following Quitting. J Smok Cessat 2010. [DOI: 10.1375/jsc.5.1.77] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AbstractObjective:To measure (a) the perceived amount of money saved by ex-smokers after quitting, (b) changes in shopping behaviours and (c) alternative uses of the money saved.Design:A 2006 computer-assisted telephone interview survey of smoking-related behaviours and attitudes in New South Wales, Australia.Main outcome measures:Participants (N= 147) who had quit smoking in the previous 12 months answered items regarding personal expenditure on tobacco smoking.Results:Most (51%) ex-smokers reported spending up to $40 per week on cigarettes when they smoked. Fifty-six per cent of lower socioeconomic status (SES) ex-smokers reported spending over $40 per week on cigarettes compared to 40% of those from higher socioeconomic areas. Almost a third (28%) of respondents reported shopping more or shopping at different locations since quitting. The three highest alternative items purchased since quitting were food (19%). other things not listed (13%) and clothing (10%); however, most respondents reported not changing their spending habits (54%).Conclusion:This study indicates that tobacco is a high-cost product with smokers spending approximately 5% of average weekly income on cigarettes. Those living in lower SES areas report spending more on cigarettes than those in higher SES areas. The majority of quitters could not identify any change in spending or saving as a result of quitting. However, changes in shopping behaviours were noted. It may be useful for quitters to quarantine their cigarette money to increase the salience and power of financial benefit as an incentive to maintain quitting.
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Kendzor DE, Businelle MS, Costello TJ, Castro Y, Reitzel LR, Cofta-Woerpel LM, Li Y, Mazas CA, Vidrine JI, Cinciripini PM, Greisinger AJ, Wetter DW. Financial strain and smoking cessation among racially/ethnically diverse smokers. Am J Public Health 2010; 100:702-6. [PMID: 20167886 DOI: 10.2105/ajph.2009.172676] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated the influence of financial strain on smoking cessation among Latino, African American, and Caucasian smokers of predominantly low socioeconomic status. METHODS Smokers enrolled in a smoking cessation study (N = 424) were followed from 1 week prequit through 26 weeks postquit. We conducted a logistic regression analysis to evaluate the association between baseline financial strain and smoking abstinence at 26 weeks postquit after control for age, gender, race/ethnicity, educational level, annual household income, marital status, number of cigarettes smoked per day, and time to first cigarette of the day. RESULTS Greater financial strain at baseline was significantly associated with reduced odds of abstinence at 26 weeks postquit among those who completed the study (odds ratio [OR] = 0.77; 95% confidence interval [CI] = 0.62, 0.94; P = .01). There was a significant association as well in analyses that included those who completed the study in addition to those lost to follow-up who were categorized as smokers (OR = 0.78; 95% CI = 0.64, 0.96; P = .02). CONCLUSIONS Greater financial strain predicted lower cessation rates among racially/ethnically diverse smokers. Our findings highlight the impact of economic concerns on smoking cessation and the need to address financial strain in smoking cessation interventions.
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Affiliation(s)
- Darla E Kendzor
- Department of Health Disparities Research, University of Texas M. D. Anderson Cancer Center, Houston, TX 77230-1402, USA.
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West R. The multiple facets of cigarette addiction and what they mean for encouraging and helping smokers to stop. COPD 2010; 6:277-83. [PMID: 19811387 DOI: 10.1080/15412550903049181] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Addiction involves powerful motivation to engage in an activity repeatedly to an extent that is harmful often accompanied by impaired capacity for self-control. To effectively combat addiction to cigarettes requires an understanding that there are several mechanisms underlying it. The PRIME Theory of motivation aims to provide a model that can encapsulate these mechanisms. It recognises that evolution has led to multiple levels of motivation from basic impulses and inhibitions, through 'motives' (feelings of want and need), to 'evaluations' (beliefs about what is good or bad), and plans (intentions regarding future actions). Self-control involves self-consciously generating motives from evaluations or plans; it requires and depletes mental energy. Nicotine from cigarettes generates the motivation to smoke and undermines self-control by interacting with all of the level of motivation. It: creates stimulus-impulse associations resulting in cue-driven urges; impairs inhibitory control; gives enjoyment resulting in 'wanting' to smoke; it leads to 'nicotine hunger', withdrawal symptoms and beliefs about benefits of smoking (e.g. stress relief) all of which can result in a 'need' to smoke. Evidence is emerging that wanting to smoke (because of enjoyment) is a major deterrent to making quit attempts but does not influence success, while cue-driven impulses to smoke, nicotine hunger and adverse mood and beliefs about the benefits of smoking are important in relapse. Combating cigarette addiction requires attention to all of these factors.
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Affiliation(s)
- Robert West
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, England, UK
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Siahpush M, Singh GK, Jones PR, Timsina LR. Racial/ethnic and socioeconomic variations in duration of smoking: results from 2003, 2006 and 2007 Tobacco Use Supplement of the Current Population Survey. J Public Health (Oxf) 2009; 32:210-8. [PMID: 19892784 DOI: 10.1093/pubmed/fdp104] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Little is known about racial/ethnic and socioeconomic variations in the duration of smoking. The goal of this research was to examine these variations. METHODS Data came from the 2003, 2006 and 2007 Tobacco Use Supplement of the Current Population Survey. The analysis was limited to ever-smokers (n = 117,168). The outcome was number of years of daily smoking. Survival analysis was employed to predict smoking duration. RESULTS American Indians with 32 years had the highest median duration of smoking, followed by Blacks and 'other' races with 30 years, Whites with 28 years and Hispanics with 24 years. The difference in the duration of smoking between Blacks and Whites disappeared after adjusting for poverty. Individuals in poverty had a median duration of smoking of 40 years, while those with a family income of at least three times that of the poverty threshold had a median duration of 22 years. Median duration of smoking was 40 years among individuals without a high-school diploma and 18 years among those with a bachelors or higher degree. CONCLUSION This research revealed large variations in smoking duration between racial/ethnic and socioeconomic groups. Longer exposure to tobacco among groups that are already disadvantaged is likely to exacerbate existing health disparities.
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Affiliation(s)
- M Siahpush
- Department of Health Promotion, Social and Behavioral Health Sciences, College of Public Health, University of Nebraska Medical Center, 986075 Nebraska Medical Center, Omaha, NE 68198-6075, USA.
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Siahpush M, Yong HH, Borland R, Reid JL, Hammond D. Smokers with financial stress are more likely to want to quit but less likely to try or succeed: findings from the International Tobacco Control (ITC) Four Country Survey. Addiction 2009; 104:1382-90. [PMID: 19438837 PMCID: PMC2714876 DOI: 10.1111/j.1360-0443.2009.02599.x] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the association of financial stress with interest in quitting smoking, making a quit attempt and quit success. DESIGN AND PARTICIPANTS The analysis used data from 4984 smokers who participated in waves 4 and 5 (2005-07) of the International Tobacco Control (ITC) Four Country Survey, a prospective study of a cohort of smokers in the United States, Canada, the United Kingdom and Australia. MEASUREMENT The outcomes were interest in quitting at wave 4, making a quit attempt and quit success at wave 5. The main predictor was financial stress at wave 4: '. . . because of a shortage of money, were you unable to pay any important bills on time, such as electricity, telephone or rent bills?'. Additional socio-demographic and smoking-related covariates were also examined. FINDINGS Smokers with financial stress were more likely than others to have an interest in quitting at baseline [odds ratio (OR): 1.63; 95% confidence interval (CI): 1.22-2.19], but were less likely to have made a quit attempt at follow-up (OR: 0.74; 95% CI: 0.57-0.96). Among those who made a quit attempt, financial stress was associated with a lower probability of abstinence at follow-up (OR: 0.53; 95% CI: 0.33-0.87). CONCLUSIONS Cessation treatment efforts should consider assessing routinely the financial stress of their clients and providing additional counseling and resources for smokers who experience financial stress. Social policies that provide a safety net for people who might otherwise face severe financial problems, such as not being able to pay for rent or food, may have a favorable impact on cessation rates.
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Affiliation(s)
- Mohammad Siahpush
- Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, 986075 Nebraska Medical Center, Omaha, Nebraska, 68198-6075
| | - Hua-Hie Yong
- The Cancer Council Victoria, 1 Rathdowne Street, Carlton, Victoria 3053, Australia
| | - Ron Borland
- The Cancer Council Victoria, 1 Rathdowne Street, Carlton, Victoria 3053, Australia
| | - Jessica L. Reid
- Department of Health Studies & Gerontology, University of Waterloo, 200 University Ave West, Waterloo, ON,N2L 3G1 Canada
| | - David Hammond
- Department of Health Studies & Gerontology, University of Waterloo, 200 University Ave West, Waterloo, ON,N2L 3G1 Canada
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