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Morris D, Gillespie D, Dockrell MJ, Cook M, Horton M, Brown J, Langley TE. Potential smoke-free dividend across local areas in England: a cross-sectional analysis. Tob Control 2024:tc-2023-058264. [PMID: 38508755 DOI: 10.1136/tc-2023-058264] [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: 07/17/2023] [Accepted: 01/09/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND The value that might be added to local economies each year through the money that people who smoke tobacco would save if everyone quit smoking is called the 'smoke-free dividend'. This study aimed to estimate the value of the smoke-free dividend across local areas in England, and how it relates to the average income in those areas. METHODS The study was a cross-sectional descriptive analysis of tobacco expenditure from the Smoking Toolkit Study (STS) matched to income and smoking prevalence data for English local authorities. The STS sample was from 2014 to 2020 and comprised 18 721 adults who smoke cigarettes. Self-reported expenditure estimates from the STS were adjusted for under-reporting. This adjustment aimed to align the total expenditure estimate with figures derived from government tax receipts and national estimates of illicit tobacco use. The smoke-free dividend is calculated as 93% of spending on legal tobacco, which is the percentage estimated to leave the local economy, plus 100% of spending on illicit tobacco. RESULTS The total dividend in England is estimated to be £10.9 billion each year, which equates to £1776 per person who smokes or £246 per adult regardless of smoking status. The estimated dividend is greater in areas with lower average income, with a correlation coefficient of -0.521 (95% CI -0.629, -0.392) between the average income of local areas and the dividend per adult. CONCLUSIONS This study has estimated that local economies could gain a substantial dividend if everybody stopped smoking, which is larger in lower income areas, meaning that geographical economic inequalities could be reduced.
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Affiliation(s)
- Damon Morris
- Sheffield Addictions Research Group, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
- SPECTRUM Consortium, UK
| | - Duncan Gillespie
- Sheffield Addictions Research Group, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
- SPECTRUM Consortium, UK
| | - Martin J Dockrell
- SPECTRUM Consortium, UK
- Office for Health Improvement and Disparities, London, UK
| | - Mark Cook
- Office for Health Improvement and Disparities, London, UK
| | - Marie Horton
- SPECTRUM Consortium, UK
- Office for Health Improvement and Disparities, London, UK
| | - Jamie Brown
- SPECTRUM Consortium, UK
- Behavioural Science and Health, University College London, London, UK
| | - Tessa Elisabeth Langley
- SPECTRUM Consortium, UK
- Nottingham Centre for Public Health and Epidemiology, University of Nottingham, Nottingham, UK
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Kim-Mozeleski JE, Smell A, Castele MC, Ogden E, Trapl ES. Assessing the Feasibility of Conducting Smoking Cessation Outreach in Food Pantries: A Pilot Intervention Study. Nicotine Tob Res 2024; 26:46-53. [PMID: 37531409 PMCID: PMC10734382 DOI: 10.1093/ntr/ntad137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/25/2023] [Accepted: 07/31/2023] [Indexed: 08/04/2023]
Abstract
INTRODUCTION Smoking prevalence is high among US adults with food insecurity. This study examined how food assistance settings, namely food pantries, can serve as a community-based venue to reach food insecure adults who smoke for smoking cessation. METHODS Partnering with a local hunger relief organization, we conducted surveys and focus groups of food pantry clients in Greater Cleveland, Ohio, followed by food pantry-based outreach events to connect people who smoke to the Ohio Tobacco Quit Line. RESULTS The survey included 132 participants who visited a food pantry (M age = 47; 74% women; 39% Black/African American), of whom 35% were using tobacco and 31% were smoking cigarettes. Among those currently smoking (M cigarettes/day = 9), 76% intended to quit in the next 6 months, and 82% had not used nor heard of the quitline. Informed by focus group themes, we conducted a total of 22 outreach events at four pantries. Among those interested in smoking cessation resources from the outreach events (n = 54), 78% were able to be subsequently contacted. Of them, 74% provided consent for quitline referral. The remainder either declined or were unable to participate. CONCLUSIONS While it was feasible to leverage food pantries for smoking cessation outreach, the overall reach was low. Despite high interest in quitting, there was limited effectiveness of outreach efforts without adaptations to each pantry setting and in recognition of the immediate food needs and with challenges related to the COVID-19 pandemic. There remains a critical need to address high rates of smoking among populations experiencing food insecurity. IMPLICATIONS Tobacco cessation services are increasingly recognizing the need to address food insecurity and other social needs that commonly occur in populations who use tobacco at higher rates. This research underscores both the value and the challenges related to leveraging food pantries as a community-based venue for smoking cessation outreach. In addition to improvements in outreach models, long-term investments in structural interventions are also needed to address underlying poverty and socioeconomic disadvantage that ultimately drive disparities in smoking and in food insecurity.
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Affiliation(s)
- Jin E Kim-Mozeleski
- Prevention Research Center for Healthy Neighborhoods, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Adrianna Smell
- Prevention Research Center for Healthy Neighborhoods, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Madeline C Castele
- Prevention Research Center for Healthy Neighborhoods, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Erin Ogden
- Prevention Research Center for Healthy Neighborhoods, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Erika S Trapl
- Prevention Research Center for Healthy Neighborhoods, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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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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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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Kang SY, Cho HJ. Association Between the Use of Tobacco Products and Food Insecurity Among South Korean Adults. Int J Public Health 2022; 67:1604866. [PMID: 36158781 PMCID: PMC9492844 DOI: 10.3389/ijph.2022.1604866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: Food insecurity is the most basic form of human deprivation; thus, strategies to eradicate poverty should include policies to improve food insecurity. This study investigated the association between the use of tobacco products and food insecurity. Methods: We analyzed 21,063 adults from the Korea National Health and Nutrition Examination Survey, 2013–2015, 2019. The OR and 95% CI for food insecurity was calculated in each category of the status of tobacco products use and sociodemographic characteristics using multivariable logistic regression analysis. Results: Of 21,063 participants, 7.3% belonged to the food insecurity group. The OR (95% CI) for food insecurity was 1.34 (1.08–1.65) among current users of any tobacco products compared with those who had never used any tobacco product. The odds for food insecurity were higher among those with secondhand smoke exposure, younger participants, those with lower household income, lower levels of education, manual workers or people without occupation, and separated/widowed/divorced participants. Conclusion: Use of any tobacco products was associated with food insecurity among South Korean adults. Tobacco control could improve food insecurity.
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Affiliation(s)
- Seo Young Kang
- International Healthcare Center, Asan Medical Center, Seoul, South Korea
| | - Hong-Jun Cho
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- *Correspondence: Hong-Jun Cho,
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Rogers ES, Rosen MI, Elbel B, Wang B, Kyanko K, Vargas E, Wysota CN, Sherman SE. Integrating Financial Coaching and Referrals into a Smoking Cessation Program for Low-income Smokers: a Randomized Waitlist Control Trial. J Gen Intern Med 2022; 37:2973-2981. [PMID: 35018561 PMCID: PMC9485413 DOI: 10.1007/s11606-021-07209-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/08/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Financial distress is a barrier to cessation among low-income smokers. OBJECTIVE To evaluate an intervention that integrated financial coaching and benefits referrals into a smoking cessation program for low-income smokers. DESIGN Randomized waitlist control trial conducted from 2017 to 2019. PARTICIPANTS Adult New York City residents were eligible if they reported past 30-day cigarette smoking, had income below 200% of the federal poverty level, spoke English or Spanish, and managed their own funds. Pregnant or breastfeeding people were excluded. Participants were recruited from two medical centers and from the community. INTERVENTION The intervention (n = 208) offered smoking cessation coaching, nicotine replacement therapy, money management coaching, and referral to financial benefits and empowerment services. The waitlist control (n=202) was usual care during a 6-month waiting period. MAIN MEASURES Treatment engagement, self-reported 7-day abstinence, and financial stress at 6 months. KEY RESULTS At 6 months, intervention participants reported higher abstinence (17% vs. 9%, P=0.03), lower stress about finances (β, -0.8 [SE, 0.4], P=0.02), and reduced frequency of being unable to afford activities (β, -0.8 [SE, 0.4], P=0.04). Outcomes were stronger among participants recruited from the medical centers (versus from the community). Among medical center participants, the intervention was associated with higher abstinence (20% vs. 8%, P=0.01), higher satisfaction with present financial situation (β, 1.0 [SE, 0.4], P=0.01), reduced frequency of being unable to afford activities (β, -1.0 [SE, 0.5], P=0.04), reduced frequency in getting by paycheck-to-paycheck (β, -1.0 [SE, 0.4], P=0.03), and lower stress about finances in general (β, -1.0 [SE, 0.4], P = 0.02). There were no group differences in outcomes among people recruited from the community (P>0.05). CONCLUSIONS Among low-income smokers recruited from medical centers, the intervention produced higher abstinence rates and reductions in some markers of financial distress than usual care. The intervention was not efficacious with people recruited from the community. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03187730.
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Affiliation(s)
- Erin S Rogers
- Department of Population Health, New York University Grossman School of Medicine, NY, New York, USA.
- VA NY Harbor Healthcare System, New York, NY, USA.
| | - Marc I Rosen
- Department of Psychiatry, Yale University, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Brian Elbel
- Department of Population Health, New York University Grossman School of Medicine, NY, New York, USA
- New York University, Wagner School of Public Service, New York, NY, USA
| | - Binhuan Wang
- Department of Population Health, New York University Grossman School of Medicine, NY, New York, USA
| | - Kelly Kyanko
- Department of Population Health, New York University Grossman School of Medicine, NY, New York, USA
| | - Elizabeth Vargas
- Department of Population Health, New York University Grossman School of Medicine, NY, New York, USA
| | - Christina N Wysota
- Department of Population Health, New York University Grossman School of Medicine, NY, New York, USA
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Scott E Sherman
- Department of Population Health, New York University Grossman School of Medicine, NY, New York, USA
- VA NY Harbor Healthcare System, New York, NY, USA
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Latent Heterogeneity in the Impact of Financial Coaching on Delay Discounting among Low-Income Smokers: A Secondary Analysis of a Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052736. [PMID: 35270426 PMCID: PMC8910110 DOI: 10.3390/ijerph19052736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 11/16/2022]
Abstract
Low-income adults are significantly more likely to smoke, and face more difficulty in quitting, than people with high income. High rates of delay discounting (DD) may be an important factor contributing to the high rates of tobacco use among low-income adults. Future-oriented financial coaching may offer a novel approach in the treatment of smoking cessation among low-income adults. This secondary analysis (N = 251) of data from a randomized controlled trial examined the integration of future-oriented financial coaching into smoking cessation treatment for low-income smokers. Linear regression and finite mixture models (FMM) estimated the overall and the latent heterogeneity of the impact of the intervention versus usual care control on DD rates 6 months after randomization. Though standard linear regression found no overall difference in DD between intervention and control (β = −0.23, p = 0.338), the FMM identified two latent subgroups with different responses to the intervention. Subgroup 1 (79% of the sample) showed no difference in DD between intervention and control (β = 0.25, p = 0.08). Subgroup 2 (21% of the sample) showed significantly lower DD (β = −2.06, p = 0.003) among intervention group participants versus control at 6 months. Participants were more likely to be a member of subgroup 2 if they had lower baseline DD rates, were living at or below 100% of federal poverty, or were married/living with a partner. This study identified a group of low-income adults seeking to quit smoking who responded to financial coaching with decreased DD rates. These results can be used to inform future targeting of the intervention to individuals who may benefit most, as well as inform future treatment adaptations to support the subgroup of low-income smokers, who did not benefit.
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Jones SM, Heffner JL. Financial anxiety: a potential new target to increase smoking cessation. Future Oncol 2022; 18:1035-1038. [PMID: 35132901 DOI: 10.2217/fon-2021-1570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Salene Mw Jones
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
| | - Jaimee L Heffner
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
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Nyakutsikwa B, Britton J, Langley T. The effect of tobacco and alcohol consumption on poverty in the United Kingdom. Addiction 2021; 116:150-158. [PMID: 32335947 DOI: 10.1111/add.15096] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/25/2020] [Accepted: 04/17/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Tobacco and alcohol use are major risk factors for premature mortality and morbidity. Tobacco and alcohol expenditure may also exacerbate poverty. This study aimed to estimate the financial impact of tobacco and alcohol consumption in low income households in the United Kingdom. DESIGN We undertook a cross-sectional study using a secondary dataset. A sample of 5031 households participated in the 2016-17 Living Costs and Food Survey. Measurements We measured the weekly household income and expenditure on tobacco and alcohol, and the proportion of households with expenditure on tobacco and alcohol overall, by income decile and in households in relative poverty (below 60% of the median household income). Estimates were extrapolated using population data to estimate the number of UK households, adults and children that would be classified as living in relative poverty on the basis of net income after subtracting tobacco or alcohol expenditure ('tobacco and alcohol expenditure-adjusted poverty'). FINDINGS Spending on alcohol was more common in high income groups; 83% of households in the highest and 47% in the lowest income decile purchased alcohol. The reverse was true for tobacco, which was purchased by 8% and 24% of households in the highest and lowest income deciles respectively. Twenty-three percent of households in relative poverty purchased tobacco and 49% alcohol, with a median expenditure of £12.50 and £9.55 per week, respectively. A total of 320 000 households comprising 590 000 adults and 175 000 children were in alcohol expenditure-adjusted poverty, and 230 000 households, comprising 400 000 adults and 180 000 children in tobacco-expenditure adjusted poverty. CONCLUSIONS Tobacco and alcohol expenditure appear to exacerbate poverty in low income households in the United Kingdom. Hundreds of thousands of additional households would be defined as living in relative poverty based on their income after subtracting their tobacco and alcohol expenditure.
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Affiliation(s)
- Blessing Nyakutsikwa
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Nottingham, NG5 1PB, England
| | - John Britton
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Nottingham, NG5 1PB, England.,SPECTRUM Consortium
| | - Tessa Langley
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Nottingham, NG5 1PB, England.,SPECTRUM Consortium
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10
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Kim-Mozeleski JE, Pandey R. The Intersection of Food Insecurity and Tobacco Use: A Scoping Review. Health Promot Pract 2020; 21:124S-138S. [PMID: 31908208 DOI: 10.1177/1524839919874054] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cigarette smoking is increasingly concentrated in socioeconomically disadvantaged groups, and food insecurity also disproportionately affects lower-income groups. Recent studies have suggested that smoking and food insecurity operate as risk factors for one another, but there is limited understanding of their intersection. This scoping review aimed to synthesize the published literature on the association between food insecurity and tobacco use across population groups in the United States and Canada. We searched PubMed, Web of Science, and PsycINFO using key words. Studies included were published in English between 2008 and 2018, reported empirical findings, measured both tobacco use and food insecurity, and considered either variable as a study outcome. Nineteen articles were identified; 6 examined tobacco use as an outcome variable and 13 examined food insecurity as an outcome variable. Most articles were of studies using cross-sectional designs. Study samples ranged from general populations, clinical samples, and underserved populations. For each article, we extracted information including specific findings related to the association between food insecurity and tobacco use. We synthesized the current research by formulating a model by which food insecurity and tobacco use are bidirectionally associated. This scoping review concludes that the co-occurrence of food insecurity and tobacco use exists across populations in the United States and Canada. As the evidence is largely from cross-sectional investigations, there is a need for longer term, comprehensive assessments of relationships between tobacco use and food insecurity. Such investigations can inform policies and interventions aimed toward addressing the inequitable burden of tobacco use and of food insecurity among disadvantaged populations.
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11
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Kim-Mozeleski JE, Poudel KC, Tsoh JY. Examining Reciprocal Effects of Cigarette Smoking, Food Insecurity, and Psychological Distress in the U.S. J Psychoactive Drugs 2020; 53:177-184. [PMID: 33143564 DOI: 10.1080/02791072.2020.1845419] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In the U.S., cigarette smoking is increasingly concentrated in disadvantaged and vulnerable populations, such as populations with lower income and with mental health needs. Food insecurity is linked with psychological distress and is an independent risk factor for smoking. We prospectively examined how cigarette smoking, food insecurity, and psychological distress operate as risk factors for one another in a 2-year longitudinal analysis of U.S. adults from the 2015 and 2017 Panel Study of Income Dynamics, a nationally representative household survey (N = 7946). Using cross-lagged panel analysis, cross-lagged regression coefficients were estimated simultaneously with direct-effect paths, controlling for covariates. Results showed significant bidirectional associations between smoking and food insecurity: 2015 smoking predicted 2017 food insecurity, and 2015 food insecurity predicted 2017 smoking. Food insecurity and psychological distress also had significant bidirectional associations. However, the association between smoking and psychological distress was unidirectional: 2015 psychological distress predicted 2017 smoking, but not vice versa. The findings suggest a cyclical possibility that smoking exacerbates food insecurity, food insecurity exacerbates psychological distress, and psychological distress exacerbates smoking. There is a need to replicate with more timepoints, but our results highlight the importance of examining the overlapping health burdens of smoking, food insecurity, and psychological distress.
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Affiliation(s)
- Jin E Kim-Mozeleski
- Prevention Research Center for Healthy Neighborhoods, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Krishna C Poudel
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, Institute for Global Health, University of Massachusetts Amherst, Amherst, MA, USA
| | - Janice Y Tsoh
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
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12
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Stinson S, Chieng A, Prochaska JJ. Discretionary spending priorities of unemployed, job-seeking adults who smoke cigarettes. Addict Behav Rep 2020; 11:100270. [PMID: 32274416 PMCID: PMC7132062 DOI: 10.1016/j.abrep.2020.100270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/18/2020] [Accepted: 03/18/2020] [Indexed: 11/16/2022] Open
Abstract
Objective Tobacco use is detrimental to physical and financial wellbeing. Smoking is associated with unemployment and a harder time finding re-employment. The current study examined job-seekers' prioritization of smoking over other discretionary items. Methods Adult, unemployed job-seekers smoking daily ranked items from 1 (highest) to 13 (lowest) for prioritization of their discretionary spending. The online survey randomly ordered the presentation of items. The Heaviness of Smoking Index (HSI, time to first cigarette and cigarettes per day) assessed severity of nicotine addiction. Results The sample (N = 290) was 70% men, 42% African American and 30% non-Hispanic Caucasian, with mean age of 43 (SD = 11), smoking an average of 12 cigarettes per day (SD = 6), and 67% smoking within 30 min of waking. Overall, cigarettes (M = 4.7, SD = 3.1) ranked second in importance behind only food (M = 2.5, SD = 2.7); 45% of the sample ranked tobacco in their top 3 spending priorities, and 26% ranked cigarettes as a higher priority than food. Cellular charges, transportation, grooming, and clothing ranked third through sixth, respectively. Higher HSI scores significantly correlated with greater prioritization of cigarettes (r = -0.25), and lower prioritization of food (r = 0.16) and transportation (r = 0.13), p's < 0.05. Conclusions Findings indicate cigarettes were highly prioritized, second only to food among job-seekers who smoke. Cigarettes were prioritized over job-seeking resources and health care, particularly among those who were more heavily addicted. Tobacco addiction can preempt basic life needs and reduce resources for finding re-employment.
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Affiliation(s)
- Sarah Stinson
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA, USA.,College of Medicine, California Northstate University, USA
| | - Amy Chieng
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA, USA
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Hawkins SS, Kull M, Baum CF. US state cigarette tax increases and smoke-free legislation in relation to cigarette expenditure across household socio-economic circumstances: a quasi-experimental study. Addiction 2019; 114:721-729. [PMID: 30461118 DOI: 10.1111/add.14505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/03/2018] [Accepted: 11/02/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS While research has focused on outcomes of tobacco control policies, less is known about the mechanisms by which policies may affect tobacco use. We estimated the associations of changes in cigarette taxes and smoke-free legislation with (1) any household cigarette expenditure and (2) the level of household expenditure on cigarettes, as well as (3) tested interactions with socio-economic circumstances. DESIGN Difference-in-differences regression models to estimate the associations between changes in US state cigarette taxes and smoke-free legislation with changes in household expenditure on cigarettes. SETTING Forty US states and District of Columbia. PARTICIPANTS From annual, cross-sectional surveys (with a longitudinal component) between 2000 and 2014, 128 138 households interviewed quarterly in the Consumer Expenditure Survey. MEASUREMENTS Dependent measures included any household cigarette expenditure, expenditure in real dollars and budget share of cigarette expenditure. Policy measures included state cigarette taxes and 100% smoke-free legislation. Covariates included respondent age, race/ethnicity, sex; household education; poverty level; family structure; and number of children and adults. FINDINGS Every $1.00 cigarette tax increase was associated with a 1.5 percentage point (-0.028, -0.002) reduction in any cigarette expenditure and an increase of 0.1% (0.1%, 0.1%) budget share and $10.11 ($8.38, $11.84) absolute expenditure. The association with absolute expenditure was stronger among smoking households above poverty level ($10.73; $8.94, $12.51) than below ($4.72; $2.37, $7.07). The enactment of smoke-free legislation was associated with $2.33 (-$4.56, -$0.10) less expenditure, but not with any expenditure (0.1%; -1.6%, 1.8%) or budget share (-0.1%; -0.1%, 0.1%). The association with absolute expenditure was stronger among households above poverty level (-$2.62; -$4.95, -$0.29) than below (-$0.34; -$4.27, $3.58) CONCLUSION: Cigarette tax increases in the United States between 2000 and 2014 may have reduced smoking prevalence due to an absolute and relative increase in household tobacco expenditure while smoke-free policies appear to have led to a reduction in expenditure. Although tax increases had a stronger impact on absolute expenditure among households above the poverty level, impact on relative expenditure was similar, and consequences for socio-economic inequalities in smoking will vary based on the broader financial situation of households.
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Affiliation(s)
| | - Melissa Kull
- Chapin Hall at the University of Chicago, Chicago, IL, USA
| | - Christopher F Baum
- Boston College, School of Social Work, Chestnut Hill, MA, USA.,Department of Economics, Boston College, Chestnut Hill, MA, USA.,German Institute for Economic Research (DIW Berlin), Berlin, Germany
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Poghosyan H, Moen EL, Kim D, Manjourides J, Cooley ME. Social and Structural Determinants of Smoking Status and Quit Attempts Among Adults Living in 12 US States, 2015. Am J Health Promot 2018; 33:498-506. [PMID: 30071738 DOI: 10.1177/0890117118792827] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This study examined the relationships among intermediary determinants, structural determinants, and adult smoking status and quit attempts. DESIGN Secondary data analysis of cross-sectional data. SETTING Data come from the 2015 Behavioral Risk Factor Surveillance System (BRFSS), Social Context module. A national, representative sample from 12 US states (Alabama, Arkansas, Delaware, District of Columbia, Georgia, Louisiana, Minnesota, Mississippi, Missouri, Rhode Island, Tennessee, and Utah). PARTICIPANTS A total of 64 053 noninstitutionalized US adults aged ≥18 years. MEASURES Smoking status and quit attempts were outcome variables. Individual-level structural determinants (age, sex, race/ethnicity, marital status, education, and employment status) and intermediary determinants (housing insecurity, food insecurity, health insurance, binge drinking, and general health mental health) from BRFSS. ANALYSIS Weighted multivariate, multinomial logistic regression. RESULTS Current smoking was greater among men, respondents aged between 35 to 64 and 55 to 64, adults who reported food insecurity, housing insecurity, frequent mental distress, binge drinking, and who were unemployed. Current smokers had higher odds of making quit attempts in the past 12 months if they were non-Hispanic Black, graduated college, and reported food and housing insecurity. CONCLUSION Multifaceted smoking cessation interventions that address food and housing needs also incorporate screening for potential comorbidities such as mental distress and/or hazardous alcohol use and may be needed to enhance smoking cessation rates among racially diverse adults.
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Affiliation(s)
- Hermine Poghosyan
- 1 Northeastern University, Bouve College of Health Sciences, Boston, MA, USA
| | - Erika L Moen
- 2 The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth Colleague, Lebanon, NH, USA
| | - Daniel Kim
- 3 Department of Health Sciences, Northeastern University, Bouve College of Health Sciences, Boston, MA, USA
| | - Justin Manjourides
- 3 Department of Health Sciences, Northeastern University, Bouve College of Health Sciences, Boston, MA, USA
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Kalkhoran S, Berkowitz SA, Rigotti NA, Baggett TP. Financial Strain, Quit Attempts, and Smoking Abstinence Among U.S. Adult Smokers. Am J Prev Med 2018; 55:80-88. [PMID: 29628382 PMCID: PMC6014904 DOI: 10.1016/j.amepre.2018.01.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/08/2018] [Accepted: 01/29/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Cigarette smoking is substantially more prevalent and rates of smoking cessation are lower in low-SES adults. Financial strain may be one explanation for this. This study assessed the association between financial strain, quit attempts, and successful smoking cessation among adult smokers in the U.S. METHODS Longitudinal data on adult current smokers (aged ≥18 years) from Waves 1 and 2 of the nationally representative Population Assessment of Tobacco and Health Study (2013-2015) were analyzed in 2017. Negative binomial regression and logistic regression models assessed the association between financial strain and (1) quit attempts and (2) cigarette abstinence, adjusting for important confounders. RESULTS Smokers with financial strain made more quit attempts than smokers without financial strain (adjusted incidence-rate ratio=1.34, 95% CI=1.07, 1.68), but financial strain was not associated with smoking abstinence at follow-up (AOR=0.86, 95% CI=0.70, 1.05). Low income was associated with less smoking abstinence at follow-up (AOR=0.66, 95% CI=0.50, 0.87, for <100% federal poverty level; AOR=0.64, 95% CI=0.48, 0.85, for 100%-199% of federal poverty level). Smokers with baseline financial strain who quit at follow-up had lower odds of financial strain at follow-up (AOR=0.57, 95% CI=0.36, 0.89). CONCLUSIONS Financially strained smokers made slightly more quit attempts than non-strained smokers but were no more likely to successfully quit. Low-income (less than 200% of the federal poverty level) smokers were less likely to quit than higher-income smokers, suggesting that financial strain alone may not explain the low quit rates in this population. Further efforts are needed to increase the success of quit attempts in low-income and financially strained smokers.
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Affiliation(s)
- Sara Kalkhoran
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Seth A Berkowitz
- Harvard Medical School, Boston, Massachusetts; Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Division of General Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Travis P Baggett
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts
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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] [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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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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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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Rogers ES, Dave DM, Pozen A, Fahs M, Gallo WT. Tobacco cessation and household spending on non-tobacco goods: results from the US Consumer Expenditure Surveys. Tob Control 2017; 27:209-216. [DOI: 10.1136/tobaccocontrol-2016-053424] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 02/21/2017] [Accepted: 02/22/2017] [Indexed: 11/04/2022]
Abstract
ObjectivesTo estimate the impact of tobacco cessation on household spending on non-tobacco goods in the USA.MethodsUsing 2006–2015 Consumer Expenditure Survey data, 9130 tobacco-consuming households were followed for four quarters. Households were categorised during the fourth quarter as having: (1) recent tobacco cessation, (2) long-term cessation, (3) relapsed cessation or (4) no cessation. Generalised linear models were used to compare fourth quarter expenditures on alcohol, food at home, food away from home, housing, healthcare, transportation, entertainment and other goods between the no-cessation households and those with recent, long-term or relapsed cessation. The full sample was analysed, and then analysed by income quartile.ResultsIn the full sample, households with long-term and recent cessation had lower spending on alcohol, food, entertainment and transportation (p<0.001). Recent cessation was further associated with reduced spending on food at home (p<0.001), whereas relapsed cessation was associated with higher spending on healthcare and food away from home (p<0.001). In the highest income quartile, long-term and recent cessations were associated with reduced alcohol spending only (p<0.001), whereas in the lowest income quartile, long-term and recent cessations were associated with lower spending on alcohol, food at home, transportation and entertainment (p<0.001).ConclusionsHouseholds that quit tobacco spend less in areas that enable or complement their tobacco cessation, most of which may be motivated by financial strain. The most robust association between tobacco cessation and spending was the significantly lower spending on alcohol.
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Thomas DP, Panaretto KS, Davey M, Briggs V, Borland R. The social determinants and starting and sustaining quit attempts in a national sample of Aboriginal and Torres Strait Islander smokers. Aust N Z J Public Health 2017; 41:230-236. [DOI: 10.1111/1753-6405.12626] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 07/01/2016] [Accepted: 09/01/2016] [Indexed: 01/28/2023] Open
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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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Siahpush M, Shaikh RA, Robbins R, Tibbits M, Kessler AS, Soliman G, McCarthy M, Singh GK. Point-of-sale cigarette marketing and smoking-induced deprivation in smokers: results from a population-based survey. BMC Public Health 2016; 16:302. [PMID: 27121197 PMCID: PMC4848780 DOI: 10.1186/s12889-016-2992-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 03/29/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Strict restrictions on outdoor cigarette marketing have resulted in increasing concentration of cigarette marketing at the point-of-sale (POS). The association between POS cigarette marketing and smoking-induced deprivation (SID) has never been studied. The aim of this study was to examine this association and how it is mediated by cravings to smoke, urges to buy cigarettes, and unplanned purchases of cigarettes. METHODS Data from a telephone survey of 939 smokers were collected in Omaha, Nebraska. POS cigarette marketing was measured by asking respondents three questions about noticing pack displays, advertisements, and promotions such as cigarette price discounts within their respective neighborhoods. SID was measured with the following question: "In the last six months, has there been a time when the money you spent on cigarettes resulted in not having enough money for household essentials such as food? [yes/no]" We used structural equation modeling to examine the study aim. RESULTS There was overwhelming evidence for an association between higher levels of POS cigarette marketing and a higher probability of SID (p < 0.001). This association was partly mediated by cravings to smoke, urges to buy cigarettes, and unplanned purchases of cigarettes during a visit to a neighborhood store (p < 0.001). CONCLUSION Given that POS cigarette marketing is associated with a higher probability of experiencing SID, policies that ban POS cigarette marketing might help some smokers afford essentials household items such as food more easily and thus have better standards of living.
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Affiliation(s)
- Mohammad Siahpush
- />University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198-4365 USA
| | - Raees A. Shaikh
- />University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198-4365 USA
| | - Regina Robbins
- />University of Nebraska Omaha, 6001 Dodge St, Omaha, NE 68182 USA
| | - Melissa Tibbits
- />University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198-4365 USA
| | - Asia Sikora Kessler
- />University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198-4365 USA
| | - Ghada Soliman
- />University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198-4365 USA
| | - Molly McCarthy
- />University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198-4365 USA
| | - Gopal K. Singh
- />The Center for Global Health and Health Policy, Global Health and Education Projects, P O Box 234, Riverdale, MD 20738 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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Nicholson AK, Borland R, Davey ME, Stevens M, Thomas DP. Predictors of wanting to quit in a national sample of Aboriginal and Torres Strait Islander smokers. Med J Aust 2015; 202:S26-32. [DOI: 10.5694/mja15.00199] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 05/11/2015] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Maureen E Davey
- Aboriginal Health Service, Tasmanian Aboriginal Centre, Hobart, TAS
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Lombardo S, Perera B, Beaudry L, Grad J, Maselko J, Østbye T. Use of and attitudes toward tobacco and alcohol among adults in southern Sri Lanka. THE SOUTHEAST ASIAN JOURNAL OF TROPICAL MEDICINE AND PUBLIC HEALTH 2013; 44:880-899. [PMID: 24437324 PMCID: PMC4169263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The adverse health effects of tobacco and alcohol are well known. Alcohol consumption is increasing in Sri Lanka, but few population studies have been conducted. The objective of this study was to document tobacco and alcohol consumption levels among adults in southern Sri Lanka and to identify the main reasons for using or refraining from alcohol and tobacco products. Tobacco and alcohol use within Sri Lanka is relatively common, particularly among adult males. Reasons given for smoking and drinking frequently relate to social and image-based motivators. Women may be especially susceptible to the influence of peer pressure in social situations. Public health efforts should consider the use of demographic-specific anti-tobacco and anti-alcohol messages, as the motivators driving behavior appear to differ across gender and age groups.
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Affiliation(s)
- Sarah Lombardo
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Bilesha Perera
- Department of Community Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Lauren Beaudry
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Jennifer Grad
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Joanna Maselko
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Truls Østbye
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
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Siahpush M, Thrasher JF, Yong HH, Cummings KM, Fong GT, de Miera BS, Borland R. Cigarette prices, cigarette expenditure and smoking-induced deprivation: findings from the International Tobacco Control Mexico survey. Tob Control 2012; 22:223-6. [PMID: 22923478 DOI: 10.1136/tobaccocontrol-2012-050613] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM Mexico implemented annual tax increases between 2009 and 2011. We examined among current smokers the association of price paid per cigarette and daily cigarette expenditure with smoking-induced deprivation (SID) and whether the association of price or expenditure with SID varies by income. METHODS We used data (n=2410) from three waves of the International Tobacco Control Mexico survey (ie, 2008, 2010, 2011) and employed logistic regression to estimate the association of price paid per cigarette and daily cigarette expenditure with the probability of SID ('In the last 6 months, have you spent money on cigarettes that you knew would be better spent on household essentials like food?'). RESULTS Price paid per cigarette increased from Mex$1.24 in 2008, to Mex$1.36 in 2010, to Mex$1.64 in 2011. Daily cigarette expenditure increased from Mex$6.9, to Mex$7.6 and to Mex$8.4 in the 3 years. There was no evidence of an association between price and SID. However, higher expenditure was associated with a higher probability of SID. There was no evidence that the association of price or expenditure with SID varied by income. CONCLUSION Tax increases in Mexico have resulted in smokers paying more and spending more for their cigarettes. Those with higher cigarette expenditure experience more SID, with no evidence that poorer smokers are more affected.
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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, NE 68198-6075, USA.
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Moore K, Borland R, Yong HH, Siahpush M, Cummings KM, Thrasher JF, Fong GT. Support for tobacco control interventions: do country of origin and socioeconomic status make a difference? Int J Public Health 2012; 57:777-86. [PMID: 22714136 DOI: 10.1007/s00038-012-0378-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 05/15/2012] [Accepted: 06/01/2012] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine the attitudes to various tobacco control regulations among smokers from four different countries and explore differences by country and socioeconomic status. METHODS Questions relating to tobacco regulation were asked of adult smokers from the 2007-2008 International Tobacco Control Four Country Survey (ITC4). Measures included attitudes to tobacco industry and product regulation, and measures of socioeconomic status and economic disadvantage. RESULTS Overall smokers supported greater regulation of the tobacco industry with least supportive US smokers and most supportive Australian smokers. Reporting smoking-related deprivation and a lower income was independently associated with increased support for regulation of the tobacco industry (both p≤0.01). CONCLUSIONS Policy-makers interested in doing more to control tobacco should be reassured that, for the most part, they have the support of smokers, with greatest support in countries with the strongest regulations. Smokers economically disadvantaged by smoking were more supportive of government policies to regulate the tobacco industry suggesting that reactance against regulation is not likely to differentially contribute to lower cessation rates in this group.
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Affiliation(s)
- Karen Moore
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
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