Examining Psychosocial Correlates of a Home Smoking Ban Among Low-income Smokers: Analysis of Social Support, Unmet Social Needs, Perceived Stress, and Depressive Symptoms

Home smoking bans reduce exposure to second-hand smoke. Understanding how psychosocial factors are related to having a home smoking ban may lead to better interventions for populations less likely to have home smoking bans, including low-income smokers. In this study, we used baseline data from 1,944 participants in a randomized trial of low-income smokers in Missouri to explore psychosocial correlates of a total home smoking ban. Using logistic regression, we examined associations between psychosocial variables (social support, unmet social needs [e.g., food, housing], perceived stress, and depressive symptoms) and a total home smoking ban. 72% of participants were female, and 58% were Black/African American; 26% reported a home smoking ban. In unadjusted and adjusted models, greater social support was associated with greater likelihood of a home smoking ban. Stress was negatively associated with a ban in adjusted models only. The fact that most participants did not have a home smoking ban highlights the need for further intervention in this population. Results suggest links between social support and having a home smoking ban, although effect sizes were small. Smoke-free home interventions that increase social connectedness or leverage existing support may be especially effective. Tobacco control planners may also consider partnering with agencies addressing social isolation.

Re-examining phone counseling for smoking cessation: Does the evidence apply to low-SES smokers?

INTRODUCTION

A 2019 Cochrane review concluded telephone counseling is an effective intervention for smoking cessation. However, the review did not assess the role of socioeconomic status (SES) indicators on the effectiveness of telephone counseling.

METHODS

We reviewed 65 U.S. studies from the Cochrane review. We abstracted data on education, income, employment status and insurance status, and examined associations with targeted recruitment, intervention uptake, attrition, and cessation outcomes.

RESULTS

Except for education, SES indicators were seldom reported or used in analysis: 61 studies reported education, 24 reported insurance status, 23 reported employment status, and 17 reported income. Nine studies exclusively recruited low-SES samples. Thirteen studies examined associations between SES and smoking cessation. Among these, two reported lower education predicted greater cessation and two reported higher education predicted greater cessation. Other studies found higher income (n = 2) or employment type (n = 1) predicted cessation.

CONCLUSIONS

Evidence supporting telephone counseling for cessation is less clear when applied to low-SES smokers. Future research should directly assess intervention effectiveness in this priority population.

PRACTICE IMPLICATIONS

Given the evidence, it may be hard to justify future studies not focusing on low-SES populations. Innovative counseling solutions from providers helping low-income smokers quit should be evaluated to inform best practice.