Sociodemographic and psychosocial correlates of smoking-induced deprivation and its effect on quitting: findings from the International Tobacco Control Policy Evaluation Survey

Aims

To determine the prevalence and characteristics of smokers who experience smoking‐induced deprivation (SID), and to examine its effect on quit attempts, relapse and cessation.

Methods

Waves 2 and 3 (2003–5) of the International Tobacco Control Policy Evaluation Survey were used, which is a prospective study of a cohort of smokers in the US, Canada, UK and Australia. SID was measured with the question “In the last six months, have you spent money on cigarettes that you knew would be better spent on household essentials like food?” A total of 7802 smokers participated in the survey in wave 2, of whom 5408 were also interviewed in wave 3.

Findings

The proportion of smokers who reported SID was highest in Australia (33%) and lowest in the UK (20%). Younger age, minority status and low income were associated with a higher probability of SID. Some of the other factors related to a higher probability of SID were higher level of nicotine dependence, having an intention to quit, and smoking to help one socialise or control weight. The relationship between SID and quit attempt was mediated by having an intention to quit and worrying that smoking would damage health and reduce the quality of life. The relationship between SID and relapse was mediated by perceived stress. SID was not associated with successful cessation.

Conclusions

Many smokers experience deprivation that is the result of their smoking. Strategies to reduce the prevalence of smoking probably effect a general improvement in standards of living and reduction in deprivation.The relationship between socioeconomic status and smoking is well established, with lower socioeconomic groups having a markedly higher prevalence of smoking in developed and many developing countries.^1,2,3,4 In addition to the common measures of socioeconomic status such as education and occupation, smoking has also been associated with direct indicators of deprivation such as financial stress. Marsh and McKay''s⁵ study on low‐income British families found that smoking was a strong predictor of financial hardship (experiencing financial anxiety, being in debt and being unable to afford consumer items such as food and clothing), independently of a lack of educational qualifications, low income, manual work, claiming welfare benefits and social tenancy. Similarly, Siahpush et al⁶ found that in Australia, households reporting tobacco expenditure were more likely to experience financial stress (measured by indicators such as being unable to afford meals or heat the home owing to shortage of money), after controlling for several indicators of socioeconomic status and demographic factors. Finally, Efroymson et al⁷ reported that in Bangladesh, tobacco expenditure exacerbates the effects of poverty and causes substantial deterioration in living standards among the poor.In the general population, there is a relationship between socioeconomic status, deprivation and being a smoker, and also among smokers, between socioeconomic status, amount smoked and deprivation. Siahpush⁸ reported that in Australia, smoking households headed by people with lower education and occupation spent more money on tobacco. He also showed that households with lower income were more likely to spend a higher percentage of their total household income on tobacco. Furthermore, Siahpush et al⁶ found that, among smoking households, a higher percentage of total household expenditure on tobacco was associated with several indexes of financial stress.Several qualitative studies also document the connection between smoking and deprivation. Bancroft et al,⁹ in a study on smokers from two socially disadvantaged areas in Scotland, reported that smoking was closely associated with dealing with difficult and stressful aspects of daily lives, as well as with boredom due to a lack of alternative activities. Similarly, Copeland¹⁰ studied a group of women from an economically and socially disadvantaged area in northwest Edinburgh and found that the pivotal role of smoking in their lives was that of a coping mechanism, particularly in response to problems such as financial stress, divorce, bereavement and worries about children. Finally, Stead et al''s¹¹ research undertaken in disadvantaged communities in Glasgow suggested that lack of resources, a stressful environment, strong pro‐smoking community norms and limited opportunities for recreation seem to foster smoking and discourage cessation.The correlational and qualitative studies cited above provide only partial evidence that smoking results in deprivation. We know of no previous studies that use indicators of smoking‐induced deprivation (SID) such as a smoker''s direct report about spending money on cigarettes that should otherwise have been spent on essentials such as food. The International Tobacco Control Policy Evaluation Survey (ITCPES) provides such an indicator. Our aim was to determine the extent to which smokers experience SID, to investigate the sociodemographic and psychosocial characteristics of smokers who experience SID and to examine its effect on quit attempts, relapse and cessation, in the US, Canada, UK and Australia by using this indicator.