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标题：Financial Strain and Smoking Cessation Among Racially/Ethnically Diverse Smokers
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作者：Darla E. Kendzor ; Michael S. Businelle ; Tracy J. Costello 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2010
卷号：100
期号：4
页码：702-706
DOI：10.2105/AJPH.2009.172676
语种：English
出版社：American Public Health Association
摘要：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. An estimated 30.6% of US adults living in poverty smoke cigarettes, as compared with 20.4% of those living above the poverty level.¹ Current economic conditions in the United States will likely lead to increased financial strain for many smokers, particularly those of low socioeconomic status (SES). The ongoing global financial crisis and economic recession are expected to force millions of Americans into poverty as a result of increased unemployment rates and reduced availability of government assistance.² Furthermore, the increases in the US federal excise tax on tobacco implemented in April 2009, in combination with existing state tobacco excise taxes, have resulted in a significant rise in the cost of cigarettes. Although increases in cigarette pack prices have historically contributed to reductions in smoking prevalence rates, research suggests that increased taxation has had a declining influence on smoking in recent years.³ Moreover, there is evidence that increases in cigarette prices are associated with the purchase of cigarettes with higher tar and nicotine yields.⁴ There is emerging evidence that financial strain may have an undesirable impact on tobacco use. Specifically, financial strain is associated with current smoking as well as greater daily cigarette consumption and smoking relapse.^{5 , 6} Furthermore, smokers and individuals living in smoking households report greater financial strain than nonsmokers and those living in nonsmoking households.^{7 , 8} The expense of smoking has been shown to “crowd out” other expenditures, including those associated with basic necessities.^{9 , 10} Plausibly, this situation may lead to further increases in both financial strain and cigarette smoking. Thus, the current economic climate has made it increasingly important to characterize the association between financial strain and smoking, particularly within low-SES populations. Although a link between financial strain and smoking prevalence has been established, little is known about the impact of financial strain on smoking cessation. Low-SES smokers are as likely as smokers of higher SES to attempt smoking cessation, but they are less likely to quit successfully.¹¹ The economic recession and increased taxation on cigarettes may place a disproportionate financial burden on low-SES smokers, who may have difficulty quitting as a result of high levels of nicotine dependence,¹² reduced access to smoking cessation resources,¹³ and a variety of other factors. Recent findings from a large-scale national study in Australia indicated that smokers facing greater financial strain were less likely to quit smoking over a 1-year period, and financially strained ex-smokers were more likely to relapse over 1 year.¹⁴ In another study, ex-smokers were more likely to relapse after an involuntary job loss (possibly indicating greater financial strain).⁵ However, little is known about the impact of financial strain on a specific quit attempt among smokers receiving smoking cessation treatment. Studies have indicated that financial strain decreases after smoking cessation and that quitters experience less financial strain than those who have not quit.^{15 , 16} Thus, quitting may attenuate smoking-related financial strain among low-SES smokers. In this study, we sought to characterize the influence of financial strain on smoking cessation among smokers of primarily low SES and diverse racial/ethnic backgrounds. We hypothesized that smokers who reported greater financial strain prior to the initiation of smoking cessation treatment would have lower cessation rates. To the best of our knowledge, this is the first study to examine the impact of financial strain on smoking cessation during a specific quit attempt in a racially/ethnically diverse sample of smokers.