Smoking Cessation and Financial Stress

Mohammad Siahpush, Professor; Matt Spittal, Dr; Gopal K. Singh, Dr

Disclosures

Journal of Public Health. 2007;29(4):338-342. 

In This Article

Discussion

This research used longitudinal data from Australia and showed that the long-term smoking cessation is likely to reduce financial stress.

The findings presented in this article are consistent with the studies of lower SES women described in the introduction.[6,7] They are also consistent with two cross-sectional population-based studies of people from a wide range of the socio-economic spectrum. Stronks et al.,[15] using a Dutch sample, reported that financial stress (difficulty in payment of bills, food, rent, etc.) was associated with smoking status. Siahpush et al.,[11] using Australian data, showed that households reporting tobacco expenditure were more likely to experience financial stress. Due to the cross-sectional nature of these studies, the causal direction between smoking and financial stress could not be ascertained. The design of the present research, however, may imply a causal direction from cessation to a reduced probability of financial stress. Our results, together with findings from a previous prospective study that financial stress may cause lower cessation rates among smokers (and higher probability of relapse among ex-smokers),[8] suggest that in all likelihood the relationship between financial stress and smoking is reciprocal. Financial deprivation can impede cessation and smoking contributes to financial disadvantage.

By examining the effect of long-term cessation on financial stress, the study contributes to the growing research on the effect of smoking on social disadvantage and inequality. A recent article based on a survey of a population-based sample from the US, UK, Canada and Australia showed that between one-fifth and one-third of respondents reported to have spent money on cigarettes that they 'knew would be better spent on household essentials like food'.[16] It was also shown that there is a social gradient in this phenomenon, such that lower income smokers are notably more likely to experience 'smoking-induced deprivation' than their well to do counterparts.[17] Thus, campaigns and interventions to encourage smoking cessation among disadvantaged groups are likely to enhance their material conditions and standards of living.

Given recent findings that smoking substantially contributes to socio-economic differentials in mortality in Australia and elsewhere,[17,18] policies that aim to reduce smoking prevalence among disadvantaged groups are not only likely to benefit the health and financial well-being of these groups, but reduce societal level health inequalities. As such, tobacco control strategies targeting these groups can be viewed as social policy. This indicates the usefulness of a partnership between the tobacco control and the social services sector. Such a partnership has recently been initiated by the New South Wales Cancer Council (Australia) with the launch of 'Lifting the Burden: Tobacco Control and Social Equity Strategy 2006-2011', to reduce high smoking prevalence among disadvantaged groups. A focus of this rare strategy is to enhance awareness and understanding of smoking risks among social services agencies and to build their capacity to contribute to tobacco control.

A strength of this study is the use of prospective national population data, and as such it adds a unique perspective to an area of research dominated primarily by cross-sectional information. The facts that smoking cessation was measured prospectively using data from Waves 1, 2 and 3, and that financial stress was measured in Wave 3, imply a causal relationship between cessation and financial stress, as explained above. The national and population-based nature of the research design, compared with experimental or intervention studies, provides more confidence in the external validity of the results. The design also afforded the inclusion of many population sub-groups in the sample and as such allowed us to statistically control for major socio-demographic factors.

The study used a self-reported measurement of smoking status, which may have resulted in underreporting of smoking. However, previous research has shown that questionnaire-based surveys of the general population provide a reliable estimate of smoking status when cotinine validated, without systematic differentials in underreporting by socio-economic groups.[19,20] The amount of misclassification (proportion of self-reported non-smokers with increased cotinine levels indicative of active smoking) is very low (for example, 0.921 and 1.4%[22]) in most community-based studies,[23] but much higher in clinical trials and intervention studies,[23] especially among young adults.[24] Under-reporting of smoking is not a major concern in the present study, as our aim was not to provide accurate estimates of smoking prevalence or cessation rates, but to examine the association of smoking cessation and financial well-being.

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