Socioeconomic variations in nicotine dependence, self-efficacy, and intention to quit across four countries: findings from the International Tobacco Control (ITC) Four Country Survey

M Siahpush, A McNeill, R Borland, G T Fong, M Siahpush, A McNeill, R Borland, G T Fong

Abstract

Objective: To examine the effect of socioeconomic status (SES) on nicotine dependence, self-efficacy, and intention to quit.

Design setting and participants: Data were from the first wave (2002) of the International Tobacco Control (ITC) Four Country Survey (ITC-4), a panel study of over 2000 adult smokers from each of four countries: the United States, Canada, the United Kingdom, and Australia. Data were collected via telephone interviews.

Main outcome measures: Nicotine dependence, intention to quit, and self-efficacy to quit smoking were the main outcome measures used in this study.

Results: Lower levels of education were associated with higher nicotine dependence. The effect of lower income on higher heaviness of smoking index (HIS) scores was significant in Canada, the UK, and Australia. Respondents with low education had 35% larger odds of low self-efficacy than those with high education. Respondents with low education had 40% larger odds of having no intention to quit than those with high education. Respondents with low income had 23% larger odds of having no intention to quit than those with high income. Country was not a moderator of the association of SES with self-efficacy and intention to quit.

Conclusion: To the extent that lower SES smokers are more addicted, they are likely to need more intensive support if they are to be successful in their attempts to quit. Given their lower incomes, this places a special responsibility on government to provide or subsidise such services. This should include access to the widest possible range of effective pharmacotherapies complemented with evidence based counselling and support.

Conflict of interest statement

Competing interest statement: There were no competing interests.

References

    1. Jarvis M J, Wardle J. Social patterning of individual health behaviours: the case of cigarette smoking. In: Marmot M, Wilkinson RG, eds. Social determinants of health. Oxford: Oxford University Press, 1999
    1. Siahpush M. Socioeconomic status and tobacco expenditure among Australian households; results from the 1998–99 Household Expenditure Survey. J Epidemiol Community Health 200357798–801.
    1. Hymowitz N, Cummings K M, Hyland al Predictors of smoking cessation in a cohort of adult smokers followed for five years. Tobacco Control 19976s57–s62.
    1. Shohaimi S, Luben R, Wareham al Residential area deprivation predicts smoking habit independently of individual educational level and occupational social class. A cross sectional study in the Norfolk cohort of the European investigation into cancer (EPIC‐Norfolk). J Epidemiol Community Health 200357270–276.
    1. Jarvis M J. A profile of tobacco smoking. Addiction 1994891371–1376.
    1. Marsh A, McKay S.Poor smokers. London: Policy Studies Institute, 1994
    1. Graham H.When life's a drag: women, smoking and disadvantage. London: Department of Health, 1993
    1. Fernandez E, Schiaffino. Garcia al Widening social inequalities in smoking cessation. J Epidemiol Community Health 200155729–730.
    1. Osler M, Prescott E, Gottschau al Trends in smoking prevalence in Danish adults, 1964–1994. The influence of gender, age, and education. Scand J Soc Med 199826293–298.
    1. Osler M, Gerdes L U, Davidsen al Socioeconomic status and trends in risk factors for cardiovascular diseases in the Danish MONICA population, 1982–1992. J Epidemiol Community Health 200054108–113.
    1. White V, Hill D, Siahpush al How has the prevalence of cigarette smoking changed among Australian adults? Trends in smoking prevalence between 1980 and 2001. Tob Control 200312(suppl II)ii67–ii74.
    1. Nelson D E, Emont S L, Brackbill R al Cigarette smoking prevalence by occupation in the United States. J Occup Med 199436516–525.
    1. Faggiano F, Versino E, Lemma P. Decennial trends of social differentials in smoking habits in Italy. Cancer Causes and Control 200112665–671.
    1. Jarvis M J. Patterns and predictors of smoking cessation in the general population. In: Bolliger CT, Fagerstrom KO, eds. The tobacco epidemic. Basel: Karger, 1997151–164.
    1. Fernandez E, Schiaffino A, Garcia al Widening social inequalities in smoking cessation in Spain, 1987–1997. J Epidemiol Community Health 200155729–730.
    1. Tillgren P, Halund B J, Lundberg al The sociodemographic pattern of tobacco cessation in the 1980s: results from a panel study of living condition surveys in Sweden. J Epidemiol Community Health 199650625–630.
    1. Stronks K, van de Mheen H D, Looman C W al Cultural, material, and psychosocial correlates of the socioeconomic gradient in smoking behavior among adults. Prev Med 199726754–766.
    1. Rose J S, Chassin L, Presson C al Prospective predictors of quit attempts and smoking cessation in young adults. Health Psychol 199615261–268.
    1. Osler M, Prescott E. Psychosocial, behavioural, and health determinants of successful smoking cessation: a longitudinal study of Danish adults. Tobacco Control 19987262–267.
    1. Zentner L, Borland R. The roles of temptation strength and self‐efficacy in predicting smoking cessation attempts. Behaviour Change 199512191–195.
    1. Hennrikus D J, Jeffery R W, Lando H A. The smoking cessation process: longitudinal observations in a working population. Prev Med 199524235–244.
    1. Stuart K, Borland R, McMurray N. Self‐efficacy, health locus of control, and smoking cessation. Addictive Behaviors 1994191–12.
    1. Bobak M, Jarvis M J, Skodova al Smoke intake among smokers is higher in lower socioeconomic groups. Tobacco Control 20009310–312.
    1. Cox B D, Huppert F, Whichelow M J. eds. The health and lifestyle survey: seven years on. Aldershot: Darmouth, 1993
    1. Jarvis M J, Wardle J, Waller al Prevalence of hardcore smoking in England, and associated attitudes and beliefs: cross sectional study. BMJ 20033261061–1065.
    1. Kozlowski L, Porter C Q, Orleans C al Predicting smoking cessation with self‐reported measures of nicotine dependence: FTQ, FTND, and HSI. Drug and Alcohol Dependence 199434211–216.
    1. Heatherton T F, Kozlowski L, Frecker R al The Fagerstrom test for nicotine dependence: a revision of the Fagerstrom tolerance questionnaire. Br J Addiction 1991861119–1127.
    1. Heatherton T F, Kozlowski L, Frecker R al Measuring the heaviness of smoking: using self‐reported time to the first cigarette of the day and number of cigarettes smoked per day. Br J Addiction 198984791–799.
    1. Geyer S, Peter R. Income, occupational position, qualification and health inequalities—competing risks? (Comparing indicators of social status). J Epidemiol Community Health 200054299–305.
    1. Liberatos P, Link B G, Kelsey J L. The measurement of social class in epidemiology. Epidemiologic Reviews 19881087–121.
    1. StataCorp Stata statistical software: release 7.0, special edition. College Station, Texas: Stata Corporation, 2002
    1. Cohen S, Williamson G. Perceived stress in a probability sample of the United States. In: Spacapan S, Oskamp S, eds. The social psychology of health. Newbury, California: Sage, 198831–68.
    1. Parrott A C. Does cigarette smoking cause stress? American Psychologist 199954817–820.
    1. Sorensen G, Emmons K, Stoddard A al Do social influences contribute to occupational differences in quitting smoking and attitudes toward quitting? Am J Health Promotion 200216135–141.
    1. Fiore M, Bailey W, Cohen alTreating tobacco use and dependence. Clinical Practice Guidelines. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 2000
    1. West R J, McNeill A, Raw M. Smoking cessation quidelines for health professionals: an update. Thorax 200055987–999.
    1. Silagy C, Lancaster T, Stead al Nicotine replacement therapy for smoking cessation (Cochrane Review). Cochrane Library, Issue 3. Oxford: Update Software, 2001
    1. Hughes J R, Wadland W C, Fenwick J al Effect of cost on the self‐administration and efficacy of nicotine gum: a preliminary study. Prev Med 199120486–496.
    1. Duckett S. Equity in access to health care. In: Eckersley R, Dixon J, Douglas B, eds. The social origins of health and well‐being. New York: Cambridge University Press, 2001149–156.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren