Income disparities in smoking cessation and the diffusion of smoke-free homes among US smokers: Results from two longitudinal surveys

Vijayaraghavan, M, Benmarnhia T, Pierce JP, White MM, Kempster J, Shi YY, Trinidad DR, Messer K.  2018.  Income disparities in smoking cessation and the diffusion of smoke-free homes among US smokers: Results from two longitudinal surveys. Plos One. 13

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adults, behavior, cigarette-smoking, population, Science & Technology - Other Topics, united-states


Background Lower rates of successful quitting among low-income populations in the United States may be from slower dissemination of smoke-free homes, a predictor of cessation. Objectives To explore the role of smoke-free homes in cessation behavior across income levels. Participants Current smokers who were >= 18 years and who participated in the longitudinal 2002-2003 (n = 2801) or 2010-2011 (n = 2723) Tobacco Use Supplements to the Current Population Survey. Measurements We categorized income as multiples of the federal poverty level (FPL) (<300% FPL versus >= 300% FPL). We examined the association of smoke-free homes with 1+day quit attempts and 30+days abstinence at 1-year follow-up. We then conducted a mediation analysis to examine the extent that smoke-free homes contributed to income disparities in 30+days abstinence. Results Between the two surveys, heavy smoking (>= 1 pack/day) declined by 17%, and smoking prevalence declined by 15% among those with higher-incomes (>300%FPL). Although similar in 2002, the prevalence of smoke-free homes was 33% lower among individuals living <300% FPL than those living >= 300% FPL. Although the quit attempt rate was similar, the 30 +days abstinence rate was higher in the 2010-11 cohort than in 2002-3 cohort (20.6% versus 15.5%, p<0.008). Whereas smoking >= 1 pack/ day was associated with lower odds of 30 +days abstinence (Adjusted odds ratio [AOR] 0.7; 95% CI 0.5-0.9), having a higher income (AOR 1.9, 95% CI 1.4-2.6) and a smoke-free home (AOR 1.6, 95% CI 1.2-2.1) were associated with greater odds of 30+day abstinence. Differential changes in smoke-free homes across income groups between the two surveys contributed to 36% (95% CI 35.7-36.3) of the observed income disparity in 30+days abstinence. Conclusions Increasing the diffusion of smoke-free homes among low-income populations may attenuate at least a third of the income disparities in smoking cessation, highlighting the need for interventions to increase adoption of smoke-free homes among low-income households.






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