Jan. 20, 2012

By Patricia Nicholson

It’s tough for anybody to go smoke-free, but a new study found that it’s even tougher for people with low incomes and low education levels. Three months after finishing a quit-smoking program, the participants with low socioeconomic status were 55 per cent less likely to still be smoke-free, compared to people with higher socioeconomic status.

Researchers at the City College of New York followed a group of 2,739 smokers in Arkansas who took part in a statewide program for people who wanted to quit. The participants were all offered cognitive behavioural therapy and nicotine patches as part of the program. Their average age was about 46, and about two-thirds were women.

Many of the study participants had factors reflecting low socioeconomic status. Almost 60 per cent had no post-secondary education (18 per cent who did not finish high school, and 41 per cent who completed high school). One in four had a household income below $10,000 US.

After dividing the group into three socioeconomic levels, the researchers compared the quitting success rates of the three sub-groups. They found that success rates for the lowest socioeconomic group were significantly lower than the highest group three months after completing the program, and the gap widened with time. Three months after treatment, the participants with the highest socioeconomic status were 55 per cent more likely to be smoke-free than those with the lowest socioeconomic status. After six months, the highest group was two-and-a-half times as likely to be smoke-free compared to the lowest group.

The researchers note in background information in the study that smoking is more prevalent in low-income households in the U.S.: smoking rates are tripled in households with less than $15,000 US income, compared to those with incomes of more than $50,000 US. They also observed that smokers with low socioeconomic status often had a difficult combination of stress and resources: high stress levels related to issues such as financial hardship or job loss, and fewer resources to address stress, making them more likely to fall back on cigarettes as a coping strategy. Given the higher prevalence of smoking associated with low-socioeconomic levels, this group may also be more likely to be exposed to other smokers.

The study also found that more treatment content (group and individual sessions, nicotine patches) was a predictor for success in quitting. They concluded that offering more content resources to people at the greatest risk of returning to smoking might help improve success rates in low socioeconomic groups.

The study was published online in the American Journal of Public Health on Jan. 19, 2012.