Socioeconomic status and smoking: a review Hiscock, Rosemary; Bauld, Linda; Amos, Amanda ...
Annals of the New York Academy of Sciences,
February 2012, Letnik:
1248, Številka:
1
Journal Article
Recenzirano
Smoking prevalence is higher among disadvantaged groups, and disadvantaged smokers may face higher exposure to tobacco's harms. Uptake may also be higher among those with low socioeconomic status ...(SES), and quit attempts are less likely to be successful. Studies have suggested that this may be the result of reduced social support for quitting, low motivation to quit, stronger addiction to tobacco, increased likelihood of not completing courses of pharmacotherapy or behavioral support sessions, psychological differences such as lack of self‐efficacy, and tobacco industry marketing. Evidence of interventions that work among lower socioeconomic groups is sparse. Raising the price of tobacco products appears to be the tobacco control intervention with the most potential to reduce health inequalities from tobacco. Targeted cessation programs and mass media interventions can also contribute to reducing inequalities. To tackle the high prevalence of smoking among disadvantaged groups, a combination of tobacco control measures is required, and these should be delivered in conjunction with wider attempts to address inequalities in health.
ABSTRACT
Aims Measuring the strength of urges to smoke during a normal smoking day among smokers in a culture where smoking is restricted could provide a good measure of the severity of cigarette ...dependence. An important criterion for a measure of cigarette dependence is how well it predicts failure of attempts to stop smoking. This study compared ratings of Strength of Urges to Smoke (SUTS) with the Fagerström Test of Nicotine Dependence (FTND) and its components, including the Heaviness of Smoking Index (HSI).
Design A longitudinal study involving a household survey of a representative sample of adult smokers at baseline and 6‐month follow‐up by postal questionnaire.
Setting England.
Participants A total of 15 740 smokers aged 16 and over underwent the baseline interview; 2593 were followed‐up 6 months later, of whom 513 reported having made a quit attempt following the baseline survey but at least 1 month prior to the follow‐up.
Measurements SUTS, FTND, HSI, cigarettes per day, time to first cigarette, age, social grade and gender were measured at baseline. Quit attempts since the baseline assessment and self‐reported abstinence were measured at 6‐month follow‐up.
Findings In logistic regressions, all dependence measures predicted success of subsequent quit attempts, but SUTS had the strongest association (beta for SUTS, FTND and HSI: 0.41: P < 0.001, 0.13: P = 0.005, and 0.19: P = 0.003, respectively). In multiple logistic regressions when SUTS was entered as a predictor of abstinence, together with other dependence measures, it remained as the only predictive dependence measure.
Conclusions A simple rating of strength of urges on a normal smoking day appears to be a good predictor of at least short‐term quit success in English smokers and as such may be a useful measure of cigarette addiction.
The west African Ebola epidemic that began in 2013 exposed deep inadequacies in the national and international institutions responsible for protecting the public from the far-reaching human, social, ...economic, and political consequences of infectious disease outbreaks. The Ebola epidemic raised a crucial question: what reforms are needed to mend the fragile global system for outbreak prevention and response, rebuild confidence, and prevent future disasters?
Up-to-date data tracking of national smoking patterns and cessation-related behaviour is required to evaluate and inform tobacco control strategies. The Smoking Toolkit Study (STS) was designed for ...this role. This paper describes the methodology of the STS and examines as far as possible the representativeness of the samples.
The STS consists of monthly, cross sectional household interviews of adults aged 16 and over in England with smokers and recent ex-smokers in each monthly wave followed up by postal questionnaires three and six months later. Between November 2006 and December 2010 the baseline survey was completed by 90,568 participants. STS demographic, prevalence and cigarette consumption estimates are compared with those from the Health Survey for England (HSE) and the General Lifestyle Survey (GLF) for 2007-2009.
Smoking prevalence estimates of all the surveys were similar from 2008 onwards (e.g 2008 STS=22.0%, 95% C.I.=21.4% to 22.6%, HSE=21.7%, 95% C.I.=20.9% to 22.6%, GLF=20.8%, 95% C.I.=19.7% to 21.9%), although there was heterogeneity in 2007 (chi-square=50.30, p<0.001). Some differences were observed across surveys within sociodemographic sub-groups, although largely in 2007. Cigarette consumption was virtually identical in all surveys and years.
There is reason to believe that the STS findings (see http://www.smokinginengland.info) are generalisable to the adult population of England.
Introduction:
Understanding motivation to continue smoking may help the development of smoking cessation interventions. However, little information exists on the prevalence of specific motives for ...smoking in representative samples of smokers. This study examined smokers' reports of their motives for continued smoking in an English general population sample.
Methods:
A total of 2,133 smokers participating in monthly cross-sectional surveys (the Smoking Toolkit Study) identified which, if any, of the following motives they believed were important in keeping them smoking: enjoyment, stress relief, weight control, boredom relief, aid to concentration, aid to socializing, pain relief, liking being a smoker, and feeling bad when not smoking. Associations between these motives and gender, age, social grade, Fagerström Test for Nicotine Dependence, and quit attempts in the last year were examined using logistic regression.
Results:
Enjoyment and stress relief were the most commonly reported motives (51% and 47%, respectively). Women reported stress relief and weight control more often than men, whereas men were more likely to report enjoyment and liking being a smoker. Older smokers reported enjoying smoking and liking being a smoker more than younger smokers but were less likely to report socializing and stress relief as important motives. Not having made a quit attempt in the last year was associated with enjoying smoking and liking being a smoker. Higher dependence was associated with a greater number of reported motives.
Discussion:
While smoking for stress relief is common, perceptions of enjoyment of smoking and positive smoker identity may be the key motives that inhibit attempts at cessation.
Abstract Background ‘Enjoyment’ and ‘addiction’ have been proposed as opposing reasons why people continue to smoke despite the manifest dangers. This study examined the roles of these as barriers to ...smoking cessation. Methods 2257 smokers taking part in a national household survey completed postal-follow-up questionnaires 6 months later. Enjoyment of smoking was measured at baseline as was strength of urges to smoke during a normal smoking day as a subjective marker of addiction. Smoking status, quit attempts and quit success were assessed at follow-up. Data on age, sex, social grade and method of cessation support used were also collected. Associations between baseline measures and smoking outcomes were assessed using logistic regression. Results Only enjoyment of smoking predicted whether a quit attempt was made (OR = 0.70, p < 0.001, 95% CI = 0.62–0.78) and only strength of urges to smoke predicted whether a quit attempt was successful (OR = 0.70, p < 0.001, 95% CI = 0.57–0.87). This pattern of results remained when controlling for sociodemographic factors and method of support used. Conclusions Both enjoyment of smoking and strength of urges to smoke are important in the smoking cessation process, but in different ways. Interventions to promote cessation need to address both in order to maximise the rate of quit attempts and their chances of success.
ABSTRACT
Aims Motivation to quit smoking predicts quit attempts, although little is known about the role played by its different aspects. This study assessed the predictive value of desire, duty and ...intention to quit, three different aspects of motivation.
Design A longitudinal study was conducted involving a nationally representative sample of smokers assessed at baseline and 3 and 6 months later. Baseline assessment took place by face‐to‐face computer‐assisted interviews; follow‐up assessments by postal questionnaires.
Setting England.
Participants From April 2008 to June 2009, a total of 5593 adult smokers were recruited; 1263 were followed‐up at 3 months and 1096 at 6 months.
Measurements Three dichotomous measures of motivation to quit (wanting to quit, believing one ought to quit, intention to quit soon) were taken at baseline. Whether a subsequent quit attempt was made was recorded at 3‐ and 6‐month follow‐up.
Findings More smokers believed they ought to quit smoking than wanted to or intended to soon (39.0, 29.3 and 23.5%, respectively). Desire and intention were independent predictors of quit attempts at both follow‐ups, whereas combining them did not add predictive value and duty was not a predictor. While the predictive value of desire or intention alone disappeared when accompanied by duty, their combination was robust against its negative effect.
Conclusions Desire and intention independently positively predict quit attempts, while duty appears to mitigate their effect. It would be worth monitoring all three aspects of motivation when evaluating the impact of smoking cessation interventions on motivation to quit.
ABSTRACT
Aim To assess smoking prevalence before and after the rise in legal age of sale of cigarettes in England and Wales from age 16 to age 18 in October 2007.
Design A series of monthly ...cross‐sectional household surveys: the ‘Smoking Toolkit Study’.
Setting England.
Participants A total of 53 322 adults aged 16 and over interviewed between October 2006 and May 2009, 1136 of whom were aged 16 or 17 years.
Measurements Change in smoking prevalence from pre‐ to post‐legislation, assessed by self‐reported smoking status, among the 16–17‐year‐old group and older adults.
Findings The prevalence change following the legislation among those aged 16 and 17 was 7.1 percentage points (denominator = 1136) compared with 2.4 percentage points (denominator = 52 186) for older adults (odds ratio 1.36, P = 0.024, 95% confidence interval = 1.04–1.77 for the interaction). There was no difference within older age categories.
Conclusions There was a greater fall in prevalence in 16–17‐year‐olds following an increase in age of sale than in older age groups. This provides some support to the view that raising the age of sale can, at least in some circumstances, reduce smoking prevalence in younger age groups.
The English network of stop-smoking services (SSSs) is among the best-value life-preserving clinical intervention in the UK NHS and is internationally renowned. However, success varies considerably ...across services, making it important to examine the factors that influence their effectiveness.
Data from 126,890 treatment episodes in 24 SSSs in 2009-10 were used to assess the association between intervention characteristics and success rates, adjusting for key smoker characteristics. Treatment characteristics examined were setting (eg, primary care, specialist clinics, pharmacy), type of support (eg, group, one-to-one) and medication (eg, varenicline, single nicotine replacement therapy (NRT), combination of two or more forms of NRT). The main outcome measure was abstinence from smoking 4 weeks after the target quit date, verified by carbon monoxide concentration in expired air.
There was substantial variation in success rates across intervention characteristics after adjusting for smoker characteristics. Single NRT was associated with higher success rates than no medication (OR 1.75, 95% CI 1.39 to 2.22); combination NRT and varenicline were more successful than single NRT (OR 1.42, 95% CI 1.06 to 1.91 and OR 1.78, 95% CI 1.57 to 2.02, respectively); group support was linked to higher success rates than one-to-one support (OR 1.43, 95% CI 1.16 to 1.76); primary care settings were less successful than specialist clinics (OR 0.80, 95% CI 0.66 to 0.99).
Routine clinic data support findings from randomised controlled trials that smokers receiving stop-smoking support from specialist clinics, treatment in groups and varenicline or combination NRT are more likely to succeed than those receiving treatment in primary care, one-to-one and single NRT. All smokers should have access to, and be encouraged to use, the most effective intervention options.
Although perceived stress has been hypothesized to be a risk factor for obesity, epidemiological studies relating stress to weight gain have shown mixed results. We examined prospective associations ...between perceived stress and changes in waist circumference and BMI in a large study of adolescents. As part of the Health and Behaviour in Teenagers Study (HABITS), height, weight, and waist circumference were measured annually in 4,065 adolescents aged from 11 to 16. Waist and BMI standard deviation scores (SDS) were used as indices of adiposity. Adolescents completed a measure of perceived stress each year, from which mean stress scores over the 5‐year period were also calculated and divided by tertile into lower, moderate, and higher stress. Associations between perceived stress at each year and adiposity 1–4 years later and also adiposity trajectories over the whole period in relation to mean stress were investigated. Analyses were adjusted for age, sex, ethnicity, socioeconomic deprivation, pubertal timing, and smoking. Perceived stress in any year was not related prospectively to increases in waist or BMI SDS 1–4 years later, nor was there any evidence that higher stress over the whole period was associated with greater gains in waist or BMI SDS. However, waist and BMI SDS were significantly higher in the moderate‐ and higher‐stress groups than the lower‐stress group across the whole 5‐year period. Persistent stress was associated with higher waist circumference and BMI in adolescence, but did not lead to differential changes over 5 years.
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