Are Patterns of Smoking Cessation and Related Behaviours Associated with Socioeconomic Status? An Analysis of Data from the International Tobacco Control Four Country Survey

Abstract

Considerable socioeconomic disparities have been identified for smoking and cessation: lower socioeconomic status (SES) groups have higher rates of tobacco use, are less likely to successfully quit, and may also be less likely to intend or attempt to quit. However, results are inconsistent for some quitting-related outcomes, and little is known about how socioeconomic disparities may vary across countries and over time. This study examined the extent to which SES was associated with smoking cessation and related constructs among representative samples of smokers in Canada, the US, the UK, and Australia, using data from the first five waves (2002-2006) of the ITC Four Country Survey (35 532 observations from 16 458 respondents). Generalized estimating equations modeling was used to examine whether education and income were related to intentions to quit (any, and within the next six months), incidence of quit attempts, smoking abstinence (for at least one, six and 12 months), and reduction in daily cigarette consumption by at least half. Potential differences in the associations over time and across countries were also considered. In addition, logistic regression modeling examined associations between education and income, reasons for quitting, and use of cessation assistance, using a cross-sectional sample of the most recent survey wave. Respondents with higher education were more likely to intend to quit, have made a quit attempt, and be abstinent for at least one and six months, and those with higher income were more likely to intend to quit and be abstinent for at least one month. Associations were stable throughout the time period under study. Country differences were observed in quit intentions: UK and US respondents were less likely to intend to quit than Australians and Canadians. Also, UK respondents were least likely to attempt to quit overall, but those that did attempt were more likely to be abstinent for at least one and six months. Socioeconomic and between-country differences were also identified in the cross-sectional analyses of use and access to cessation assistance and reasons for quitting. The results suggest that socioeconomic disparities exist at multiple stages in the path to smoking cessation.