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Income disparities in smoking cessation and the diffusion of smoke-free homes among U.S. smokers: Results from two longitudinal surveys.
- Author(s): Vijayaraghavan, Maya;
- Benmarhnia, Tarik;
- Pierce, John P;
- White, Martha M;
- Kempster, Jennie;
- Shi, Yuyan;
- Trinidad, Dennis R;
- Messer, Karen
- et al.
Published Web Locationhttps://doi.org/10.1371/journal.pone.0201467
BackgroundLower 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.
ObjectivesTo explore the role of smoke-free homes in cessation behavior across income levels.
ParticipantsCurrent 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.
MeasurementsWe 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.
ResultsBetween 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.
ConclusionsIncreasing 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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