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Smokers living in deprived areas are less likely to quit: a longitudinal follow-up

Abstract

Objective: To follow up smokers to examine whether the likelihood of quitting smoking varied by area deprivation, and whether smoking history, health status, personality characteristics, social support and stressful situations contributed to differences in area deprivation in quit rates.

Design: Longitudinal data with a 6-year follow-up period were analysed using multilevel logistic regression. Area-level deprivation was characterised by a composite measure that was the sum of the proportion of unemployed residents, the percentage of residents in blue-collar occupations and the proportion with only elementary-level education. Previously established predictors of smoking cessation, including education, age at smoking initiation, self-assessed health, chronic illness, locus of control, neuroticism, negative life events, longlasting relationship difficulties, emotional social support and negative neighbourhood conditions were examined separately and in a combined model to assess whether they contributed to neighbourhood deprivation differences in quitting.

Participants: 404 participants (residing in 83 areas) identified as smokers at baseline and who did not change their residential address over the follow-up period.

Main outcome: Being a non-smoker at follow-up.

Results: Odds ratios of quitting decreased with greater area-level deprivation, but differences reached significance only between the most and least deprived quartiles. Smoking history, health status, personality characteristics, social support and stressful situations did not contribute to the lower quitting rates seen among smokers in deprived areas.

Conclusions: Living in a deprived area seems to reduce the likelihood of quitting smoking; hence individual-level tobacco control efforts should be complemented with area-based interventions. However, we need to identify and understand the underlying factors associated with living in a deprived area that contributes to lower quitting rates.

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