Objective: To examine the effect of socioeconomic status (SES) on nicotine dependence, self-efficacy, and intention to quit.
Design setting and participants: Data were from the first wave (2002) of the International Tobacco Control (ITC) Four Country Survey (ITC-4), a panel study of over 2000 adult smokers from each of four countries: the United States, Canada, the United Kingdom, and Australia. Data were collected via telephone interviews.
Main outcome measures: Nicotine dependence, intention to quit, and self-efficacy to quit smoking were the main outcome measures used in this study.
Results: Lower levels of education were associated with higher nicotine dependence. The effect of lower income on higher heaviness of smoking index (HIS) scores was significant in Canada, the UK, and Australia. Respondents with low education had 35% larger odds of low self-efficacy than those with high education. Respondents with low education had 40% larger odds of having no intention to quit than those with high education. Respondents with low income had 23% larger odds of having no intention to quit than those with high income. Country was not a moderator of the association of SES with self-efficacy and intention to quit.
Conclusion: To the extent that lower SES smokers are more addicted, they are likely to need more intensive support if they are to be successful in their attempts to quit. Given their lower incomes, this places a special responsibility on government to provide or subsidise such services. This should include access to the widest possible range of effective pharmacotherapies complemented with evidence based counselling and support.
- HSI, heaviness of smoking index
- ITC-4, International Tobacco Control Four Country Survey
- NRT, nicotine replacement therapy
- SES, socioeconomic status
- intention to quit
- nicotine addiction
- self efficacy
- socioeconomic status
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Competing interest statement: There were no competing interests.
Ethics approval: The study protocol was cleared for ethics by the Institutional Review Boards or Research Ethics Boards in each of the countries: the University of Waterloo (Canada), Roswell Park Cancer Institute (USA), the University of Illinois-Chicago (USA), the University of Strathclyde (UK), and The Cancer Council Victoria (Australia).
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