UK Centre for Tobacco Control Studies, University of Nottingham, Nottingham, UK.
Eur J Public Health. 2012 Feb;22 Suppl 1(Suppl 1):41-8. doi: 10.1093/eurpub/ckr199.
In high-income countries, those with low-to-middle incomes have been observing stagnating median wages and marginal improvements in their living standards. Smokers in financial difficulties appear to be less likely to quit smoking. Understanding the reasons for this is essential to intervening to improve cessation outcomes in this population, and reduce smoking-related health inequalities.
We used longitudinal data from Waves 4 to 7 of the ITC Four Country Survey (ITC-4), and included those with data from at least two consecutive waves. Associations between financial difficulties and making a quit attempt, and quit success were analysed using generalised estimating equations, with adjustment for confounders. Mediation analysis was conducted to identify potential mediators of the observed effects of financial difficulties on cessation outcomes.
Having financial difficulties had little impact on making quit attempts (adjusted OR 0.84, 95% CI 0.70-1.01). Smokers with financial difficulties were substantially less likely to succeed at quitting (adjusted OR 0.55, 95% CI 0.39-0.76); an effect which was consistent over the survey years. Among the potential mediators examined, those relating to cognition of health-related and quality of life-related consequences of smoking were the most important mediators, though the proportion of the effect mediated by the largest mediator was small (6.8%).
Having financial difficulties remains an important barrier to smokers achieving quit success. This effect does not appear to be due to anticipated factors such as reduced use of cessation services or treatment. Further research is required to determine strong mediators of the financial difficulties effect on quit success and to tailor more effective cessation programmes.
在高收入国家，那些中低收入人群的工资中位数停滞不前，生活水平略有提高。经济困难的吸烟者戒烟的可能性似乎较小。了解其中的原因对于干预这一人群的戒烟效果，减少与吸烟有关的健康不平等至关重要。
我们使用了 ITC-4 四国调查（ITC-4）的第 4 波至第 7 波的纵向数据，并纳入了至少有两次连续波数据的人群。使用广义估计方程分析经济困难与戒烟尝试和戒烟成功之间的关联，并进行了混杂因素调整。进行中介分析以确定观察到的经济困难对戒烟效果的潜在中介因素。
经济困难对戒烟尝试的影响很小（调整后的 OR 0.84，95%CI 0.70-1.01）。经济困难的吸烟者戒烟成功的可能性要低得多（调整后的 OR 0.55，95%CI 0.39-0.76）；这一效应在调查期间是一致的。在检查的潜在中介因素中，与吸烟对健康和生活质量相关后果的认知有关的因素是最重要的中介因素，尽管最大中介因素所介导的效应比例很小（6.8%）。
经济困难仍然是吸烟者戒烟成功的一个重要障碍。这种影响似乎不是由于预期的因素造成的，如戒烟服务或治疗的减少。需要进一步研究以确定经济困难对戒烟成功的影响的有力中介因素，并制定更有效的戒烟计划。
