Kastaun Sabrina, Brown Jamie, Kotz Daniel
Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany.
Department of Behavioural Science and Health, University College London, London, UK.
Addict Behav. 2020 Dec;111:106553. doi: 10.1016/j.addbeh.2020.106553. Epub 2020 Jul 15.
Smoking is more prevalent in smokers from lower compared with higher socioeconomic (SES) groups, but studies are inconsistent regarding underlying mechanisms. We aimed to assess associations between SES indicators and three distinct aspects of the smoking cessation process: attempting to quit; use of evidence-based cessation treatments; and success.
We analysed data of 12,161 last-year smokers (i.e., current smokers and recent ex-smokers who quit ≤ 12 months) from 20 waves (June/July 2016 to August/September 2019) of the German Study on Tobacco Use (DEBRA) - a representative household survey. Associations between indicators of SES (income and education) and (1) last-year quit attempts; (2) use of evidence-based cessation treatment or electronic cigarettes during the last attempt; and (3) short-term self-reported abstinence were analysed using multivariable logistic regression, adjusted for potential confounders.
Of all last-years smokers, 18.6% had attempted to quit, of whom 15.2% had successfully stopped. Higher income (OR 0.82, 95%CI = 0.77-0.88 per 1000€) but low vs. high education (OR 0.83, 95%CI = 0.73-0.95) were associated with lower odds of quit attempts. In smokers with quit attempts, higher income but not education was associated with higher odds of using cessation medication (OR 1.31, 95%CI = 1.08-1.59 per 1000 €). Neither income nor education were associated with using behavioural support or success.
In the German healthcare system without free access to evidence-based cessation therapy, low-income smokers are more likely to make a quit attempt but less likely to use cessation medication than high-income smokers. Equitable access to such medication is crucial to reduce SES-related health disparities.
与社会经济地位较高的吸烟者相比，社会经济地位较低的吸烟者中吸烟更为普遍，但关于其潜在机制的研究并不一致。我们旨在评估社会经济地位指标与戒烟过程的三个不同方面之间的关联：尝试戒烟；使用循证戒烟治疗；以及戒烟成功。
我们分析了来自德国烟草使用研究（DEBRA）20轮（2016年6月/7月至2019年8月/9月）的12161名去年吸烟者（即当前吸烟者和戒烟时间≤12个月的近期戒烟者）的数据，这是一项具有代表性的家庭调查。使用多变量逻辑回归分析社会经济地位指标（收入和教育程度）与（1）去年的戒烟尝试；（2）上次尝试期间使用循证戒烟治疗或电子烟的情况；以及（3）短期自我报告的戒烟情况之间的关联，并对潜在混杂因素进行了调整。
在所有去年吸烟者中，18.6%曾尝试戒烟，其中15.2%成功戒烟。较高的收入（每增加1000欧元，比值比为0.82，95%置信区间=0.77-0.88）以及低教育程度与高教育程度相比（比值比为0.83，95%置信区间=0.73-0.95）与较低的戒烟尝试几率相关。在有戒烟尝试的吸烟者中，较高的收入而非教育程度与使用戒烟药物的较高几率相关（每增加1000欧元，比值比为1.31，95%置信区间=1.08-1.59）。收入和教育程度均与使用行为支持或戒烟成功无关。
在无法免费获得循证戒烟治疗的德国医疗体系中，低收入吸烟者比高收入吸烟者更有可能尝试戒烟，但使用戒烟药物的可能性较小。公平获得此类药物对于减少与社会经济地位相关的健康差距至关重要。
