Financial strain mediates the relationship between socioeconomic status and smoking
More details
Hide details
Department of Psychology, Louisiana State University, Louisiana, United States
Health Sciences Center University of Oklahoma,Oklahoma, United States
Amy L. Copeland   

Department of Psychology, Louisiana State University, Louisiana, United States
Publish date: 2019-01-22
Submission date: 2018-09-06
Final revision date: 2018-12-11
Acceptance date: 2018-12-20
Tob. Prev. Cessation 2019;5(January):3
Smoking is the leading cause of preventable death accounting for about 0.48 million deaths in the US every year. Across the socioeconomic status (SES) gradient smoking prevalence differs greatly, with those of lower SES smoking at much higher rates than those of higher SES. Previous studies have shown relationships between socioeconomic status, financial strain, and smoking. However, little research has explored the possibility that financial strain might mediate the relationship between socioeconomic status and smoking. Thus, the goal of the current study was to determine whether financial strain was a mediating factor in the relationship between socioeconomic status and smoking.

Participants (N=238) were primarily female (67.6%) and African-American adults (51.7%) from the Dallas metropolitan area. The majority of the sample reported that they did not currently smoke (n=164). Participants who reported currently smoking at baseline (n=74) smoked an average of 9.96 (SD=10.79) cigarettes per day.

Analyses revealed that financial strain partially mediates the relationship between socioeconomic status and smoking status. Additionally, financial strain was found to significantly partially mediate the relationship between socioeconomic status and cigarettes smoked prospectively over the next 7 days.

Overall, findings suggest that greater financial strain may be one factor that links SES with current smoking and smoking level among those who smoke.

Jamal A, Homa DM, O'Connor E, et al. Current cigarette smoking among adults - United States, 2005-2014. MMWR Morbidity and mortality weekly report. 2015;64(44):1233-1240. doi:10.15585/mmwr.mm6444a2
USDHHS. The health consequences of smoking—50 years of progress: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2014.
Kendzor DE, Reitzel LR, Mazas CA, et al. Individual- and area-level unemployment influence smoking cessation among African Americans participating in a randomized clinical trial. Soc Sci Med. 2012;74(9):1394-1401. doi:10.1016/j.socscimed.2012.01.013
Fagan P, Shavers VL, Lawrence D, Gibson JT, O'Connell ME. Employment characteristics and socioeconomic factors associated with disparities in smoking abstinence and former smoking among U.S. workers. J Health Care Poor Underserved. 2007;18(4 Suppl):52-72. doi: 10.1353/hpu.2007.0119
Wetter DW, Cofta-Gunn L, Irvin JE, et al. What accounts for the association of education and smoking cessation? Prev Med. 2005;40(4):452-460. doi:10.1016/j.ypmed.2004.07.001
Fernandez E, Schiaffino A, Borrell C, et al. Social class, education, and smoking cessation: Long-term follow-up of patients treated at a smoking cessation unit. Nicotine Tob Res. 2006;8(1):29-36. doi:10.1080/14622200500264432
Kotz D, West R. Explaining the social gradient in smoking cessation: it's not in the trying, but in the succeeding. Tob Control. 2009;18(1):43-46. doi:10.1136/tc.2008.025981
Siahpush M, Borland R, Scollo M. Smoking and financial stress. Tob Control. 2003;12(1):60-66. doi:10.1136/tc.12.1.60
Siahpush M, Carlin JB. Financial stress, smoking cessation and relapse: results from a prospective study of an Australian national sample. Addiction. 2006;101(1):121-127. doi:10.1111/j.1360-0443.2005.01292.x
Graham H. When life's a drag: women, smoking and disadvantage. HM Stationery Office London; 1993.
Dorsett R, Marsh A. The health trap: poverty, smoking and lone parenthood. Vol 855: Policy Studies Institute London; 1998.
Kendzor DE, Businelle MS, Costello TJ, et al. Financial strain and smoking cessation among racially/ethnically diverse smokers. Am J Public Health. 2010;100(4):702-706. doi:10.2105/ajph.2009.172676
Hayes AF. The PROCESS macro for SPSS and SAS; 2015.
Hayes AF. Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford Press; 2013.
Hayes AF. Beyond Baron and Kenny: Statistical mediation analysis in the new millennium. Communication monographs. 2009;76(4):408-420. doi:10.1080/03637750903310360
Shiffman S, Hickcox M, Paty JA, Gnys M, Richards T, Kassel JD. Individual differences in the context of smoking lapse episodes. Addict Behav. 1997;22(6):797-811. doi:10.1016/s0306-4603(97)00063-4
Shiffman S, Paty JA, Gnys M, Kassel JA, Hickcox M. First lapses to smoking: Within-subjects analysis of real-time reports. J Consult Clin Psych. 1996;64(2):366-379. doi:10.1037//0022-006x.64.2.366
Matthews KA, Gallo LC. Psychological perspectives on pathways linking socioeconomic status and physical health. Annu Rev Psychol. 2011;62:501-530. doi:10.1146/annurev.psych.031809.130711
Winkleby MA, Jatulis DE, Frank E, Fortmann SP. Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease. Am J Public Health. 1992;82(6):816-820. doi:10.2105/ajph.82.6.816
Pearlin LI, Menaghan EG, Lieberman MA, Mullan JT. The Stress Process. J Health Soc Behav. 1981;22(4):337-356. doi:10.2307/2136676
Kendzor DE, Businelle MS, Waters AF, Frank SG, Hébert ET. Financial strain indirectly influences smoking cessation through withdrawal symptom severity. Drug & Alcohol Dependence. 2018;183:55-61. doi:10.1016/j.drugalcdep.2017.10.027
Kendzor DE, Businelle MS, Poonawalla IB, et al. Financial incentives for abstinence among socioeconomically disadvantaged individuals in smoking cessation treatment. Am J Public Health. 2015;105(6):1198-1205. doi:10.2105/ajph.2014.302102
Courtney RJ, Bradford D, Martire KA, et al. A randomized clinical trial of a financial education intervention with nicotine replacement therapy (NRT) for low socio-economic status Australian smokers: a study protocol. Addiction. 2014;109(10):1602-1611. doi:10.1111/add.12669
Fritz MS, Mackinnon DP. Required sample size to detect the mediated effect. Psychol Sci. 2007;18(3):233-239. doi:10.1111/j.1467-9280.2007.01882.x.