The role of income and psychological distress in the relationship between work loss and smoking cessation: Findings from three International Tobacco Control (ITC) Europe countries
Karin Hummel 1  
Ute Mons 3
Marc C. Willemsen 1, 4
Geoffrey T. Fong 5, 6
Hein de Vries 1
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Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, Netherlands
Department of Communication, University of Amsterdam (ASCoR), Amsterdam, Netherlands
Cancer Prevention Unit & WHO Collaborating Center for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
Trimbos Institute, Netherlands Institute for Mental Health and Addiction, Utrecht, Netherlands
Department of Psychology, School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
Ontario Institute for Cancer Research, Toronto, Canada
Santé Publique France, the National Public Health Agency, Saint-Maurice, France
Department of Family Medicine, Maastricht University (CAPHRI), Maastricht, Netherlands
IVO Research Institute, The Hague, Netherlands
Karin Hummel   

Department of Health Promotion, Maastricht University (CAPHRI), P. Debyeplein 1, 6229 HA Maastricht, Netherlands
Publish date: 2019-11-19
Submission date: 2019-07-03
Final revision date: 2019-09-30
Acceptance date: 2019-10-15
Tob. Prev. Cessation 2019;5(November):42
The relationship between work loss and smoking has not been studied extensively, and underlying factors are often not examined. The aim of this study was to test two hypotheses. First, work loss is associated with greater intention to quit and more likelihood of smoking cessation, and this relationship is moderated by a decrease in income. Second, work loss is associated with lower quit intention and lower rates of smoking cessation, and this relationship is moderated by an increase in psychological distress.

We used pooled data from three countries participating in the ITC Project: France, Germany and the Netherlands (n=2712). We measured unemployment, income and psychological distress at two consecutive survey waves, and calculated changes between survey waves. We first conducted multiple logistic regression analyses to examine the association between work loss and smoking cessation behavior. Next, we added income decrease and psychological distress increase to the models. Finally, we added interaction terms of work loss by income decrease and work loss by distress increase to the model.

Work loss was not associated with quit intention, quit attempts, and quit success. When income decrease and psychological distress increase were added to the model, we found a positive association between distress increase and quit attempts. The interactions, however, were not statistically significant.

Our results indicate that smokers who become unemployed and face a decrease in income are not less likely to quit smoking than smokers who are employed.

Several members of the ITC Project team at the University of Waterloo have assisted in all stages of the ITC Netherlands Survey, which we gratefully acknowledge. In particular, we thank Thomas Agar, Project Manager of the ITC Europe Project, and Anne Quah, ITC Managing Director.
The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
The ITC Europe surveys were supported by grants from the French Institute for Health Promotion and Health Education (INPES) (now Santé publique France), the French National Cancer Institute (INCa) (France), the German Federal Ministry of Health, Dieter Mennekes-Umweltstiftung, and German Cancer Research Center (DKFZ) (Germany), and the Netherlands Organization for Health Research and Development (ZonMw) (the Netherlands).
KH conducted the statistical analyses and drafted the manuscript. All authors contributed to the interpretation of the data and to the writing of the manuscript. All authors revised the manuscript critically for important intellectual content and read and approved the final manuscript.
Not commissioned; externally peer reviewed.
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