Considerable socioeconomic disparities have been identified for smoking and cessation: lower socioeconomic status (SES) groups have higher rates of tobacco use, are less likely to successfully quit, and may also be less likely to intend or attempt to quit. However, results are inconsistent for some quitting-related outcomes, and little is known about how socioeconomic disparities may vary across countries and over time. This study examined the extent to which SES was associated with smoking cessation and related constructs among representative samples of smokers in Canada, the US, the UK, and Australia, using data from the first five waves (2002-2006) of the ITC Four Country Survey (35 532 observations from 16 458 respondents). Generalized estimating equations modeling was used to examine whether education and income were related to intentions to quit (any, and within the next six months), incidence of quit attempts, smoking abstinence (for at least one, six and 12 months), and reduction in daily cigarette consumption by at least half. Potential differences in the associations over time and across countries were also considered. In addition, logistic regression modeling examined associations between education and income, reasons for quitting, and use of cessation assistance, using a cross-sectional sample of the most recent survey wave. Respondents with higher education were more likely to intend to quit, have made a quit attempt, and be abstinent for at least one and six months, and those with higher income were more likely to intend to quit and be abstinent for at least one month. Associations were stable throughout the time period under study. Country differences were observed in quit intentions: UK and US respondents were less likely to intend to quit than Australians and Canadians. Also, UK respondents were least likely to attempt to quit overall, but those that did attempt were more likely to be abstinent for at least one and six months. Socioeconomic and between-country differences were also identified in the cross-sectional analyses of use and access to cessation assistance and reasons for quitting. The results suggest that socioeconomic disparities exist at multiple stages in the path to smoking cessation.

Considerable socioeconomic disparities have been identified for smoking and cessation: lower socioeconomic status (SES) groups have higher rates of tobacco use, are less likely to successfully quit, and may also be less likely to intend or attempt to quit. However, results are inconsistent for some quitting-related outcomes, and little is known about how socioeconomic disparities may vary across countries and over time. This study examined the extent to which SES was associated with smoking cessation and related constructs among representative samples of smokers in Canada, the US, the UK, and Australia, using data from the first five waves (2002-2006) of the ITC Four Country Survey (35 532 observations from 16 458 respondents). Generalized estimating equations modeling was used to examine whether education and income were related to intentions to quit (any, and within the next six months), incidence of quit attempts, smoking abstinence (for at least one, six and 12 months), and reduction in daily cigarette consumption by at least half. Potential differences in the associations over time and across countries were also considered. In addition, logistic regression modeling examined associations between education and income, reasons for quitting, and use of cessation assistance, using a cross-sectional sample of the most recent survey wave. Respondents with higher education were more likely to intend to quit, have made a quit attempt, and be abstinent for at least one and six months, and those with higher income were more likely to intend to quit and be abstinent for at least one month. Associations were stable throughout the time period under study. Country differences were observed in quit intentions: UK and US respondents were less likely to intend to quit than Australians and Canadians. Also, UK respondents were least likely to attempt to quit overall, but those that did attempt were more likely to be abstinent for at least one and six months. Socioeconomic and between-country differences were also identified in the cross-sectional analyses of use and access to cessation assistance and reasons for quitting. The results suggest that socioeconomic disparities exist at multiple stages in the path to smoking cessation.

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

published_or_final_version / Public Health / Master / Master of Public Health

Background Smoking is a well known risk factor for increased mortality. Although some smokers may survive to older ages, they often suffer from poor health and impaired quality of life (QoL) because of chronic diseases. The construct of health-adjusted life expectancy (HALE) combines mortality and the subjective perception of health-related quality of life (HRQoL) into a single index. The impact of smoking on HALE might be useful information for encouraging smokers to quit or young people not to start smoking. However, scarce information is available, particularly from Chinese populations, on how smoking affects HALE. Aims The study aimed to determine the impact of smoking on HALE among Chinese people aged 65 years or over in Hong Kong who had enrolled in an Elderly Health Centre (EHC). Methods Data on a cohort of 66,820 people enrolled in EHCs of the Department of Health during 1998 to 2001, were used. These were supplemented by a follow-up telephone survey of a stratified (for smoking status) sample of 2,441 from the whole EHC database, which included more recent enrollees. Two measures of HALE were used: (1) based on a simple measure of perceived health and (2) based on quality-adjusted life years (QALYs) estimated. The first measure had been included in the EHC database but current information was obtained by telephone for each year of follow-up. The second measure was only available from the survey. Multi-state life tables and Sullivan?s method were employed to investigate HALEs among current, ex and never smokers. The yearly transition rates between health statuses were calculated using the existing data on self-assessed health and supplemented by the survey data. Utility scores for calculation of QALYs used a local estimation equation for the SF-12. Results Men at age 65 who had never smoked could expect to live a further 20 years and women a further 22 years. This was around 3-5 years more than for current or ex-smokers. Both male and female never smokers at age 65 could expect to be in a good QoL for 16 of those future years. Those still smoking at age 65 could expect 3-4 fewer years in a good QoL. People who had quit smoking before age 65 gained about one more year in good health compared with continuing smokers. Conclusions It has already been estimated that smokers of all ages lose up to about 10 years of life due to smoking. However, the longer they survive, the lower the difference in mortality between ever smoker and never smokers. This study shows that, for those who were still alive at age 65 years in this cohort, smoking was still detrimental to their survival and to their QoL, especially if they were still smoking at that age. Results for males and females were similar. Therefore, even if a smoker does not die prematurely, their HRQoL is still affected and a never smoker will have not only longer life but more life years in good health than an ever smoker. Stopping smoking at an earlier age might gain back some HRQoL. / published_or_final_version / Community Medicine / Master / Master of Philosophy

published_or_final_version / Community Medicine / Master / Master of Philosophy

Thesis (M.A.)--University of Montana, 2008. / Title from title screen. Description based on contents viewed Aug. 28, 2008. Includes bibliographical references (p. 80-93).

Thesis (Ph.D.)--Duquesne University, 2007. / Title from document title page. Abstract included in electronic submission form. Includes bibliographical references (p. 85-90).

Thesis (M.A.)--University of British Columbia, 2004. / Includes bibliographical references (leaves 110-115). Also available online (PDF file) by a subscription to the set or by purchasing the individual file.

Thesis (M.A.)--University of British Columbia, 2004. / Includes bibliographical references (leaves 110-115).