BACKGROUND: In recent years, the COVID-19 pandemic and cost-of-living crisis have heightened financial challenges, potentially motivating some individuals who smoke, especially those on lower incomes, to quit smoking to reduce expenditure. However, financial stress may hinder quit attempts, and people with nicotine-dependence may prioritise cigarettes over essentials like food. This study analysed trends in smoking-induced deprivation (SID) and its association with participant characteristics in England, Canada, Australia, and the US from 2016 to 2022.
METHODS: We analysed individuals who smoked cigarettes (≥monthly) from the 2016-2022 International Tobacco Control Four Country Smoking and Vaping Surveys in four countries (N=27.248; observations=35.251). Logistic regression, fitted using generalised estimating equations, was used to estimate the association between participant characteristics and SID (defined as reporting that, in the past six months, spending money on cigarettes resulted in not having enough money for household essentials such as food).
RESULTS: Across countries, SID prevalence increased from 9.5% in 2016 to 15.0% in 2022 (p<0.001), with year-country interactions (p<0.001), but non-significant year-income interactions (p=0.833). Australia had the highest SID in 2022 at 22.8%, while the US had the lowest at 10.8%. Young adults aged 18-24 years (aOR=3.86; 95% CI=2.94-5.07, vs. 55+), males (aOR=1.21, 95% CI=1.03-1.43, vs. females), those with low income (aOR=2.45; 95% CI=1.97-3.05, vs. high), higher nicotine dependence (aOR=1.31; 95% CI=1.24-1.38), an intention to quit (aOR=1.76, 95% CI=1.49-2.07, vs. no), recent illicit tobacco use (aOR=2.63; 95% CI=2.13-3.24, vs. no), higher perceived stress (aOR=1.74; 95% CI=1.62-1.87), and lower smoking cessation self-efficacy (aOR=1.11; 95% CI=1.04-1.18) were associated with SID.
CONCLUSIONS: Individuals prioritising purchasing cigarettes over essentials have increased in recent years, with those with socioeconomically disadvantaged, higher nicotine dependence and lower self-efficacy being the most affected. Providing tailored smoking cessation support to these groups could enhance quit rates, improve living standards, and alleviate deprivation.