Journal Article

Socioeconomic patterns of smoking cessation behavior in low and middle-income countries: Emerging evidence from the Global Adult Tobacco Surveys and International Tobacco Control Surveys

Thompson, Mary E., Borland, Ron, Giovino, Gary A., Nargis, Nigar, Siahpush, Mohammad, Yong, Hua-Hie, Fong, Geoffrey T., Palipudi, Krishna M., Thrasher, James F., Zhao, Luhua, Driezen, Pete, Mbulo, Lazarous

2019

Overview

Tobacco smoking is often more prevalent among those with lower socio-economic status (SES) in high-income countries, which can be driven by the inequalities in initiation and cessation of smoking. Smoking is a leading contributor to socio-economic disparities in health. To date, the evidence for any socio-economic inequality in smoking cessation is lacking, especially in low- and middle-income countries (LMICs). This study examined the association between cessation behaviours and SES of smokers from eight LMICs. Data among former and current adult smokers aged 18 and older came from contemporaneous Global Adult Tobacco Surveys (2008-2011) and the International Tobacco Control Surveys (2009-2013) conducted in eight LMICs (Bangladesh, Brazil, China, India, Mexico, Malaysia, Thailand and Uruguay). Adjusted odds ratios (AORs) of successful quitting in the past year by SES indicators (household income/wealth, education, employment status, and rural-urban residence) were estimated using multivariable logistic regression controlling for socio-demographics and average tobacco product prices. A random effects meta-analysis was used to combine the estimates of AORs pooled across countries and two concurrent surveys for each country. Estimated quit rates among smokers (both daily and occasional) varied widely across countries. Meta-analysis of pooled AORs across countries and data sources indicated that there was no clear evidence of an association between SES indicators and successful quitting. The only exception was employed smokers, who were less likely to quit than their non-employed counterparts, which included students, homemakers, retirees, and the unemployed (pooled AOR≈0.8, p<0.10). Lack of clear evidence of the impact of lower SES on adult cessation behaviour in LMICs suggests that lower-SES smokers are not less successful in their attempts to quit than their higher-SES counterparts. Specifically, lack of employment, which is indicative of younger age and lower nicotine dependence for students, or lower personal disposable income and lower affordability for the unemployed and the retirees, may be associated with quitting. Raising taxes and prices of tobacco products that lowers affordability of tobacco products might be a key strategy for inducing cessation behaviour among current smokers and reducing overall tobacco consumption. Because low-SES smokers are more sensitive to price increases, tobacco taxation policy can induce disproportionately larger decreases in tobacco consumption among them and help reduce socio-economic disparities in smoking and consequent health outcomes.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adolescent / Adult / Adults / Affordability / Aged / Bangladesh / Behavior / Biology and Life Sciences / Brazil / Cancer / China / Cigarette smoking / Cigarettes / Consumption / Demographics / Demography / Dependence / Developing countries / Developing Countries - statistics & numerical data / Disease control / Disposable income / Drug addiction / Drug dependence / Economic aspects / Economic conditions / Economic inequality / Economic status / Economics / Education / Employment / Employment status / Equality / Female / Handbooks / Health aspects / Health disparities / Health promotion / Health status / Homemakers / Humans / Income / Income inequality / India / Indicators / Influence / Low income groups / Malaysia / Male / Medical research / Medicine and Health Sciences / Meta-analysis / Middle Aged / Mortality / Multivariable control / Nicotine / People and Places / Personal income / Polls & surveys / Prices / Psychology / Public health / Random effects / Regression analysis / Research and Analysis Methods / Retirees / Retirement / Rural schools / Rural urban differences / Smokers / Smoking / Smoking cessation / Smoking Cessation - statistics & numerical data / Social class / Social inequality / Social Sciences / Sociodemographics / Socioeconomic Factors / Socioeconomic status / Socioeconomics / Students / Surveys / Systematic review / Taxation / Taxes / Tobacco / Tobacco products / Tobacco smoking / Tobacco Smoking - epidemiology / Tobacco Smoking - therapy / Trends / Unemployed people / Wealth / Womens health