When a smoker decides to quit, the task is never easy. New research finds the task is doubly hard if you are poor and uneducated.
Researchers from The City College of New York followed smokers from different socioeconomic backgrounds after they had completed a statewide smoking cessation program in Arkansas.
After a program of cognitive-behavioral therapy, either with or without nicotine patches, underprivileged and those from higher social economic backgrounds were able to quit at about the same rate.
However, as time progressed, a significant number of the underprivileged returned to smoking. Those with the fewest social and financial resources had the hardest time staving off cravings over the long run.
“The poorer they are, the worse it gets,” said clinical psychologist Christine Sheffer, Ph.D., who directed the program.
Shaffer discovered smokers on the lowest rungs of the socioeconomic ladder were 55 percent more likely than those at the upper end to start smoking again three months after treatment.
By six months post-quitting, the probability of their going back to cigarettes jumped to 2-1/2 times that of the more affluent smokers.
The research will be published in the March issue of the American Journal of Public Health and will appear online under the journal’s “First Look” section.
As part of the study, Sheffer and her colleagues noted that overall, Americans with household incomes of $15,000 or less smoke at nearly three times the rate of those with incomes of $50,000 or greater.
Smoking is still the greatest cause of preventable death and disease in the U.S. today, noted Sheffer. “And it’s a growing problem in developing countries.”
Sheffer believes there are several reasons why it may be harder for some to give up tobacco permanently. Stress is a common reason for nicotine addiction. Unfortunately, those on the lower end of the socioeconomic scale suffer more hardships than those at the top, in the form of financial difficulties, discrimination, and job insecurity, to name a few.
And for those smokers who started as teenagers, they may have never learned other ways to manage stress, Sheffer said.
For people with lower socioeconomic status (SES), it can be tougher to avoid temptation as well.
“Lower SES groups, with lower paying jobs, aren’t as protected by smoke-free laws,” said Sheffer, so individuals who have quit can find themselves back at work and surrounded by smokers. Also, fewer of them have no-smoking policies in their homes.
Unfortunately these real-world circumstances are rarely addressed in standard treatment programs.
“The evidence-based treatments that are around have been developed for middle-class patients,” Sheffer pointed out. “So (in therapy) we talk about middle-class problems.”
Additional research will help determine how the standard six sessions of therapy may be augmented to address various clients.
“Our next plan is to take the results of this and other studies and apply what we learned to revise the approach, in order to better meet the needs of poor folks,” says Sheffer. “Maybe there is a better arrangement, like giving ‘booster sessions’. Not everybody can predict in six weeks all the stresses they will have later on down the road.
“Some people say [quitting] is the most difficult thing in their life to do,” she said. “If we better prepare people with more limited resources to manage the types of stress they have in their lives, we’d get better results. “
Source: The City College of New York