Financial Strain and Smoking Cessation and Relapse Among U.S. Adults Who Smoke: A Longitudinal Cohort Study.

Introduction: This study examines the prospective association between financial strain and smoking cessation and smoking relapse among U.S. adults with established smoking.

Methods: Discrete-time survival models were fit to nationally representative data in Waves 1-5 (2013-2019) of the U.S. Population Assessment of Tobacco and Health Study for smoking cessation (n=6,972) and smoking relapse (n=1,195). Models were adjusted for demographics (age, sex, race, and ethnicity), socioeconomic positioning (education, income, health insurance status), and tobacco-related confounders (quit attempts, coupon receipt, and nicotine dependence). Data were collected between 2013 and 2019, and the analysis was conducted in 2023-2024.

Results: Among adults with established cigarette smoking, financial strain was associated with a reduced likelihood of cigarette smoking cessation (HR: 0.81, 95% CI: 0.72, 0.92) and an increased likelihood of cigarette smoking relapse (HR: 1.56, 95% CI: 1.24, 1.96) in multivariable models. Results were robust to sensitivity analyses varying confounder control, sample restrictions, and survey weights used.

Conclusions: The results from this study suggest that financial strain is a barrier to cigarette smoking without relapse, which may be due to stress and coping processes. Smoking cessation interventions would benefit from considering the role that financial strain plays in inhibiting smoking cessation without relapse.