Socioeconomic variations in nicotine dependence, self-efficacy, and intention to quit across four countries: findings from the International Tobacco Control (ITC) Four Country Survey.
OBJECTIVE
To examine the effect of socioeconomic status (SES) on nicotine dependence, self-efficacy, and intention to quit.


METHODS
Data were from the first wave (2002) of the International Tobacco Control (ITC) Four Country Survey (ITC-4), a panel study of over 2000 adult smokers from each of four countries: the United States, Canada, the United Kingdom, and Australia. Data were collected via telephone interviews.


METHODS
Nicotine dependence, intention to quit, and self-efficacy to quit smoking were the main outcome measures used in this study.


RESULTS
Lower levels of education were associated with higher nicotine dependence. The effect of lower income on higher heaviness of smoking index (HIS) scores was significant in Canada, the UK, and Australia. Respondents with low education had 35% larger odds of low self-efficacy than those with high education. Respondents with low education had 40% larger odds of having no intention to quit than those with high education. Respondents with low income had 23% larger odds of having no intention to quit than those with high income. Country was not a moderator of the association of SES with self-efficacy and intention to quit.


CONCLUSIONS
To the extent that lower SES smokers are more addicted, they are likely to need more intensive support if they are to be successful in their attempts to quit. Given their lower incomes, this places a special responsibility on government to provide or subsidise such services. This should include access to the widest possible range of effective pharmacotherapies complemented with evidence based counselling and support.
Siahpush
M
M
Centre for Behavioural Research in Cancer, Cancer Control Research Institute, The Cancer Council Victoria, 100 Drummond Street, Carlton 3053, Australia. mohammad.siahpush@cancervic.org.au
McNeill
A
A
Borland
R
R
Fong
G T
GT
D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D003431:Cross-Cultural Comparison; D006306:Health Surveys; D006801:Humans; D033182:Intention; D008875:Middle Aged; D020377:Self Efficacy; D016540:Smoking Cessation / Q000523:psychology*; D014029:Tobacco Use Disorder / Q000453:epidemiology* / Q000523:psychology; D006113:United Kingdom / Q000453:epidemiology; D014481:United States / Q000453:epidemiology