Mechanisms linking socioeconomic status to smoking cessation: a structural equation modeling approach.
OBJECTIVE
Although there has been a socioeconomic gradient in smoking prevalence, cessation, and disease burden for decades, these disparities have become even more pronounced over time. The aim of the current study was to develop and test a conceptual model of the mechanisms linking socioeconomic status (SES) to smoking cessation.


METHODS
The conceptual model was evaluated using a latent variable modeling approach in a sample of 424 smokers seeking treatment (34% African American; 33% Latino; 33% White). Hypothesized mechanisms included social support, neighborhood disadvantage, negative affect/stress, agency, and craving.


METHODS
The primary outcome was Week 4 smoking status.


RESULTS
As was hypothesized, SES had significant direct and indirect effects on cessation. Specifically, neighborhood disadvantage, social support, negative affect/stress, and agency mediated the relation between SES and smoking cessation. A multiple group analysis indicated that the model was a good fit across racial/ethnic groups.


CONCLUSIONS
The present study yielded one of the more comprehensive models illuminating the specific mechanisms that link SES and smoking cessation. Policy, community, and individual-level interventions that target low SES smokers and address the specific pathways identified in the current model could potentially attenuate the impact of SES on cessation.
Businelle
Michael S
MS
Department of Health Disparities Research, University of Texas M. D. Anderson Cancer Center, UT School of Public Health, Dallas Regional Campus, 5323 Harry Hines Blvd., Dallas, TX 75390-9128, USA. michael.businelle@utsouthwestern.edu
Kendzor
Darla E
DE
Reitzel
Lorraine R
LR
Costello
Tracy J
TJ
Cofta-Woerpel
Ludmila
L
Li
Yisheng
Y
Mazas
Carlos A
CA
Vidrine
Jennifer Irvin
JI
Cinciripini
Paul M
PM
Greisinger
Anthony J
AJ
Wetter
David W
DW
D000328:Adult; D000339:Affect; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D012907:Smoking / Q000523:psychology*; D016540:Smoking Cessation / Q000191:economics* / Q000523:psychology*; D012931:Social Environment; D012944:Social Support; D012959:Socioeconomic Factors; D055815:Young Adult