title: Tobacco expenditure, smoking-induced deprivation and financial stress: results from the International Tobacco Control (ITC) Four-Country Survey.
abstract: OBJECTIVE
  While higher tobacco prices lead to a reduction in smoking prevalence, there is a concern that paying more for cigarettes can lead to excess financial burden. Our primary aim was to examine the association of daily cigarette expenditure with smoking-induced deprivation (SID) and financial stress (FS).
  
  
  METHODS
  We used data from wave 7 (2008-2009) of the International Tobacco Control (ITC) Four-Country Survey which is a survey of smokers in Canada, the USA, the UK and Australia (n = 5887). Logistic regressions were used to assess the association of daily cigarette expenditure with SID and FS.
  
  
  RESULTS
  In multivariate analyses, a one standard deviation increase in daily cigarette expenditure was associated with an increase of 24% (P = 0.004) in the probability of experiencing SID. While we found no association between daily cigarette expenditure and FS, we found that SID is a strong predictor of FS (odds ratio 6.25; P < 0.001). This suggests that cigarette expenditure indirectly affects FS through SID. Results showed no evidence of an interaction between cigarette expenditure and income or education in their effect on SID or FS.
  
  
  CONCLUSIONS
  Our results imply that spending more on tobacco may result in SID but surprisingly has no direct effect on FS. While most smokers may be adjusting their incomes and consumption to minimise FS, some fail to do so occasionally as indexed by the SID measure. Future studies need to prospectively examine the effect of increased tobacco expenditure on financial burden of smokers.
authors.affiliation: Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198-4365, USA. msiahpush@unmc.edu
authors.forename: Mohammad
authors.initials: M
authors.lastname: Siahpush
authors.forename: Ron
authors.initials: R
authors.lastname: Borland
authors.forename: Hua-Hie
authors.initials: HH
authors.lastname: Yong
authors.forename: K Michael
authors.initials: KM
authors.lastname: Cummings
authors.forename: Geoffrey T
authors.initials: GT
authors.lastname: Fong
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia; D002170:Canada; D003132:Commerce / Q000706:statistics & numerical data*; D005260:Female; D006306:Health Surveys; D006801:Humans; D007182:Income; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012907:Smoking / Q000191:economics* / Q000453:epidemiology; D016540:Smoking Cessation / Q000191:economics* / Q000379:methods; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000209:etiology*; D006113:United Kingdom; D014481:United States; D055815:Young Adult