title: Psychosocial stress and cigarette smoking persistence, cessation, and relapse over 9-10 years: a prospective study of middle-aged adults in the United States.
abstract: OBJECTIVE
  Year-to-year decreases in smoking in the US have been observed only sporadically in recent years, which suggest a need for intensified efforts to identify those at risk for persistent smoking. To address this need, we examined the association between a variety of psychosocial stressors and smoking persistence, cessation, and relapse over 9-10 years among adults in the United States (n = 4,938, ages 25-74).
  
  
  METHODS
  Using information provided at baseline and follow-up, participants were categorized as non-smokers, persistent smokers, ex-smokers, and relapsed smokers. Stressors related to relationships, finances, work-family conflict, perceived inequality, neighborhood, discrimination, and past-year family problems were assessed at baseline and follow-up.
  
  
  RESULTS
  High stress at both assessments was associated with greater odds of persistent smoking for stressors related to relationships, finances, work, perceived inequality, past-year family problems, and a summary score. Among respondents who were smokers at baseline, high stress at both time points for relationship stress, perceived inequality, and past-year family problems was associated with nearly double the odds of failure to quit.
  
  
  CONCLUSIONS
  Interventions to address psychosocial stress may be important components within smoking cessation efforts.
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA, nslopen@hsph.harvard.edu.
authors.forename: Natalie
authors.initials: N
authors.lastname: Slopen
authors.forename: Emily Z
authors.initials: EZ
authors.lastname: Kontos
authors.forename: Carol D
authors.initials: CD
authors.lastname: Ryff
authors.forename: John Z
authors.initials: JZ
authors.lastname: Ayanian
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Albert
authors.forename: David R
authors.initials: DR
authors.lastname: Williams
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology*; D016540:Smoking Cessation / Q000523:psychology* / Q000706:statistics & numerical data*; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology; D014481:United States / Q000453:epidemiology; D055815:Young Adult