title: Associations between smoking behaviors and financial stress among low-income smokers.
abstract: OBJECTIVE
  Many American households struggle to bring in sufficient income to meet basic needs related to nutrition, housing, and healthcare. Nicotine addiction and consequent expenditures on cigarettes may impose extra financial strain on low-income households. We examine how cigarette use behaviors relate to self-reported financial stress/strain among low-income smokers.
  
  
  METHODS
  At baseline in 2011/12, OPT-IN recruited adult smokers age 18-64 from the administrative databases of the state-subsidized Minnesota Health Care Programs (N = 2406). We tested whether nicotine dependency, type of cigarettes used, and smoking intensity were associated with self-reported difficulty affording food, healthcare, housing, and living within one's income. All regression models were adjusted for race, education, income, age, and gender.
  
  
  RESULTS
  Difficulty living on one's income (77.4%), paying for healthcare (33.6%), paying for housing (38.4%), and paying for food (40.8%) were common conditions in this population. Time to first cigarette and cigarettes smoked per day predicted financial stress related to affording food, housing, and living within one's income (all p < 0.05). For instance, those whose time to first cigarette was greater than 60 minutes had about half the odds of reporting difficulty paying for housing compared to those who had their first cigarette within five minutes of waking (adjusted odds ratio = 0.55 [95% CI: 0.41, 0.73]). Type of cigarette used was not associated with any type of financial stress/strain.
  
  
  CONCLUSIONS
  Smoking and particularly heavy smoking may contribute in an important way to the struggles that low-income households with smokers face in paying for necessities.
authors: Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA.
authors: Rachel
authors: R
authors: Widome
authors: Department of Medicine, University of Minnesota Medical School, MN, USA.
authors: Anne M
authors: AM
authors: Joseph
authors: Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA; Department of Medicine, University of Minnesota Medical School, MN, USA; VA HSR&D Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, MN, USA.
authors: Patrick
authors: P
authors: Hammett
authors: Mayo Clinic, Division of Health Care Policy & Research, Rochester, MN, USA.
authors: Michelle
authors: M
authors: Van Ryn
authors: VA HSR&D Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, MN, USA.
authors: David B
authors: DB
authors: Nelson
authors: Division of Health Policy and Management, University of Minnesota School of Public Health, MN, USA.
authors: John A
authors: JA
authors: Nyman
authors: Department of Medicine, University of Minnesota Medical School, MN, USA; VA HSR&D Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, MN, USA.
authors: Steven S
authors: SS
authors: Fu
keywords: financial strain; financial stress; tobacco use