Social and Structural Determinants of Smoking Status and Quit Attempts Among Adults Living in 12 US States, 2015

Abstract

Purpose: This study examined the relationships among intermediary determinants, structural determinants, and adult smoking status and quit attempts. Design: Secondary data analysis of cross-sectional data. Setting: Data come from the 2015 Behavioral Risk Factor Surveillance System (BRFSS), Social Context module. A national, representative sample from 12 US states (Alabama, Arkansas, Delaware, District of Columbia, Georgia, Louisiana, Minnesota, Mississippi, Missouri, Rhode Island, Tennessee, and Utah). Participants: A total of 64 053 noninstitutionalized US adults aged ≥18 years. Measures: Smoking status and quit attempts were outcome variables. Individual-level structural determinants (age, sex, race/ethnicity, marital status, education, and employment status) and intermediary determinants (housing insecurity, food insecurity, health insurance, binge drinking, and general health mental health) from BRFSS. Analysis: Weighted multivariate, multinomial logistic regression. Results: Current smoking was greater among men, respondents aged between 35 to 64 and 55 to 64, adults who reported food insecurity, housing insecurity, frequent mental distress, binge drinking, and who were unemployed. Current smokers had higher odds of making quit attempts in the past 12 months if they were non-Hispanic Black, graduated college, and reported food and housing insecurity. Conclusion: Multifaceted smoking cessation interventions that address food and housing needs also incorporate screening for potential comorbidities such as mental distress and/or hazardous alcohol use and may be needed to enhance smoking cessation rates among racially diverse adults.