Socioeconomic disadvantage and abrupt versus gradual method of quitting smoking: Findings from the International Tobacco Control (ITC) Four-Country Survey

Introduction: Our aim was to investigate the association between socioeconomic disadvantage and abrupt versus gradual method of smoking cessation. Methods: The analysis used data (n=5,629) from Waves 1 through 6 (2002 to 2008) of the International Tobacco Control (ITC) Four-Country Survey, a prospective study of a cohort of smokers in the US, Canada, the UK, and Australia. Income and education were combined to create a 13-point index of socioeconomic disadvantage. Results: Logistic regression analyses using generalized estimating equations (GEE) provided overwhelming evidence (P<0.001) that higher socioeconomic disadvantage was associated with a lower probability of abrupt quitting. A one unit increase in the value of the index of socioeconomic disadvantage was associated with a 6% decrease (OR: 0.94; 95% CI: 0.92-0.96) in the odds of adopting abrupt quitting. Conclusion: In light of the accumulating evidence that abrupt quitting results in more favorable cessation outcomes, we recommend that cessation programs encourage socioeconomically disadvantaged smokers to quit abruptly rather than gradually reducing smoking first. Future research needs to confirm that the socioeconomic differences in quit method actually contribute to lower success rates in lower socioeconomic groups before stronger recommendations for action can be made.