Financial strain indirectly influences smoking cessation through withdrawal symptom severity

• Published in: Drug and alcohol dependence Vol. 183; pp. 55 - 61
• Main Authors: Kendzor, Darla E., Businelle, Michael S., Waters, Aaron F., Frank, Summer G., Hébert, Emily T.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.02.2018; Elsevier Science Ltd
• Subjects: Abstinence; Adults; African Americans; Anxiety; Drug addiction; Economic stress; Financial strain; Indirect effects; Mediation; Nicotine withdrawal; Questionnaires; Self report; Severity; Sleep; Smoking; Smoking cessation; Socioeconomic factors; Socioeconomic status; United States > US; African Americans; Smoking cessation; Nicotine withdrawal; Socioeconomic status; Mediation; Financial strain
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2017.10.027

•Financial strain influences smoking cessation through withdrawal symptom severity.•Financial strain is associated with post-quit anger, anxiety, and sleep symptoms.•Greater withdrawal symptom severity increases the likelihood of smoking.•Addressing financial strain or its effects may increase the odds of cessation.•Findings contribute to our understanding of tobacco-related health disparities. Financial strain has an adverse impact on smoking cessation. However, the mechanisms through which financial strain influences cessation remain unclear. The purpose of the current study was to determine whether financial strain indirectly influenced smoking cessation through withdrawal symptom severity. Participants (N=139) were primarily Black (63.3%) and female (57.6%) adults enrolled in a smoking cessation program at a safety-net hospital. A self-report financial strain questionnaire was completed one week prior to the scheduled quit date, and the Wisconsin Smoking Withdrawal Scale (WSWS) was completed on the day after the scheduled quit date. Biochemically-verified 7-day point prevalence abstinence was assessed four weeks after the scheduled quit date. Adjusted mediation analyses were conducted using the PROCESS macro for SPSS to evaluate the indirect effects of financial strain on smoking cessation via post-quit withdrawal symptom severity. Analyses indicated a significant indirect effect of financial strain on smoking cessation through total withdrawal symptom severity, B=0.027; 95% CI (0.003, 0.066); and specifically anger, B=0.035; 95% CI (0.008, 0.074), anxiety, B=0.021; 95% CI (0.001, 0.051), and sleep symptoms, B=0.015; 95% CI (0.005, 0.043). Greater pre-quit financial strain was associated with greater post-quit withdrawal symptom severity, which increased the likelihood of non-abstinence 4 weeks after the scheduled quit attempt. The direct effect of financial strain on smoking cessation was not significant in any of the mediation models. Findings: suggest that withdrawal severity is an underlying mechanism through which financial strain influences smoking cessation.