Barriers to Effective Tobacco-Dependence Treatment for the Very Poor

Abstract

People who live in poverty have a high prevalence of smoking, are less likely to engage in evidence-based treatment, and find it harder to quit. Their beliefs about smoking and quitting can serve as barriers to quitting. Little is known about the smoking and quitting beliefs of the very poor (about U.S. $15,000 or less annual family income) because they tend not to be included in research. This study sought to assess beliefs about smoking and quitting by the very poor in relation to past quitting behavior and intention to quit in the future. A survey was administered in person to residents in randomly selected addresses in two very impoverished Milwaukee, WI, ZIP codes during the day to ensure the inclusion of the very poor. Six hundred fifty-four people completed the survey, a response rate of 78.3%. Sixty-eight percent reported annual household incomes of less than $15,000 compared with 30.8% in the community as a whole and 13.0% of households nationally. Self-reported smoking prevalence was 42.1%. Specific beliefs about smoking and quitting were related to past quit attempts and intentions to quit in the future. Both race and income predicted beliefs and quitting-related variables independently and jointly. Continued tobacco-control progress requires addressing specific populations with known high tobacco use. One of these populations is those with low income. Efforts to engage them in treatment will have to address specific beliefs about smoking and quitting.