Abstract
BackgroundThere is a well-established social gradient in smoking, but little is known about the underlying behavioral mechanisms. Here, we take a social-ecological perspective by examining daily stress experience as a process linking social disadvantage to smoking behavior.MethodA sample of 194 daily smokers, who were not attempting to quit, recorded their smoking and information about situational and contextual factors for three weeks using an electronic diary. We tested whether socioeconomic disadvantage (indicated by educational attainment, income and race) exerts indirect effects on smoking (cigarettes per day) via daily stress. Stress experience was assessed at the end of each day using Ecological Momentary Assessment methods. Data were analyzed using random effects regression with a lower-level (2-1-1) mediation model.ResultsOn the within-person level lower educated and African American smokers reported significantly more daily stress across the monitoring period, which in turn was associated with more smoking. This resulted in a small significant indirect effect of daily stress experience on social disadvantage and smoking when using education and race as indicator for social disadvantage. No such effects were found when for income as indicator for social disadvantage.ConclusionThese findings highlight the potential for future studies investigating behavioral mechanisms underlying smoking disparities. Such information would aid in the development and improvement of interventions to reduce social inequality in smoking rates and smoking rates in general.
Highlights
There is a well-established social gradient in smoking, but little is known about the underlying behavioral mechanisms
On the within-person level lower educated and African American smokers reported significantly more daily stress across the monitoring period, which in turn was associated with more smoking
This resulted in a small significant indirect effect of daily stress experience on social disadvantage and smoking when using education and race as indicator for social disadvantage
Summary
There is a well-established social gradient in smoking, but little is known about the underlying behavioral mechanisms. We take a social-ecological perspective by examining daily stress experience as a process linking social disadvantage to smoking behavior. It is well documented that there is a substantial social gradient in smoking behavior: among smokers, those who are more socially disadvantaged smoke more heavily [1,2,3] and suffer worse health implications as a result [4, 5]. The concentration of smoking among socially disadvantaged groups is based on complex individual and social processes and are fundamental to understanding the persistent unequal distribution of Harwood and colleagues [8] posited that psychosocial factors, such as perceived stress mediate the relationship between socioeconomic status (SES) and smoking. The unequal distribution of socioeconomic resources and the resulting socioeconomic disadvantages imply greater stress experience for those with less access to resources [9, 10]. This, in turn, might lead to increased smoking as a maladaptive way of coping with
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
