Financial Stress and Tobacco Expenditure in Australian Households: A Cross-Sectional Analysis of Prevalence and Association Across Wealth and Income Levels

BackgroundTobacco use deepens poverty. Egypt, a lower-middle income country, is one of the few countries worldwide where tobacco use is rising. However, no published study examined the adverse impacts of tobacco on the Egyptian household welfare, specifically after the first Egyptian Pound (EGP) devaluation by 80% in 2016. To address this gap and inform tobacco taxation policymaking, we aimed to provide evidence characterizing national household tobacco expenditure in Egypt.MethodsWe conducted a secondary analysis of the 2017/2018 Household Income, Expenditure and Consumption Survey, focusing on the most used tobacco products in Egypt: cigarette and waterpipe tobacco. We identified the proportion and background characteristics of cigarette and waterpipe tobacco smoker households. We calculated household tobacco expenditure share as a proportion of total household expenditure. We compared mean household expenditure shares of 12 expenditure groups among smoker and nonsmoker households and examined the differences by income quintiles. We determined the factors associated with household tobacco expenditure. Descriptive, bivariable, and multivariable analyses were performed.ResultsCigarette and waterpipe tobacco smokers were present in 41.1% and 7.0% of 12,845 households, respectively. Annual household expenditure on cigarettes (10.7%) was triple that of waterpipe tobacco (3.4%) (p < 0.001). Smoker households spent less than nonsmoker households on virtually all expenditure groups (p < 0.001). The poorest income quintile spent 11.1% of its total expenditure on tobacco (1.26 times higher than the richest, p = 0.006). More waterpipe tobacco than cigarette smoker households lived below the poverty line (40.6% versus 24.4%, p < 0.001). Cigarette smoker households spent less on food and housing but more on tobacco than waterpipe tobacco smoker households. The poorest cigarette and waterpipe tobacco smoker households spent 7.0-9.7 times as much on tobacco as on education. Common independent factors associated with higher household expenditure on cigarettes and waterpipe tobacco were urban residence (p = 0.011 and p = 0.015, respectively), and lower income (p < 0.001).ConclusionIn 2017/2018, one-tenth of Egyptian smoker household’s expenditure was allocated to tobacco, disproportionately concentrated among the poorest. Our results preliminarily indicate that tobacco expenditure is associated with potential compromises of varying extent in almost all other expenditures in smoker households. This baseline profiling of household tobacco expenditure can potentially inform an evidence-based tobacco taxation policy, supporting the reduction of tobacco-associated socioeconomic inequalities.

Poor people have remarkably lower health expenditures than rich people in Vietnam. According to the 2016 Vietnam Household Living Standard Survey (VHLSS), per capita health expenditure of the top quintile households is around 6 times higher than that of the bottom quintile households. We analyze economic inequalities in health expenditure using the concentration index approach and data from the VHLSS 2010-2016. Next, we use the instrumental-variable regression analysis to examine the crowding-out effect of tobacco expenditure on health expenditure. Finally, we use decomposition analysis to explore whether economic inequality in tobacco expenditure is associated with an economic inequality in health expenditure. We find a crowding-out effect of tobacco expenditure on health expenditure of households. The share of health expenditure of households with tobacco spending is 0.78% lower than that of households without tobacco spending. It is estimated that a one-VND increase in tobacco expenditure results in a 0.18 Vietnamese Dong (VND) (95% CI: -0.30 to -0.06) decrease in health expenditure. There is a negative association between economic inequality in tobacco expenditure and economic inequality in health expenditure. This means that if the poor consume less tobacco, their expenditure on health can be increased, resulting in a decrease in inequality in health expenditure. Findings from this study suggest that reducing tobacco expenditure could improve health care of the poor and reduce inequality in health care in Vietnam. Our study recommends that the government continuously increase the tobacco tax in order to effectively reduce tobacco consumption. Empirical studies show mixed results on the effect of tobacco expenditure on health expenditure. We find a crowding-out effect of tobacco expenditure on health expenditure of poor households in Vietnam. It implies that if the poor reduce their expenditure on tobacco, economic inequality in health expenditure can be reduced. Our findings suggest that reducing tobacco consumption in poor households can increase their health expenditure, therefore, decreasing inequality in health expenditure. Different policies to reduce tobacco consumption such as tobacco taxation, smoke-free areas, and tobacco advertisement bans should be strengthened.

The financial impact and consequences of cancer on the lives of survivors remain poorly understood. This is especially true for colorectal cancer. We investigated objective cancer-related financial stress, subjective cancer-related financial strain, and their association with health-related quality of life in colorectal cancer survivors. This was a cross-sectional postal survey. The study was conducted in Ireland, which has a mixed public-private healthcare system. Colorectal cancer survivors, diagnosed 6 to 37 months prior, were identified from the population-based National Cancer Registry. Cancer-related financial stress was assessed as impact of cancer on household ability to make ends meet and cancer-related financial strain by feelings about household financial situation since cancer diagnosis. Health-related quality of life was based on European Organisation for Research and Treatment of Cancer QLQ-C30 global health status. Logistic regression was used to identify associations between financial stress and strain and low health-related quality of life (lowest quartile, score ≤50). A total of 493 survivors participated. Overall, 41% reported cancer-related financial stress and 39% cancer-related financial strain; 32% reported both financial stress and financial strain. After adjustment for sociodemographic and clinical variables, the odds of low health-related quality of life were significantly higher in those who reported cancer-related financial stress postdiagnosis compared with those who reported no change in financial stress postcancer (OR = 2.54 (95% CI, 1.62-3.99)). The odds of low health-related quality of life were also significantly higher in those with worse financial strain postdiagnosis (OR =1.73 (95% CI, 1.09-2.72)). The OR for those with both cancer-related financial stress and financial strain was 2.59 (95% CI, 1.59-4.22). Survey responders were younger, on average, than nonresponders. Responders and nonresponders may have differed in cancer-related financial stress and strain or health-related quality of life. Four in 10 colorectal cancer survivors reported an adverse financial impact of cancer. Cancer-related financial stress and strain were significantly associated with low health-related quality of life. To inform support strategies, additional research is needed to better understand how both objective and subjective financial distress influence survivors' health-related quality of life. See Video Abstract http://links.lww.com/DCR/A447.

Muslim young adults’ financial strain and financial stress during the COVID-19 pandemic: The moderating role of religiosity

While higher tobacco prices lead to a reduction in smoking prevalence, there is a concern that paying more for cigarettes can lead to excess financial burden. Our primary aim was to examine the association of daily cigarette expenditure with smoking-induced deprivation (SID) and financial stress (FS). We used data from wave 7 (2008-2009) of the International Tobacco Control (ITC) Four-Country Survey which is a survey of smokers in Canada, the USA, the UK and Australia (n = 5887). Logistic regressions were used to assess the association of daily cigarette expenditure with SID and FS. In multivariate analyses, a one standard deviation increase in daily cigarette expenditure was associated with an increase of 24% (P = 0.004) in the probability of experiencing SID. While we found no association between daily cigarette expenditure and FS, we found that SID is a strong predictor of FS (odds ratio 6.25; P < 0.001). This suggests that cigarette expenditure indirectly affects FS through SID. Results showed no evidence of an interaction between cigarette expenditure and income or education in their effect on SID or FS. Our results imply that spending more on tobacco may result in SID but surprisingly has no direct effect on FS. While most smokers may be adjusting their incomes and consumption to minimise FS, some fail to do so occasionally as indexed by the SID measure. Future studies need to prospectively examine the effect of increased tobacco expenditure on financial burden of smokers.

Cancer places a financial and economic burden on individuals, but relatively little is known about the consequences. We investigated associations between cancer-related financial stress and strain and psychological well-being. Individuals >6 months post-diagnosis with breast, prostate and lung cancer, identified from the National Cancer Registry Ireland, completed a postal questionnaire. Financial stress was assessed by the impact of the cancer diagnosis on household ability to make ends meet, financial strain by feelings about household financial situation since the cancer diagnosis and psychological well-being (depression, anxiety and distress) by the Depression Anxiety Stress Scales-21. Logistic regression was used to identify associations between financial stress and strain and depression, anxiety and distress of (a) any severity and (b) severe or worse. The response rate was 54%. Of 654 respondents, 49% reported increased financial stress and 32% increased financial strain due to cancer. Depression, anxiety and distress were present in: 36%, 29% and 29%, respectively (any severity); and 14%, 13% and 13%, respectively (severe or worse). In adjusted analyses, depression risk was raised threefold in those reporting increased cancer-related financial stress (odds ratio (OR) = 2.79, 95%CI 1.87-4.17) and increased cancer-related financial strain (OR = 3.56, 95%CI 2.23-5.67). For severe or worse depression, the risk estimates were more pronounced (increased stress: OR = 4.36, 95%CI 2.35-8.10; increased strain: OR = 8.21, 95%CI 3.79-17.77). Similar associations were found for anxiety and distress. Cancer-related financial stress and strain were consistently associated with increased risk of adverse psychological outcomes. If confirmed, these findings provide further rationale for initiatives to alleviate the financial burden of cancer.

This paper examines the role of demographic, socio‐economic and debt portfolio characteristics as contributors to financial stress in Australian households. The data are drawn from the most recent Household Expenditure Survey and relate to 3268 probability‐weighted households. Financial stress is defined, among other things, in terms of financial reasons for being unable to have a holiday, to have meals with family and friends, to engage in hobbies and other leisure activities, and general money management. Characteristics examined include family structure and composition, source and level of household income, age, gender and marital status, ethnic background, housing value, debt repayment of various types and credit card usage. Binary logit models are used to identify the source and magnitude of factors associated with financial stress. The evidence provided suggests that financial stress is higher in families with more children and those from ethnic minorities, especially when reliant on government pensions and benefits, and lower in families with higher disposable incomes and housing values. There is weak evidence that Australia's historically high levels of household debt cause financial stress.

Economic burden on families coping with end-stage cancer remains poorly understood. Advanced malignancy threatens financial stability of families, and interventions are needed to buffer them from impoverishment. This study examined the relationship between subjective and objective assessments of financial burden on families (financial strain and stress, respectively) and identified potentially modifiable factors to inform intervention efforts. Using national survey data, we analyzed responses from households that had recently experienced a cancer death; 176 of households provided information on financial strain, and 158 provided data on financial stress. In addition to self-reported appraisals of financial burden, measures assessed elements of the cancer care experience, treatment, symptom burden, work impact, insurance coverage, and demographics. Despite being well insured, approximately a quarter of respondents reported that the cost of care was a major financial burden, and a third used all or most of their savings. Financial strain and stress were moderately positively correlated (r = 0.46, p < 0.01). Higher financial stress scores were negatively correlated with decedent's age at death (r = -0.34, p < 0.01), and minority respondents ('other' race) reported much higher financial stress (M = 4.7; SD = 3.2) than White (M = 0.8; SD = 1.4) or Black (M = 1.6; SD = 2.2) respondents (p < 0.001). Financial burden was also associated with no or limited insurance coverage, changes in employment, severe pain and nausea, and provider interactions during the cancer care experience (e.g., whether the MD paid attention to non-medical factors or having unanswered questions about medications) (p < 0.05 for all). The cancer care experience, symptoms, and work impact were associated with financial burden and have important implications for research and practice. Copyright © 2015 John Wiley & Sons, Ltd.

Objective: To investigate the relation between socioeconomic status (SES) and tobacco expenditure among Australian households. Design and setting: Cross sectional study (The Household Expenditure Survey 1998–99) by the Australian Bureau...

Objective financial stress, which incorporates all medical and non-medical financial stressors by households, shapes patients’ subjective perceptions of financial strain. This study addresses whether patient age and disability days reveal patients to have different perceptions of financial strain even when their households incur the same level of financial stress. Among patients with the same level of household financial stress, older patients perceived less financial strain from difficulty paying bills than younger patients. However, among patients reporting above-average disability days, older patients also perceived more financial strain than younger patients about the adequacy of their health insurance and finances in the future. Thus, financial strain measures that focus on projected health needs should supplement those that describe current household circumstances to improve screenings of older patients who are under-prescribed, or unable to adhere to, a regimen for all necessary health care.

With the onset of globalization, the economic contexts and working conditions within many countries are changing, presenting new challenges' for governments, organizations, and workers. Amid these challenges, concerns about personal finances are prevalent among employees and detrimental to workers' health, well-being, and families. Research on how this financial stress affects employees at work is lacking. In this thesis, I propose an appraisal-based model of financial stress whereby actual income and expenses are related to perceptions of income adequacy to afford wants and needs. These adequacy perceptions are, in turn, related to financial strain, representing a heightened negative affective state regarding one's financial situation. I hypothesize that, through a drain in emotional resources, financial strain will negatively predict life satisfaction by potentially inhibiting participation in healthy, enjoyable behaviors. I argue that this drain in emotional resources will also inhibit successful task performance and restrict participation in discretionary citizenship behaviors. Data from two working samples provide support for the hypothesized financial stress model and establish preliminary evidence of construct validity for new financial stress scales. In a prospective investigation, financial strain fully mediated the effects of income adequacy on subsequent life satisfaction, but was not related to job performance. Instead, perceived income adequacy to afford wants had a direct negative relationship with both task performance and citizenship behaviors at work, while income adequacy to afford needs had a positive direct effect on organizational citizenship behaviors. This work resolves many conceptual inconsistencies about financial stress in the literature, and contributes to the understanding of how income perceptions and financial stress might influence psychological resources and work motivation. This work has important implications for how organizations manage employees who may be experiencing low income adequacy and high financial strain. Finally, there are several meaningful opportunities for future research that would substantially build upon existing theory and evidence in this new area of financial stress and work.

Cancer may have a significant financial impact on patients, but the characteristics that predispose patients to cancer-related financial hardship are poorly understood. We investigated factors associated with cancer-related financial stress and strain in breast and prostate cancer survivors in Ireland, which has a complex mixed public-private healthcare system. Postal questionnaires were distributed to 1373 people diagnosed with cancer 3-24 months previously identified from the National Cancer Registry Ireland. Outcomes were cancer-related financial stress (impact of cancer diagnosis on household ability to make ends meet) and financial strain (concerns about household financial situation since cancer diagnosis). Modified Poisson regression was used to estimate relative risks (RR) for factors associated with cancer-related financial stress and strain. Seven hundred forty survivors participated (response rate = 54 %). Of the respondents, 48 % reported cancer-related financial stress and 32 % cancer-related financial strain. Compared to those employed at diagnosis, risk of cancer-related financial stress was significantly lower in those not working (RR = 0.71, 95 % CI 0.58-0.86) or retired (RR = 0.48, 95 % CI 0.34-0.68). It was significantly higher in those who had dependents; experienced financial stress pre-diagnosis; had a mortgage/personal loans; had higher direct medical out-of-pocket costs; and had increased household bills post-diagnosis. For cancer-related financial strain, significant associations were found with dependents, pre-diagnosis employment status and pre-diagnosis financial stress; risk was lower in those with higher direct medical out-of-pocket costs. Cancer-related financial stress and strain are common. Pre-diagnosis employment status and financial circumstances are important predictors of post-diagnosis financial wellbeing. These findings could inform development of tools to identify patients/survivors most in need of financial advice and support.

Tobacco use and perceived financial strain among junior enlisted in the U.S. Military in 2002

This paper quantifies factors affecting energy‐related financial stress in Australia, a key economic challenge facing a minority of households. We find that low net wealth is a particularly important factor affecting difficulty in paying energy bills. Having insulation reduces reported difficulties in being able to heat and cool homes. The odds of not paying energy bills on time are doubled by households not having solar panels. Other important factors contributing to energy‐related financial stress include being a renter, being a mortgage holder, having a large number of occupants in a household, and having a resident who requires energy‐consuming medical equipment.

Student Loan Debt and Financial Stress: Implications for Academic Performance Amanda R. Baker (bio) and Catherine P. Montalto (bio) With the costs of college on the rise across the United States, many postsecondary educators are concerned about the potential effect of financial strain on student outcomes. Scholars have long hypothesized that students who are concerned about finances may demonstrate lower goal commitment, academic engagement, and persistence (Boatman & Long, 2016; Cabrera, Nora, & Castañeda, 1992; Nora, Barlow, & Crisp, 2006). High levels of student loan debt and financial stress have been associated with increases in students’ likelihood of dropping out, stopping out, or reducing their course loads (Dwyer, Hodson, & McCloud, 2013; Joo, Durband, & Grable, 2008; Robb, Moody, & Abdel-Ghany, 2012). Financial concerns have also been linked with extended time to degree (Letkiewicz et al., 2014), which can further escalate the costs of college. The causal mechanisms linking financial concerns to college outcomes are not fully understood. Researchers have suggested that financial strain may reduce students’ motivation to complete college (Cabrera et al., 1992; Nora et al., 2006) or deplete the cognitive resources students have available to allocate to academic concerns (Northern, O’Brien, & Goetz, 2010), yet few studies have specifically examined the associations between financial concerns and academic performance. Furthermore, researchers have not yet distinguished the effects of high levels of financial stress from more moderate levels of financial stress. These questions have significant implications for student affairs practitioners, who are tasked with ensuring that financial concerns do not negatively affect students’ academic success. Trends in student borrowing and financial stress vary between racial and ethnic groups and by gender, pointing to possible inequities in financial support for college. One study shows that Black bachelor’s degree recipients were more likely to have borrowed $30,000 or more in student loans, potentially reflecting lower access to other forms of financial support (Baum & Steele, 2010). Conversely, Latinx and Asian students may be more averse to taking out student loans, even when other sources of financial aid do not cover college costs (Goldrick-Rab & Kelchen, 2015). Some studies have shown that self-reported financial stress is higher among Students of Color, though this may be accounted for by the inadequacy of available financial resources (Archuleta, Dale, & Spann, 2013; Grable & Joo, 2006). Researchers have found that women report higher levels of financial stress than do men (Archuleta et al., 2013; Heckman, Lim, & Montalto, 2014) but that the amount of student debt associated with an increased risk of dropping out is lower for men than for women (Dwyer et al., 2013). Financial concerns include both objective factors, reflecting the actual availability and use of resources, and subjective factors, reflecting students’ perceptions of their financial stability (Nora et al., 2006). We examined how both objective and subjective indicators of financial [End Page 115] concerns were associated with academic performance. First, we examined whether expected student loan debt and subjective levels of financial stress were associated with academic performance after 1 year, controlling for prior grades and demographics. Then, we examined interaction effects to determine whether the academic implications of financial concerns differed on the basis of race/ethnicity or gender. METHOD Data Source An online survey was distributed to a random sample of 5,000 undergraduate students enrolled at a large Midwestern public university in Fall 2014. Two reminders were sent, and participation was incentivized with entry into a gift card drawing. Of the 666 students who responded, data were analyzed for 299 respondents who were still enrolled 1 year later and who provided complete information about their finances and demographics. Of those excluded, 168 had graduated, 15 had dropped out or stopped out, and 184 had missing data on one or more key variables. We did not find statistically significant differences in the race/ethnicity, gender, student loan debt amount, financial stress, or grades of students with and without missing data. The sample was demographically similar to the undergraduate population of the institution, although female students were overrepresented among survey participants. Most respondents (89.7%) were traditional-aged college students, and 60.5% were female. The sample was 72.4% White, 10.0% Asian, 7.6% Black, 1.3% Latinx, 7.3% multiracial/ethnic, and 1...