Abstract
Low-income adults are significantly more likely to smoke, and face more difficulty in quitting, than people with high income. High rates of delay discounting (DD) may be an important factor contributing to the high rates of tobacco use among low-income adults. Future-oriented financial coaching may offer a novel approach in the treatment of smoking cessation among low-income adults. This secondary analysis (N = 251) of data from a randomized controlled trial examined the integration of future-oriented financial coaching into smoking cessation treatment for low-income smokers. Linear regression and finite mixture models (FMM) estimated the overall and the latent heterogeneity of the impact of the intervention versus usual care control on DD rates 6 months after randomization. Though standard linear regression found no overall difference in DD between intervention and control (β = −0.23, p = 0.338), the FMM identified two latent subgroups with different responses to the intervention. Subgroup 1 (79% of the sample) showed no difference in DD between intervention and control (β = 0.25, p = 0.08). Subgroup 2 (21% of the sample) showed significantly lower DD (β = −2.06, p = 0.003) among intervention group participants versus control at 6 months. Participants were more likely to be a member of subgroup 2 if they had lower baseline DD rates, were living at or below 100% of federal poverty, or were married/living with a partner. This study identified a group of low-income adults seeking to quit smoking who responded to financial coaching with decreased DD rates. These results can be used to inform future targeting of the intervention to individuals who may benefit most, as well as inform future treatment adaptations to support the subgroup of low-income smokers, who did not benefit.
Highlights
People living with low income are significantly more likely to smoke than people with high income [3–5]
Behavioral economics suggest that higher rates of delay discounting (DD) may be an important factor contributing to the increased initiation of tobacco use and difficulties quitting among low-income adults
Participants were more likely to be in Subgroup 2 if they had lower baseline DD rates, were married or living with a partner, or were living at/below federal poverty level (FPL)
Summary
People living with low income (i.e., below 150–200% of the federal poverty level, FPL [1,2]) are significantly more likely to smoke than people with high income [3–5]. People with low income are as interested in quitting, but are less likely to be successful, than people with high income [3]. The income disparity in tobacco use has persisted over the past 50 years—pointing to a need for novel interventions that address the unique needs and barriers to quitting for low-income smokers [6–8]. Behavioral economics suggest that higher rates of delay discounting (DD) may be an important factor contributing to the increased initiation of tobacco use and difficulties quitting among low-income adults. DD is a phenomenon in which people prefer small, immediate rewards compared to larger, delayed rewards—meaning that they “discount”.
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