Social class, education, and smoking cessation: Long‐term follow‐up of patients treated at a smoking cessation unit

Abstract

Our objective was to examine social class and educational differences in long-term smoking cessation success among a cohort of smokers attending a specialized smoking clinic. We studied sustained abstinence after cessation among 1,516 smokers (895 men and 621 women) treated for smoking cessation between 1995 and 2001 at a university teaching hospital in the metropolitan area of Barcelona, Spain. We calculated 1-year and long-term (up to 8-year) abstinence probabilities by means of Kaplan-Meier curves and the hazard ratio of relapse by means of Cox regression, after adjusting for other predictors of relapse. Overall abstinence probability was .277 (95% CI = .254-.301). Men and women in social classes IV-V had significant hazard ratios of relapse after long-term follow-up (men: 1.36, 95% CI = 1.07-1.72; women: 1.60, 95% CI = 1.24-2.06), as compared with patients in social classes I-II. The same independent effect was observed for education: Men and women with primary or less than primary studies had higher hazard ratios of relapse (men: 1.75, 95% CI = 1.35-2.25; women: 1.92, 95% CI = 1.51-2.46), as compared with patients with a university degree. Similar estimates were obtained after adjustment for stage of change, Fagerström score for nicotine dependence, and type of treatment. Patients of lower socioeconomic status are at higher risk of relapse, and this association is independent of other well-known predictors of relapse. Social differences have to be taken into account in the clinical setting when tailoring specific actions to treat smoking dependence.

A Comparative Study for Successful Treatment per Gender in a Specialized Smoking Cessation Unit in the Albacete University Hospital during Two Years

“…The authors' results are similar to those reported in other studies, and they found no difference [7,8]. In the present study, females smoked less cig/day than males (23.7 cig/day vs. 30.3 cig/day, respectively).…”

Socioeconomic position and abrupt versus gradual method of quitting smoking: Findings from the International Tobacco Control Four-Country Survey

“…Although we do not expect that the outcome of an attempt would influence memories of how it took place or that such memories would be influenced by the factors we have studied here, we cannot rule out these possibilities. Furthermore, we cannot rule out recall bias being a plausible explanation, at least in part, for the lower report of abrupt quitting among the socially disadvantaged since this group is more likely to have shorter or brief attempts (Fernandez et al, 2006), which are more easily forgotten. Another limitation might be the variation in understanding of what constitutes abrupt cessation.…”

“…Greater use of cutting down might be a reason why smokers from more disadvantaged socioeconomic backgrounds are sometimes found to have less success in quitting (Fernandez et al, 2006;West et al) and why sometimes females are found to be less successful than males (Bjornson et al, 1995;Wetter et al, 1999).…”

Abstinencia a los 12 meses de un programa multicomponente para dejar de fumar

“…Educational level is stable in adults, while the occupation variable can show considerable instability over the course of life (Belleudi et al, 2006), which would explain why the former yields greater significance and more robust results than the latter, as the previously-cited studies have also shown (Fernández et al, 2006;Yanez, Leiva, Gorreto, Estela, Tejera, & Torrent, 2013).…”