Socio-economic disadvantage at the area level poses few direct barriers to smoking cessation for Australian smokers: Findings from the International Tobacco Control Australian cohort survey (2012)

Introduction. Area-level indicators of socio-economic variation are frequently included in models of individual health outcomes. Area disadvantage is linearly related to smoking prevalence, but its relation to cessation outcomes is less well understood.
Aims. To explore the relationship between area-level disadvantage and prospective data on smoking cessation.
Design and Methods. The Australian cohort of the International Tobacco Control Four-Country Survey (N = 3503) was used to prospectively examine the contribution of area-level socio-economic disadvantage to predicting three important smoking-cessation outcomes: making a quit attempt, achieving 1 month abstinence and achieving 6 month abstinence from smoking, while controlling for individual-level socio-economic indicators and other individual-level covariates related to smoking cessation.
Results. Only two independent associations were observed between socio-economic disadvantage and cessation outcomes. Area-level disadvantage was related to 1 month abstinence in a non-linear fashion, and the individual experience of smoking-induced deprivation was associated with a lower likelihood of making quit attempts.
Discussion. Despite the documented higher prevalence of smoking among the more disadvantaged and in more disadvantaged areas, socio-economic disadvantage was not consistently related to making quit attempts, nor to medium-term success. Nevertheless, indirect effects of disadvantage, like its impact on psychological distress, cannot be ruled out, and considering smokers' individual psychosocial circumstances is likely to aid cessation efforts.
Conclusion. Socio-economic disadvantage, particularly at the area level, poses few direct barriers to smoking cessation.