9.4 The relationship between tobacco smoking and financial stress

Last updated: December 2016 

Suggested citation: Greenhalgh, EM, Scollo, MM, & Pearce, M. 9.4 The relationship between tobacco smoking and financial stress. In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2016. Available from: http://www.tobaccoinaustralia.org.au/chapter-9-disadvantage/9-4-the-relationship-between-tobacco-smoking-and-f

Tobacco use is both a contributor to and an outcome of financial stress.1

9.4.1 Spending on tobacco as a cause of financial stress

According to the ABS 2009–10 Household Expenditure Survey, households with lower-than-average income appear to spend (on average) slightly less on tobacco products per week than do higher-income households. However, average spending on tobacco products as a percentage of total weekly expenditure is higher among low-income households. In the lowest-income households expenditure on tobacco products as a proportion of total household weekly expenditure was over double that of the highest income households.2

In households where the main source of income is government pensions and allowances, the reported weekly expenditure for those on disability or carer payments was $20.98; among those on study or unemployment benefits, $24.77; and $18.92 for households receiving family support payments. This represents 2.9%, 3.5% and 2.3% of total weekly household expenditure among these groups respectively.2

Expenditure on tobacco products in single parent households was on average $16.83 per week, and those in state/territory housing reported average expenditure of $17.67 per week.2

In coupled households, those with children under five years of age spent an average $7.80 per week on tobacco products and those with children aged 5¬–14 years spent an average $10.95. In comparison, couples (aged under 35 years) with no children spent an average $9.83 per week on tobacco in 2009–10.2

Table 9.4.1
Average weekly expenditure on tobacco products among households in each income quintile, Australia, 2009–10, and as percentage of total household spending

Source: Australian Bureau of Statistics 20112
* Current dollars: the price in the applicable year; no adjustment has been made for inflation
† Includes a high proportion of households comprising older single people on pensions, with a higher proportion of females than males

The ABS figures above include both smoking and non-smoking households. When isolating smoking households, the proportion of income spent on cigarettes among the lowest income group—and the gap between income groups—is substantially higher. For example, an analysis in NSW found that in 1998–99, the poorest smoking households spent an average of over 18 per cent of their income on tobacco, while smoking households in the top income quintile spent only three per cent of their total income on tobacco.3 A more recent Australian study in 2012 of socioeconomically smokers, more than half of whom lived below the poverty line (i.e., earned less than A$300/week), found that smokers spent an average of A$56.07 on tobacco each week.4

International research shows similar disproportionate spending among disadvantaged groups. A survey of homeless smokers in Boston found that on average, they had spent $44 on tobacco in the past week, equating to 36% of their average monthly income. One-third said they had difficulty finding shelter, food, clothing, or a place to wash.5 Smoking can also exacerbate financial deprivation for children; research in the UK found that nearly half of all children in relative poverty in 2012 had at least one smoking parent, and about 432,000 additional children would be classed as being in poverty if parental tobacco expenditure were subtracted from household income.6

Smokers are more likely to experience financial distress than non-smokers.1 Factors such as lower income, high nicotine addiction, a social circle of smokers, and being of younger age are associated with a likelihood of experiencing an instance of ‘smoking-induced deprivation’—whereby the smoker has reported spending money on tobacco rather than on household essentials.7 Research from Canada, the USA, the UK, and Australia found that those who spent more on cigarettes were more likely to experience smoking-induced deprivation, which was predictive of financial stress.8

Being unable to afford enough food to maintain an active and healthy lifestyle (termed ‘food insecurity’) and its connection with low-income groups and high smoking prevalence has been shown in studies in the US population.9, 10 One study found that past-year food insecurity was significantly associated with daily but not non-daily smoking, independent of sociodemographic characteristics and alcohol use.11 Another found that higher nicotine dependence predicted financial stress related to affording food, housing, and living within one's income.12 In low- and middle-income countries, daily tobacco use is associated with lower household expenditures on education and healthcare.13

Employment status may also be an important factor in the relationship between smoking and financial stress. People who are unemployed have significantly higher levels of regular smoking than those who are employed (see Section 1.7). Research in California found that smokers struggled to gain employment compared to non-smokers, and that those who did were paid less than non-smokers. Even after controlling for factors such as sex, stable housing, reliable transportation, criminal history, and prior treatment for alcohol or drug use, non-smokers were 24% more likely to be re-employed at one year relative to smokers.14 Another study in the US found that workplace discrimination was associated with current and daily smoking among racial/ethnic minorities.15

9.4.2 Financial stress and its influence on smoking abstinence

Research suggests that low-income smokers, or smokers experiencing financial stress, are less likely to quit and remain quit.16-18 Data from wave 4 of the International Tobacco Control Four-Country Survey showed that smokers experiencing financial stress were more likely than others to want to quit smoking, but at follow-up, they were less likely to have made an attempt to quit smoking. Among the smokers who had made a quit attempt, financial stress was associated with less chance of smoking abstinence at follow-up.19 Looking only at the Australian cohort, another study found that experiencing smoking-induced deprivation was associated with a lower likelihood of making quit attempts.20

A study of tobacco use in older homeless adults in the US found that rates of quit attempts were similar to that observed in the general population, but successful quitting was lower.21

Smokers of low socio-economic status may describe differing motives for quitting and reasons for relapse than smokers of high socio-economic status.22 For example, one study found that social stressors and the use of smoking to cope with homelessness were perceived as the main barriers to quitting.23 A small qualitative study in the UK explored factors that are important in smoking cessation in women from deprived communities. Based on the participants’ concerns, the authors concluded that interventions that address women's postcessation weight gain, hormonal fluctuations during the menstrual cycle, and stress may aid with smoking cessation and reduce relapse.24

9.4.3 Smoking cessation and the reduction of financial stress

Data from the Household Income and Labour Dynamics in Australia (HILDA) study also show that if smokers do manage to quit, their odds of experiencing financial stress reduce substantially when compared to those of continuing smokers.

Data from the first, second and third waves of the study indicated that, on average, a smoker who quits could be expected to have a 42% reduction in the odds of experiencing financial stress.25 Another study, which used data from four waves of HILDA, showed that the odds of experiencing financial stress were 25% smaller for quitters than continuing smokers, and there was strong evidence of enhanced material wellbeing.26

Relevant news and research

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1. Siahpush M, Borland R, and Scollo M. Smoking and financial stress. Tobacco Control, 2003; 12(1):60–6. Available from: http://tobaccocontrol.bmj.com/cgi/content/full/12/1/60

2. Australian Bureau of Statistics. 6503.0 household expenditure survey and survey of income and housing: Summary of results, 2009-10. Canberra: ABS, 2011. Available from: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/6530.02009-10?OpenDocument

3. Junor W, Collins D, and Lapsley H, The macroeconomic and distributional effects of reduced smoking prevalence in New South Wales. Vol. 16 June 2004.Sydney, Australia: The Cancer Council New South Wales; 2004. Available from: http://www.cancercouncil.com.au/32003/cancer-prevention/smoking-reduce-risks/publications-reports/the-macroeconomic-and-distributional-effects-of-reduced-smoking-prevalence-in-nsw/

4. Guillaumier A, Bonevski B, Paul C, D'Este C, Doran C, et al. Paying the price: A cross-sectional survey of Australian socioeconomically disadvantaged smokers' responses to hypothetical cigarette price rises. Drug and Alcohol Review, 2014; 33(2):177–85. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24350887

5. Baggett TP, Rigotti NA, and Campbell EG. Cost of smoking among homeless adults. New England Journal of Medicine, 2016; 374(7):697–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26886544

6. Belvin C, Britton J, Holmes J, and Langley T. Parental smoking and child poverty in the UK: An analysis of national survey data. BMC Public Health, 2015; 15:507. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26021316

7. Siahpush M, Borland R, and Yong H. Socio-demographic and psychosocial correlates of smoking-induced deprivation and its effect on quitting: Findings from the international tobacco control policy evaluation survey. Tobacco Control, 2007; 16:e2. Available from: http://www.tobaccocontrol.com/cgi/content/full/16/2/e2

8. Siahpush M, Borland R, Yong HH, Cummings KM, and Fong GT. Tobacco expenditure, smoking-induced deprivation and financial stress: Results from the international tobacco control (ITC) four-country survey. Drug and Alcohol Review, 2012; 31(5):664–71. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22404640

9. Armour B, Pitts M, and Lee C-W. Cigarette smoking and food insecurity among low-income families in the United States, 2001. American Journal of Health Promotion, 2008; 22(6):386–93. Available from: www.ncbi.nlm.nih.gov/pubmed/18677878

10. Cutler-Triggs C, Fryer GE, Miyoshi TJ, and Weitzman M. Increased rates and severity of child and adult food insecurity in households with adult smokers. Archives of Pediatrics & Adolescent Medicine, 2008; 162(11):1056–62. Available from: http://archpedi.ama-assn.org/cgi/content/full/162/11/1056

11. Kim JE and Tsoh JY. Cigarette smoking among socioeconomically disadvantaged young adults in association with food insecurity and other factors. Preventing Chronic Disease, 2016; 13:E08. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26766849

12. Widome R, Joseph AM, Hammett P, Van Ryn M, Nelson DB, et al. Associations between smoking behaviors and financial stress among low-income smokers. Preventive Medicine Reports, 2015; 2:911–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26844167

13. Do YK and Bautista MA. Tobacco use and household expenditures on food, education, and healthcare in low- and middle-income countries: A multilevel analysis. BMC Public Health, 2015; 15(1):1098. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26521133

14. Prochaska J, Michalek AK, Brown-Johnson C, Daza E, Baiocchi M, et al. Likelihood of unemployed smokers vs nonsmokers attaining reemployment in a one-year observational study. JAMA Internal Medicine, 2016; 176(5):662–70. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27065044

15. Chavez LJ, Ornelas IJ, Lyles CR, and Williams EC. Racial/ethnic workplace discrimination: Association with tobacco and alcohol use. American Journal of Preventive Medicine, 2015; 48(1):42–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25441232

16. Hiscock R, Judge K, and Bauld L. Social inequalities in quitting smoking: What factors mediate the relationship between socioeconomic position and smoking cessation? Journal of Public Health, 2010; 33(1):39–47. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21178184

17. Siahpush M and Carlin JB. Financial stress, smoking cessation and relapse: Results from a prospective study of an Australian national sample. Addiction, 2006; 101(1):121–7. Available from: www.ncbi.nlm.nih.gov/pubmed/16393198

18. Dobson R. Poor more likely to smoke and less likely to quit. British Medical Journal, 2004; 328(7445):914. Available from: http://www.bmj.com/cgi/content/full/328/7445/914-e

19. Siahpush M, Yong H, Borland R, Reid J, and Hammond D. Smokers with financial stress are more likely to want to quit but less likely to try or succeed: Findings from the International Tobacco Control (ITC) Four Country Survey. Addiction, 2009; 104(8):1382–90. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2009.02599.x/full

20. Partos TR, Borland R, and Siahpush M. 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. Drug and Alcohol Review, 2012; 31(5):653–63. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22385265

21. Vijayaraghavan M, Hurst S, and Pierce JP. Implementing tobacco control programs in homeless shelters: A mixed-methods study. Health Promotion Practice, 2016; 17(4):501–11. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26678988

22. Pisinger C, Aadahl M, Toft U, and Jorgensen T. Motives to quit smoking and reasons to relapse differ by socioeconomic status. Preventive Medicine, 2011; 52(1):48–52. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21047525

23. Chen JS, Nguyen AH, Malesker MA, and Morrow LE. High-risk smoking behaviors and barriers to smoking cessation among homeless individuals. Respiratory Care, 2016. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26860400

24. Memon A, Barber J, Rumsby E, Parker S, Mohebati L, et al. What factors are important in smoking cessation and relapse in women from deprived communities? A qualitative study in southeast England. Public Health, 2016. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26920856

25. Siahpush M, Spittal M, and Singh G. Smoking cessation and financial stress. Journal of Public Health, 2007; 29(4):338–42. Available from: http://jpubhealth.oxfordjournals.org/cgi/content/full/29/4/338

26. Siahpush M, Spittal M, and Singh GK. Association of smoking cessation with financial stress and material well-being: Results from a prospective study of a population-based national survey. American Journal of Public Health, 2007; 97(12):2281–7. Available from: http://www.ajph.org/cgi/content/abstract/97/12/2281