Introduction

Smoking is more prevalent in smokers from lower compared with higher socioeconomic (SES) groups, but studies are inconsistent regarding underlying mechanisms. We aimed to assess associations between SES indicators and three distinct aspects of the smoking cessation process: attempting to quit; use of evidence-based cessation treatments; and success.

Methods

We analysed data of 12,161 last-year smokers (i.e., current smokers and recent ex-smokers who quit ≤ 12 months) from 20 waves (June/July 2016 to August/September 2019) of the German Study on Tobacco Use (DEBRA) – a representative household survey. Associations between indicators of SES (income and education) and (1) last-year quit attempts; (2) use of evidence-based cessation treatment or electronic cigarettes during the last attempt; and (3) short-term self-reported abstinence were analysed using multivariable logistic regression, adjusted for potential confounders.

Results

Of all last-years smokers, 18.6% had attempted to quit, of whom 15.2% had successfully stopped. Higher income (OR 0.82, 95%CI = 0.77–0.88 per 1000€) but low vs. high education (OR 0.83, 95%CI = 0.73–0.95) were associated with lower odds of quit attempts. In smokers with quit attempts, higher income but not education was associated with higher odds of using cessation medication (OR 1.31, 95%CI = 1.08–1.59 per 1000 €). Neither income nor education were associated with using behavioural support or success.

Conclusions

In the German healthcare system without free access to evidence-based cessation therapy, low-income smokers are more likely to make a quit attempt but less likely to use cessation medication than high-income smokers. Equitable access to such medication is crucial to reduce SES-related health disparities.

中文翻译：

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吸烟者的收入与教育，戒烟尝试，戒烟辅助工具的使用以及短期成功之间的关联：德国一项基于人口的横断面家庭调查的社会梯度分析（DEBRA研究）。

介绍

与较高的社会经济（SES）组相比，吸烟在较低年龄段的吸烟者中更为普遍，但有关潜在机制的研究并不一致。我们旨在评估SES指标与戒烟过程的三个不同方面之间的关联：尝试戒烟；尝试戒烟；尝试戒烟。使用循证戒烟治疗；和成功。

方法

我们分析了德国烟草使用研究（DEBRA）的20次浪潮（2016年6月/ 2016年7月至2019年8月/ 2019年9月）中的12,161名去年吸烟者（即当前吸烟者和最近戒烟≤12个月的前吸烟者）的数据–代表性的家庭调查。SES指标（收入和教育程度）与（1）去年戒烟尝试之间的关联；（2）在最后一次尝试中使用循证戒烟治疗或电子烟；（3）使用多因素logistic回归分析了短期自我报告的戒断，并针对潜在的混杂因素进行了调整。

结果

去年所有吸烟者中，有18.6％尝试戒烟，其中15.2％成功戒烟。较高的收入（OR 0.82，95％CI =每1000欧元€0.77-0.88），但相对于高等教育水平较低（OR 0.83，95％CI = 0.73-0.95）与较低的戒烟几率相关。在尝试戒烟的吸烟者中，较高的收入但没有受过教育的人使用戒烟药物的几率更高（OR 1.31，95％CI = 1.08–1.59 / 1000€）。收入和教育都与使用行为支持或成功无关。

结论

在无法免费获得循证戒烟疗法的德国医疗体系中，低收入吸烟者比高收入吸烟者更有可能戒烟，但使用戒烟药物的可能性较小。公平获得此类药物对于减少与SES相关的健康差异至关重要。