Smoking-induced deprivation and subsequent smoking cessation among adults who smoke in four high-income countries: Trends, correlates and longitudinal associations, 2016-2024.

BACKGROUND AND AIMS: Tobacco smoking substantially contributes to poverty. Smoking-induced deprivation (SID) occurs when people continue smoking despite financial stress. This study examined (i) trends in SID in Canada, the United States (US), England and Australia from 2016 to 2024; (ii) associated factors; and (iii) its impact on quit attempts and quit success. DESIGN: Multi-country longitudinal study using five waves (2016, 2018, 2020, 2022 and 2024) of the International Tobacco Control Four Country Smoking and Vaping Survey. SETTING: Web panel surveys of adults who smoke in Canada, the US, England and Australia, weighted to national smoking populations. PARTICIPANTS: Participants (n = 26 888) were aged ≥18 years, completed at least one wave, smoked at least monthly and answered the SID question. Longitudinal analyses included 8484 respondents retained from baseline (T) to the subsequent wave (T + 1), including 3848 who attempted to quit. MEASUREMENTS: SID was self-reported as not having enough money for household essentials in the past six months due to spending on cigarettes. Predictors included survey wave, sociodemographic factors, smoking dependence, illicit tobacco purchasing, vaping status, quit intention and quit self-efficacy. Quit attempts were any attempt since the previous wave. Quit success was not smoking at T + 1 among quit attempters. RESULTS: Weighted SID prevalence among adults who smoke increased from 9.5% in 2016 to 14.6% in 2022 and decreased to 13.6% in 2024, with significant year-by-country interactions (P < 0.001). Prevalence increased across all countries between 2016 and 2022, was greatest in Australia (12% to 22.7%) and remained higher in 2024 than 2016 despite declines from 2022 in England and Australia. SID was associated with age 18-24 years [adjusted odds ratio (aOR) = 3.61, 95% confidence interval (CI) = 3.04-4.28 vs. 55+], low income (aOR = 2.70, 95% CI = 2.36-3.10 vs. high), low education (aOR = 1.18, 95% CI = 1.01-1.38 vs. high), high smoking dependence (aOR = 2.97, 95% CI = 2.36-3.73 vs. non-daily), current vaping (aOR = 1.59, 95% CI = 1.40-1.80 vs. never vaped), illicit tobacco use (aOR = 2.41, 95% CI = 2.15-2.71 vs. no), intending to quit within one month (aOR = 1.73, 95% CI = 1.57-1.90) and lowest self-efficacy (aOR = 1.54, 95% CI = 1.34-1.77 vs. highest). SID was associated with quit attempts (aOR = 1.18, 95% CI = 1.00-1.39), but lower quit success (aOR = 0.48, 95% CI = 0.33-0.72). SUMMARY: In Australia, Canada, England and the United States, smoking-induced deprivation (continuing smoking despite financial stress) among adults who smoke remained higher in 2024 than in 2016, despite declining from 2022 and was associated with socioeconomic disadvantage, higher nicotine dependence and lower quit success.