- Access to health care. Lower income individuals are less likely to have regular contact with their health care provider (Hargraves, 2003) and therefore, fewer opportunities to receive education on smoking cessation.
- Insurance coverage. Lower income individuals are less likely to have health insurance, especially in terms of insurance coverage for nicotine replacement therapies and cessation counseling interventions (DeVoe, 2007; Novotny, 2000).
- Increased levels of stress. Lower income populations often face a greater amount of life stressors, such as poverty, making smoking seem like less of a problem. This may lead to a greater reliance on cigarettes as a coping mechanism (Wilkinson, 1997).
Strategies to address these considerations:
- Increase the price of tobacco. Lower income people are more likely to be affected by an increase in the unit price of tobacco. Increasing the price of cigarettes is not only an effective tobacco control strategy to lower smoking prevalence in the general population, but also may provide a means of reducing social disparities in smoking (Siahpush, 2009; CDC, 1998).
- Increase access to cessation assistance. Strategies for decreasing out of pocket costs for tobacco cessation interventions and products for lower income people may help decrease smoking in this population. This could include offering cessation interventions through Medicaid or offering counseling in clinics. Telephone quit lines and campaigns and promotions may provide a free or low out-of-pocket cost for the lower income population to receive tobacco cessation information (Barbeau, 2004)
- Environmental policies. Workplace cessation interventions in blue collar or service industry jobs may be helpful in reaching lower income populations. When smoking cessation programs for blue-collar workers are integrated with efforts to reduce job-related health and safety hazards, workers are significantly more likely to quit compared with workers exposed to a smoking cessation-only program (Barbeau, 2004).
- Involve the community. Effective community programs involve and influence people in their homes, worksites, schools, places of worship, places of entertainment, health care settings, civic organizations and other public places. Changing policies that can influence societal organizations, systems and networks requires the involvement of community partners (CDC, 1999).
- Enact Smoke-Free Laws. Smoke-free legislation has had a significant effect on adult smoking rates (Hahn, 2008). “No smoking” policies are the most common method to reduce environmental tobacco smoke in public places (Barbeau, 2004).
- Educate. Some interventions have used warnings and educational material to deter individuals from smoking in public places. More comprehensive efforts to reduce environmental tobacco smoke include educational campaigns for employees and managers, posting signs about the “no smoking” policy and providing smoking cessation assistance for those who smoke (Barbeau, 2004).
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