As overall smoking prevalence in the U.S. declines, it becomes more important to understand the characteristics of the smokers that remain in order to reach them with interventions that will help them quit. Research has shown that as the number of smokers declines, at the population level, remaining smokers are likely to consume fewer cigarettes and be more willing to quit, indicating softening of the smoking population.
Given this finding and the high variability in smoking prevalence among different subgroups of smokers, the goal of the proposed research is to test whether the same or whether differential softening patterns are occurring in different subgroups of smokers in California, a state that has been known for its rigorous tobacco control policy environment. The subgroups of smokers to be examined include men and women, different age groups, those of varying socioeconomic status, racial and ethnic groups, those with different sexual identities, those living in rural vs. urban areas, those with and without mental distress, and daily vs. non-daily smokers.
To achieve the research goal I will complete three specific aims: (1) Determine whether, over time, as smoking prevalence declines, there are differential patterns of softening among the remaining California smokers, varying by subgroup. (2) Identify the determinants of differential softening for the different smoking population subgroups, by detecting the associations between individual, societal and policy factors and the willingness/ability to quit. (3) Determine how electronic cigarette (e-cigarette) use affects differential softening. Since a smoker’s immediate environment, policies like clean indoor air laws, the inclusion of nicotine replacement therapy (NRT) in health insurance coverage, or the recent surge in the popularity of e-cigarettes may all be contributing to differential softening through differential exposure among population subgroups, these factors will all be included in the analyses.
Segmenting the remaining smokers and identifying those who need more targeted policies and interventions will inform the design of state and local tobacco control policies and interventions specifically addressing these population subgroups that are currently underserved. Doing so will also contribute to decreasing health disparities.