Promoting Smoking Cessation among Individuals With Food Insecurity

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PROJECT SUMMARY/ABSTRACT Despite overall declines in the prevalence of cigarette smoking, smoking remains the leading cause of preventable disease and death. Smoking prevalence is also disproportionately concentrated among population groups that are economically disadvantaged, contributing to an uneven burden of tobacco-related health problems. Socioeconomic disparities in tobacco use persist largely because economically disadvantaged smokers are less likely to succeed in quitting than non-economically disadvantaged smokers. Many economically disadvantaged smokers are motivated to quit, but various life stressors pose significant barriers to cessation. One of the most stressful conditions in the experience of poverty is food insecurity, or the inability to afford adequate and appropriate foods needed to live an active and healthy life. Epidemiological studies have demonstrated that food insecurity is independently associated with increased odds of smoking. However, proximal factors linking food insecurity and smoking are not well understood, and research has not extended this association towards informing cessation. Extant literature suggests that there are shared psychological (e.g., stress) and physiological (e.g., hunger) factors that may predispose food insecure smokers to encountering difficulties with quitting smoking. The overall goal of this proposal is to build the candidate's research expertise on the intersection of food insecurity, smoking, and quitting. This award will support the candidate's career development as a social and health psychologist whose research addresses social determinants of health to promote smoking cessation among socioeconomically disadvantaged populations. The career development plan includes advanced training and mentorship in (1) social epidemiology, (2) qualitative research methods, (3) food insecurity and nutrition policy, and (4) smoking cessation intervention research. Aim 1 of the proposed study will determine whether the experience of food insecurity is associated with continued smoking among a nationally representative sample of low-income smokers, using extant longitudinal data from the 2001-2013 Panel Study of Income Dynamics. Aim 2 will target a subset of the local population with food insecurity—individuals seeking federal food assistance through the Supplemental Nutrition Assistance Program (SNAP) in San Francisco, California—to conduct surveys and in-depth interviews on the lived experience of food insecurity and its association with smoking behaviors and quitting. Aim 3 will develop and pilot test a smoking cessation outreach program that is delivered to 100 smokers with food insecurity in the context of SNAP, which provides a novel venue for smoking cessation and health promotion research. Taken together, this research and training plan will lay the foundation for a planned community-based randomized controlled trial of a smoking cessation intervention targeting households with food insecurity. This work has the potential to inform reductions in tobacco-related health disparities.