Socioeconomic Status, Social Context, and Smoking Lapse during a Quit Attempt: An Ecological Momentary Assessment Study

Background. Low socioeconomic status (SES) is linked to failure to quit smoking. Health inequity models suggest that SES influences smoking cessation indirectly through increased exposure to pro-smoking social contexts. Purpose. The current study examined longitudinal associations among socioeconomic status; social context factors including exposure to other smokers, places where smoking was allowed, and cigarette availability; and smoking lapse during a quit attempt. Methods. Ecological momentary assessments (EMA) were gathered from a multi-ethnic sample of 365 smokers engaged in a quit attempt. Multilevel structural equation models (MSEMs) estimated associations among EMA variables and indirect effects of SES through exposure to other smokers, places where smoking was allowed, and cigarette availability, to subsequent smoking lapse. Results. Lower SES was associated with greater exposure to other smokers, places where smoking is allowed, and cigarette availability, as well as a higher likelihood of smoking lapse. There were significant indirect paths from SES through exposure to places where smoking is allowed and cigarette availability to subsequent lapse. Additionally, there were significant serial indirect paths whereby SES was associated with both exposure to other smokers and places where smoking was allowed, that in turn, were associated with cigarette availability, and, ultimately, with smoking lapse. Conclusions. Consistent with models positing that SES influences health behaviors via contextual factors, the current study demonstrated that low SES smokers experience greater pro-smoking social contexts that impact subsequent risk for lapse.