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Abstract
Australia did not meet its National Tobacco Strategy (NTS) target of a 10% smoking rate by 2018. Low-socioeconomic status (low-SES) smokers are not quitting at the same rate as other smokers and the disparity in smoking prevalence between the most and least advantaged Australians contributes to health inequalities. National guidelines recommend a focus on these smokers, and reduced smoking in low-SES groups is a priority for Australia’s NTS.
The overarching aim of this thesis was to evaluate effective approaches to smoking cessation, and to examine quantitatively and qualitatively the factors associated with the utilisation of smoking cessation treatment and smoking abstinence among low-SES smokers. This thesis addressed this aim through a series of five studies that were designed to examine and determine among low-SES smokers: 1) the methodological quality and effectiveness of alternative and novel technology-based smoking cessation interventions; 2) the factors associated with self-reported behavioural and pharmacological smoking cessation treatment; 3) the factors associated with verified smoking abstinence; 4) the qualitative factors that impacted treatment engagement and the acceptability and feasibility of alternative approaches to smoking cessation support; and 5) the motivational influences of quitting behaviours as experienced by smokers and ex-smokers.
Several important findings were identified. Firstly, a paucity of high-quality technology-based smoking cessation interventions were identified. The pooled estimates suggest some technology-based platforms are more effective for increasing abstinence than standard care. Secondly, reporting a mental health disorder, alcohol consumption at hazardous levels, and self-efficacy to quit were factors associated with prior smoking cessation treatment utilisation. Logistic regression suggested that independent factors associated with reduced likelihood of achieving verified abstinence were having a mental health disorder or reporting prior treatment utilisation at study enrolment. Finally, the experience of smoker-related stigma and positive smoker identity undermined quit attempts, and mobile phone text messaging for quit support was endorsed as an alternative to existing Quitline services.
Providing cost-effective, easily accessible and tailored cessation support is required to lift treatment engagement, quit attempts, and quit rates among low-SES smokers. Future research aimed at developing tailored technology-based quit support that can be upscaled and incorporated into existing services is warranted.