Stress, stress management, smoking prevalence and quit rates in a disadvantaged area: has anything changed?

ISSUE ADDRESSED: To assess the prevalence of smoking, quit rates, and perceived levels of stress as a barrier to quitting in the most disadvantaged area in metropolitan Adelaide in comparison to smokers recruited from a neighbouring, more affluent area. To assess how frequently general practitioners (GPs) in the two areas use stress management as a smoking cessation strategy and to assess how effective this strategy is for each area.
METHODS: One thousand smokers aged between 18 and 75 were recruited from general practices in the two areas; eligibility criteria included having had at least one puff of a cigarette in the past week. A baseline survey was administered at recruitment and at follow-up 12 months later. Semi-structured telephone interviews were also conducted at the 12-month follow-up with 50 randomly selected participants from the two areas.
RESULTS: The disadvantaged area had a higher prevalence of smoking, significantly higher levels of perceived stress as a barrier to cessation, and significantly lower quit rates compared with the more affluent neighbouring area. Stress management as a smoking cessation strategy occurred less frequently and was less effective with the disadvantaged group. The prevalence rate for the disadvantaged area has not changed in the past 10 years.
CONCLUSIONS: Stress may present as a significant barrier to smoking cessation in disadvantaged areas. Higher levels of stress may therefore, at least in part, explain the lower quit rate and higher prevalence of smoking in disadvantaged areas. More effective stress management strategies need to be developed and promoted in disadvantaged areas.