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Current 26 - Smoking Prevalence Increases With Each Additional Social Need



A 2022 study in Preventive Medicine Reports found that smoking prevalence increased along with the number of unmet social needs identified. Prior studies on social needs and tobacco use found food insecurity is associated with increased odds of smoking, and smoking prevalence is concentrated disproportionately in populations with socioeconomic disadvantages.

Among 45,000 patient records of adults in a safety-net health system in Ohio, smoking was more common among patients with reported transportation barriers (41%), financial strain (39%), food insecurity (34%), and housing insecurity (27%). Smoking prevalence was twice as high for patients with food insecurity compared to those without food insecurity; this pattern was also observed for the other studied social determinants. With each additional unmet social need identified, a dose-response association with current smoking was found (adjusted OR 1.56 - 3.76, all p <0.001).

Research integrating smoking cessation efforts with social supports is emerging, and recent frameworks have adapted the “5A’s” intervention approach to include social needs assessments as part of smoking cessation counseling. Study authors suggest that addressing social needs may help to address the disparities in tobacco use.   


  1. Kim-Mozeleski JE, Chagin KM, Sehgal AR, et al. Food insecurity, social needs, and smoking status among patients in a county hospital system. Prev Med Rep. 2022;29:101963. doi:10.1016/j.pmedr.2022.101963.
  2. Kim-Mozeleski JE, Seligman HK, Yen IH, et al. Changes in food insecurity and smoking status over time: Analysis of the 2003 and 2015 panel study of income dynamics. 2019;33(5):698-707. doi:10.1177/0890117118814397.
  3. Leventhal AM, Bello MS, Galstyan E, et al. Association of cumulative socioeconomic and health-related disadvantage with disparities in smoking prevalence in the United States, 2008 to 2017. JAMA Intern Med. 2019;179(6):777-785. 
    doi: 10.1001/jamainternmed.2019.0192.
  4. McQueen A, Roberts C, Garg R, et al. Specialized tobacco quitline and basic needs navigation interventions to increase cessation among low income smokers: study protocol for a randomized controlled trial. Contemp Clin Trials. 2019;80:40-47. doi:10.1016/j.cct.2019.03.009.
  5. Tsoh JY, Hessler D, Parra JR, et al. Addressing tobacco use in the context of complex social needs: a new conceptual framework and approach to address smoking cessation in community health centers. PEC Innovation. 2022;1:100011. doi:10.1016/j.pecinn.2021.100011.


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