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Psychosocial stress and cigarette smoking persistence, cessation, and relapse over 9–10 years: a prospective study of middle-aged adults in the United States

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Abstract

Purpose

Year-to-year decreases in smoking in the US have been observed only sporadically in recent years, which suggest a need for intensified efforts to identify those at risk for persistent smoking. To address this need, we examined the association between a variety of psychosocial stressors and smoking persistence, cessation, and relapse over 9–10 years among adults in the United States (n = 4,938, ages 25–74).

Methods

Using information provided at baseline and follow-up, participants were categorized as non-smokers, persistent smokers, ex-smokers, and relapsed smokers. Stressors related to relationships, finances, work–family conflict, perceived inequality, neighborhood, discrimination, and past-year family problems were assessed at baseline and follow-up.

Results

High stress at both assessments was associated with greater odds of persistent smoking for stressors related to relationships, finances, work, perceived inequality, past-year family problems, and a summary score. Among respondents who were smokers at baseline, high stress at both time points for relationship stress, perceived inequality, and past-year family problems was associated with nearly double the odds of failure to quit.

Conclusions

Interventions to address psychosocial stress may be important components within smoking cessation efforts.

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Acknowledgments

The MIDUS study was supported by a grant from the National Institute on Aging (P01-AG020166) to conduct a longitudinal follow-up of the MIDUS (Midlife in the U.S.) investigation. The original study was supported by the John D. and Catherine T. MacArthur Foundation Research Network on Successful Midlife Development. This research was also supported by a grant from National Cancer Institute (P50-CA148596) to the Harvard Lung Cancer Disparities Center. The first author is supported by a postdoctoral fellowship at the Center on the Developing Child sponsored by the Robert Wood Johnson Foundation.

Conflict of interest

The authors have no financial disclosures or conflicts of interest to report.

Author information

Authors and Affiliations

  1. Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA

    Natalie Slopen, Emily Z. Kontos & David R. Williams

  2. Center on the Developing Child, Harvard University, 50 Church Street, 4th Floor, Cambridge, MA, 02139, USA

    Natalie Slopen

  3. Department of Psychology/Institute on Aging, University of Wisconsin-Madison, Madison, WI, USA

    Carol D. Ryff

  4. Division of General Medicine and Primary Care, Department of Health Care Policy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    John Z. Ayanian

  5. Division of Cardiovascular Medicine, Howard University College of Medicine and Howard University Hospital, Washington, DC, USA

    Michelle A. Albert

  6. Department of African and African American Studies, Harvard University, Cambridge, MA, USA

    David R. Williams

  7. Institute on Aging, University of Wisconsin, Madison, Madison, WI, USA

    Carol D. Ryff

Authors
  1. Natalie Slopen
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  2. Emily Z. Kontos
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  3. Carol D. Ryff
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  4. John Z. Ayanian
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  5. Michelle A. Albert
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  6. David R. Williams
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Corresponding author

Correspondence to Natalie Slopen.

Appendix: Components of 8 stress domains

Appendix: Components of 8 stress domains

  1. 1.

    Relationship stress

    1. i.

      Family strain (responses range 1–4, from “often” to “never”)

      1. (a)

        Not including your spouse or partner, how often do members of your family make too many demands on you?

      2. (b)

        How often do they criticize you?

      3. (c)

        How often do they let you down when you are counting on them?

      4. (d)

        How often do they get on your nerves?

    2. ii.

      Friend strain (responses range 1–4, from “often” to “never”)

      1. (a)

        How often do your friends make too many demands on you?

      2. (b)

        How often do they criticize you?

      3. (c)

        How often do they let you down when you are counting on them?

      4. (d)

        How often do they get on your nerves?

    3. iii.

      Marital risk scale

      1. (a)

        During the past year, how often have you thought your relationship might be in trouble? (responses range 1–5, from “never”“all the time”)

      2. (b)

        Realistically what do you think the chances are that you and your partner will eventually separate? (responses range 1–4, not likely at all → very likely)

      3. (c)

        How much do you and your spouse or partner disagree on the following issues?

        1. a.

          Money matters, such as how much to spend, save or invest?

        2. b.

          Household tasks, such as what needs doing and who does it?

        3. c.

          Leisure time activities, such as what to do and with whom? (responses range 1–4, from “not at all” to “a lot”)

    4. iv.

      Spouse/partner strain scale (responses range 1–4, from “a lot” to “not at all”)

      How much:

      1. (a)

        Does your spouse/partner really care about you?

      2. (b)

        Does he/she understand the way you feel about things?

      3. (c)

        Does he/she appreciate you?

      4. (d)

        Do you rely on him/her for help if you have a serious problem?

      5. (e)

        Can you open up to him/her if you need to talk about your worries?

      6. (f)

        Can you relax and be yourself around him/her?

  2. 2.

    Financial stress scale

    1. (a)

      In general, would you say you (and your family living with you) have more money than you need, just enough money for your needs, or not enough money to meet your needs? (responses range 1-3, from “more $ than you need” to “not enough $”)

    2. (b)

      How difficult is it for you (and your family) to pay your monthly bills? (responses range 1-4, from “very difficult” to “not at all difficult”)

  3. 3.

    Work stress (responses range 1-5, from “all of the time” to “never”, unless otherwise noted)

    1. i.

      Skill discretion

      1. (a)

        How often do you learn new things at work?

      2. (b)

        How often does your work demand a high level of skill or expertise?

      3. (c)

        How often does your job provide you with a variety of things that interest you?

    2. ii.

      Decision authority

      1. (a)

        On your job, how often do you have to initiate things—such as coming up with your own ideas, or figuring out on your own what needs to be done?

      2. (b)

        How often do you have a choice in deciding how you do your tasks at work?

      3. (c)

        How often do you have a choice in deciding what tasks you do at work?

      4. (d)

        How often do you have a say in decisions about your work?

      5. (e)

        How often do you have a say in planning your work environment—that is, how your workplace is arranged or how things are organized?

      6. (f)

        How often do you control the amount of time you spend on task?

    3. iii.

      Demands scale

      1. (a)

        How often do have to work very intensively—that is, you are very busy trying to get things done?

      2. (b)

        How often do different people or groups at work demand things from you that you think are hard to combine?

      3. (c)

        How often do you have too many demands made on you?

      4. (d)

        How often do you have a lot of interruptions?

    4. iv.

      Coworker support

      1. (a)

        How often do you get help and support from your coworkers?

      2. (b)

        How often are your coworkers willing to listen to your work-related problems?

    5. v.

      Supervisor support

      1. (a)

        How often do you get the information you need from your supervisor or superiors?

      2. (b)

        How often do you get help and support from your immediate supervisor?

      3. (c)

        How often is your immediate supervisor willing to listen to your work-related problems?

    6. vi.

      Risk of injury on the job

      1. (a)

        To what extent, over the past 10 years, have you been exposed to the risk of accidents or injuries on your job?

    7. vii.

      Job insecurity (response ranges 1–5, from “excellent” to “poor”)

      1. (a)

        If you wanted to stay in your present job, what are the chances that you could keep it for the next 2 years?

  4. 4.

    Work–family spillover (responses range 1–5, from “all of the time” to “never”)

    1. i.

      Negative work-to-family spillover

      1. (a)

        Your job reduces the effort you can give to activities at home.

      2. (b)

        Stress at work makes you irritable at home.

      3. (c)

        Your job makes you feel too tired to do the things that need attention at home.

      4. (d)

        Job worries or problems distract you when you are at home.

    2. ii.

      Negative family-to-work spillover

      1. (a)

        Responsibilities at home reduce the effort you can devote to your job.

      2. (b)

        Personal or family worries and problems distract you when you are at work.

      3. (c)

        Activities and chores at home prevent you from getting the amount of sleep you need to do your job well.

      4. (d)

        Stress at home makes you irritable at work.

  5. 5.

    Perceived inequality (responses range 1–4, from “a lot” to “not at all”)

    1. i.

      Perceived inequality in family

      1. (a)

        I feel good about the opportunities I have been able to provide for my children.

      2. (b)

        It seems to me that family life with my children has been more negative than most people’s.

      3. (c)

        Problems with my children have caused me shame and embarrassment at times.

      4. (d)

        As a family, we have not had the resources to do many fun things together with the children.

      5. (e)

        I believe that I have been able to do as much for my children as most other people.

      6. (f)

        I feel a lot of pride about what I have been able to do for my children.

    2. ii.

      Perceived inequality in home

      1. (a)

        I live in as nice a home as most people.

      2. (b)

        I am proud of my home.

      3. (c)

        Most people live in a better neighborhood than I do.

      4. (d)

        I don’t like to invite people to my home because I do not live in a very nice place.

      5. (e)

        I feel very good about my home and neighborhood.

      6. (f)

        It feels helpless to try to improve my home and neighborhood situation.

    3. iii.

      Perceived inequality in work

      1. (a)

        I feel cheated about the chances I have had to work at good jobs.

      2. (b)

        When I think about the work I do on my job, I feel a good deal of pride.

      3. (c)

        I feel that others respect the work I do on my job.

      4. (d)

        Most people have more rewarding jobs than I do.

      5. (e)

        When it comes to my work life, I’ve had opportunities that are as good as most people’s.

      6. (f)

        It makes me feel discouraged that other people have much better jobs than I do.

  6. 6.

    Neighborhood stress (responses range 1–4, from “a lot” to “not at all”)

    1. (a)

      I feel safe being out alone in my neighborhood during the daytime.

    2. (b)

      I feel safe being out alone in my neighborhood at night.

    3. (c)

      I could call on a neighbor for help if I needed it.

    4. (d)

      People in my neighborhood trust each other.

  7. 7.

    Discrimination

    1. i.

      Lifetime discrimination (yes/no response)

      You were:

      1. (a)

        Discouraged by a teacher or advisor from seeking higher education.

      2. (b)

        Denied a scholarship.

      3. (c)

        Not hired for a job.

      4. (d)

        Not given a promotion.

      5. (e)

        Fired.

      6. (f)

        Prevented from renting or buying a home in the neighborhood you wanted.

      7. (g)

        Prevented from remaining in a neighborhood because neighbors made life so uncomfortable.

      8. (h)

        Hassled by the police.

      9. (i)

        Denied a bank loan.

      10. (j)

        Denied or provided inferior service by a plumber, car mechanic, or other service provider.

    2. ii.

      Everyday discrimination (responses range 1–4, from “often” to “never”)

      1. (a)

        You are treated with less courtesy than other people.

      2. (b)

        You are treated with less respect than other people.

      3. (c)

        You receive poorer service than other people at restaurants or stores.

      4. (d)

        People act as it if they think you are not smart.

      5. (e)

        People act as if they are afraid of you.

      6. (f)

        People act as if they think you are dishonest.

      7. (g)

        People act as if they think you are not as good as they are.

      8. (h)

        You are called names or insulted.

      9. (i)

        You are threatened or harassed.

  8. 8.

    Past-year problems in immediate family (asked separately for (i) spouse/partner, (ii) parents, (iii) children; yes/no responses)

    1. (a)

      Chronic disease or disability?

    2. (b)

      Frequent minor illness?

    3. (c)

      Emotional problems (such as sadness, anxiety)?

    4. (d)

      Alcohol or substance problems?

    5. (e)

      Financial problems, such as low income or heavy debts?

    6. (f)

      Problems at school or at work (such as failing grades, poor job performance)?

    7. (g)

      Difficulty finding or keeping a job?

    8. (h)

      Marital or partner relationship problems?

    9. (i)

      Legal problems (such as involved in law suits, police changes, traffic violations)?

    10. (j)

      Difficulty getting along with people?

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Slopen, N., Kontos, E.Z., Ryff, C.D. et al. Psychosocial stress and cigarette smoking persistence, cessation, and relapse over 9–10 years: a prospective study of middle-aged adults in the United States. Cancer Causes Control 24, 1849–1863 (2013). https://doi.org/10.1007/s10552-013-0262-5

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