Date of Award

Fall 2023

Document Type

Open Access Dissertation

Department

Health Promotion, Education and Behavior

First Advisor

James Thrasher

Abstract

Conversations about smoking and cessation in response to cessation messages appear to encourage quit attempts, yet there is some evidence that smokers with lower income and education have these conversations less often than their counterparts with higher income and education. No research has investigated the social network characteristics that encourage smokers to have these conversations or the mechanisms for SES differences in these conversations. Because social factors play a role in SES disparities in smoking and cessation as well as other health behaviors and outcomes, social network characteristics likely explain some SES differences in conversations about smoking and cessation. The purpose of this dissertation is to investigate the relationships between network characteristics and conversations about smoking and cessation (Aim 1) as well as the role of networks in SES differences in these conversations (Aim 2). Data for this research came from a convenience sample of adult smokers in South Carolina, North Carolina, and New York state. At baseline, participants reported their network characteristics and received a 14-day supply of cigarettes with packs modified to include cessation messages on the inside and/or outside of their packs. Each night for 14 days, participants completed a survey that queried their conversations about smoking and cessation with network members in the prior 24 hours. For Aim 1, I used bivariate and adjusted mixed effects logistic regression models to assess the relationships between social network characteristics and these conversations, with separate models predicting the likelihood of conversations about the dangers of smoking and about the benefits of quitting on any given day. For Aim 2, I used generalized structural equation models and bootstrapped confidence intervals (for indirect effects) to assess the associations of income and education with conversations about smoking and cessation as well as the mediating role of social networks characteristics. In models adjusting for all network and control variables, network disapproval of smoking and network smoking prevalence were positively associated with the likelihood of conversations about smoking harms and quitting benefits. Network size was negatively associated with, and average closeness to alters was positively associated with, conversations about quitting benefits. Furthermore, contrary to prior research, low SES smokers reported more conversations about smoking and cessation within their strong networks. However, network disapproval of smoking was associated with more conversations for high SES smokers. The findings from this dissertation research imply that approaches to increase social norms against tobacco use – which often involve societal-level interventions like policies– may influence more interpersonal interactions that encourage conversations. Furthermore, study results suggest that smokers converse with other smokers about both the harms of smoking and the benefits of cessation. Though previous research suggests that being around other smokers makes cessation more difficult, our findings suggest that having other smokers in one’s network may encourage discussions that encourage quitting. More research, likely with much larger sample sizes, is needed to understand if the number of smokers in one’s networks moderates the influence of these conversations on cessation. Finally, the results of this research also suggest that close network members of smokers from lower SES groups are resources for smoking cessation. Interventions aimed at low SES smokers may consider involving these network members by encouraging more conversations and ensuring these network members have the tools and information needed to be as helpful as possible in their efforts to support smokers’ cessation attempts.

Rights

© 2024, Victoria Catherine Lambert

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