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Friends of the Behavioral Economics Club, this week we present the paper “Predictors of Counseling Participation Among Low-Income People Offered an Integrated Intervention Targeting Financial Distress and Tobacco Use”, by Tempchin, J.; Vargas, E.; Sherman, S. and Rogers, E. (2022), in which authors carry out a study in which they propose a special method to reduce tobacco addiction, in which they combine concepts like financial education, health and long-term objectives.

Smoking was first identified as a public health threat in the United States almost 60 years ago. Since that time, tobacco addiction and the number of people who occasionally smoke a cigarette has declined by almost 30%. 

However, smoking rates among people with low or very low incomes remain high. 

Currently, people over 18 years of age living at or below the poverty line are twice as likely to smoke as those who have better economic conditions. 

Part of this may be because people with a wealthy and stable economic situation can afford access to personalized and effective treatment to overcome their tobacco addiction.

Although several interventions have been shown to be effective in the short term, there are many that fail in the long term for those at greatest risk and vulnerability. 

Having a low income is usually an indicator of more complex problems. One of these is poor financial health or education. This is a social determinant and actually affects many more areas of life apart from people’s economic status. It is someone’s ability to manage their expenses, cover their needs, minimize and recover from financial crises, minimize their debts and generate wealth. 

Poor financial health or training is associated with poor physical and mental health, overall well-being, and is one of the greatest sources of chronic stress among adults in the United States. 

In people with lower incomes, stress in general and financial stress in particular, are very significant barriers to long-term smoking cessation. 

In addition, behavioral economics research suggests that financial deprivation induces people to focus on their most immediate and survival needs, leaving them without the emotional and cognitive resources necessary to resist immediate gratification and prioritize goals that are deferred and whose benefits will be seen in the non-immediate future, such as quitting smoking. 

Interventions with financial incentives are quite common in studies in the field of behavioral economics and generally have a positive effect. That is, providing a temporary monetary reward for quitting smoking is effective in increasing abstinence rates in the short term. 

But what about the long term? Small monetary rewards for quitting smoking do not remedy structural financial difficulties, nor do they help people not to return to the addictive habit over time.

A trial has been conducted this past year that demonstrated that a smoking cessation intervention incorporated money management training and education and, although only half of the people enrolled attended the sessions, 85% of them completed the training and were successful in quitting smoking

Based on this trial, authors decided to conduct a similar study themselves, involving 208 New York adults with household incomes below the federal poverty line who had smoked at least one cigarette in the past 30 days.

Up to nine individual counseling sessions in financial education were offered, and all participants also received a program that included smoking cessation training.

The results showed that the rate of attendance at the interventions, and the success of the interventions, increased as the age, education and income of the participants increased. This finding is of concern, because then, the younger people are, the less education they have, and the lower their income, the greater their likelihood of having a tobacco addiction. In other words, when vulnerability increases, the risk of smoking increases. 

On the other hand, it seems that other factors such as being an immigrant, having high levels of psychological distress or anxiety disorders, being unemployed, having low levels of literacy, or very little motivation to quit smoking also contributed to increase the risk of addiction. 

Authors point out the need to devote more efforts and resources to research on smoking, since, as we have pointed out in the first lines, it is one of the most serious health problems that currently affects millions of people around the world.

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