Abstract PR02: Contextualizing the association between social isolation and smoking among socioeconomically disadvantaged adults: Psychosocial, life-contextual, and health care factors
Authors: Alcaraz Kassandra I. , Vereen Rhyan N. , Souder Antonika , Bienvenida Alan 
Published: August 2020

Abstract
Purpose: Social influences on health are inadequately understood, hindering progress in eliminating disparities in cancer. One such influence, social isolation, is well established as an independent risk factor for mortality and comparable in magnitude to other risks such as obesity. Social isolation is associated with smoking, which is increasingly concentrated in socioeconomically disadvantaged (SED) populations. However, the association between social isolation and smoking is understudied. This study examined the extent to which psychosocial, life-contextual, and health care factors account for the social isolation-smoking relationship among SED adults.
Methods: The study used data from a cross-sectional survey of SED adults (N=3064) recruited from an information and referral program that helps individuals with meeting basic needs (e.g., food). Measures included current smoking status, social isolation, psychosocial factors (stress, loneliness), life-contextual factors (unmet basic needs), health care factors (time since last routine checkup, health self-efficacy), and demographics. A social isolation score was derived using a modified version of the Social Network Index. Bivariate analyses and multivariable logistic regression examined the association between social isolation and smoking. Path analyses estimated indirect associations between social isolation and smoking via psychosocial, life-contextual, and health care factors while controlling for demographics. Path analyses used full information maximum likelihood with robust estimation and the theta parameterization. Model fit was assessed using the comparative fit index (CFI ≥0.95) and root mean square error of approximation (RMSEA &lt;0.06). Analyses were conducted using SAS and Mplus.
Results: The sample was predominantly female (81%), non-Hispanic Black (79%), and highly SED, with 44% having a high school education or less and 52% having an annual household income less than $10,000. Overall, 29% of participants were current smokers, and 62% were highly socially isolated. Social isolation was associated with smoking, with only 10% of the least isolated individuals smoking currently compared to 39% of the most socially isolated individuals (p&lt;0.0001). In analyses adjusting for demographics, odds of being a current smoker increased as social isolation increased (aORs=1.8 to 3.2; p&lt;0.0001). The final path model (RMSEA=0.031 with 90% CI: 0.025, 0.038; CFI=0.970) confirmed a direct path from social isolation to smoking (β=0.14, p&lt;0.0001) and indirect pathways operating through psychosocial, life-contextual, and health care factors (all β≤0.44, all p&lt;0.05).
Conclusions: Findings elucidate possible mechanisms driving the social isolation-smoking relationship in SED populations, suggesting several potential intervention approaches for reducing cancer disparities. Evidence-based interventions that consider psychosocial and life-contextual issues may be especially salubrious for SED populations.
This abstract is also being presented as Poster A090.
Citation Format: Kassandra I. Alcaraz, Rhyan N. Vereen, Antonika Souder, Alan Bienvenida. Contextualizing the association between social isolation and smoking among socioeconomically disadvantaged adults: Psychosocial, life-contextual, and health care factors [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr PR02.