Subjective social status affects smoking abstinence during acute withdrawal through affective mediators.

Tobacco use is the leading cause of preventable death and disability among adults in the United States (1), and although smoking prevalence has decreased in recent decades, it is becoming increasingly concentrated among individuals with the lowest levels of income, education, and occupational status (2–5). In fact, smoking plays a critical role in health disparities, accounting for a large proportion of the differences in disease incidence and mortality attributable to socioeconomic status (SES; 6–8). Similar to smoking prevalence, there is also a SES gradient in smoking cessation whereby persons with low SES are less successful at quitting (9–11). Although previous research has linked traditional indicators of SES (i.e., income, education, and occupation) with smoking cessation, no studies have examined the association between subjective perceptions of SES (i.e., subjective social status) and cessation, or the mechanisms that might account for a relationship. Subjective social status (SSS) reflects an individual’s perception of her/his relative position in the social hierarchy (12), with known determinants including a myriad of SES indicators, as well as estimations of financial satisfaction, perceived future security (13), social trust, and perceived opportunities (14). Although SSS is highly correlated with traditional indicators of SES, low SSS predicts poor mental and physical health [e.g., (13, 15–20)] and undesirable health behaviors [e.g., lower physical activity (21)] over and above traditional SES indicators (14, 21–23). Thus, SSS may offer enhanced prediction of health outcomes and health behaviors over SES because it captures the components of social standing in a more comprehensive and meaningful way (24). Various factors accounting for the association of low SSS and poor health have been examined, including depression (24), stress (21, 25), anxiety, pessimism (21), and negative affect (19). Although little is known about how SSS affects smoking cessation, previous research suggests that similar mechanisms may be involved. For example, among young pregnant women who quit smoking during pregnancy, low SSS was uniquely associated with a constellation of characteristics indicative of increased vulnerability to postpartum smoking, including less positive affect and more negative affect (23). Moreover, numerous studies have linked negative affect or affective changes, especially during the initial withdrawal period, to relapse during a quit attempt (26–30). As withdrawal effects emerge very soon after quitting (27, 28, 31) and generally peak during the initial two weeks following the quit attempt (32), affective mediators of an SSS-abstinence relationship might be ideally examined during the period of acute withdrawal from smoking. To our knowledge, no previous research has examined the association between SSS and smoking abstinence during the period of acute withdrawal, or the mechanisms that might account for an association. The purpose of this study was to redress this gap by examining these relationships among racially/ethnically diverse adult smokers undergoing a smoking quit attempt. Potential mediators of interest were depression, stress, and positive and negative affect. Increasing understanding about these associations can inform treatment interventions designed to address tobacco use among low SSS smokers and potentially reduce tobacco-related health disparities.