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      Household expenditure of smokers and ex-smokers across socioeconomic groups: results from a large nationwide Australian longitudinal survey

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          Abstract

          Background

          Countries with best practice tobacco control measures have experienced significant reductions in smoking prevalence, but socioeconomic inequalities remain. Spending on tobacco products, particularly by low-income groups can negatively affect expenditure on other goods and services. This study aims to compare the household expenditure of adults who smoke tobacco products and those who formerly smoked across socioeconomic groups.

          Methods

          Daily smokers and ex-smokers were compared using the Household, Income and Labour Dynamics in Australia Survey, over 7 waves. Adults who never smoked were not included. Participants were continuing sample members across waves. Mean number of participants per wave was 2505, 25% were smokers and 75% ex-smokers. The expenditure variables investigated included tobacco products, alcohol, motor vehicle fuel, health practitioners, insurance, education, and meals eaten out. Regression models using the generalized estimating equation technique were employed to compare expenditure data aggregated across the waves by Socioeconomic Index for Areas (SEIFA) quintiles of relative socio-economic advantage/disadvantage while accounting for within-participant autocorrelation. Quintiles are ranked by information such as the income, occupation and access to material and social resources of the residents.

          Results

          Smokers from all quintiles spent significantly less per year on meals out, education and insurance than ex-smokers ( p < 0.001). Smokers from quintiles 2–5 spent less on groceries, medicines, and health practitioners ( p < 0.01). Smokers from quintiles 1 and 2 (most disadvantaged), spent less on motor vehicle fuel than ex-smokers ($280;95%CI: $126–$434 ), ($213;95%CI: $82–$344). Smokers from quintiles 2 and 3 spent more on alcohol ($212;95%CI: $86–$339), ($231.8;95%CI: $94–$370) than ex-smokers. Smokers from the least disadvantaged groups spent less on clothing than ex-smokers ($348;95%CI: $476–$221), ($501; 95%CI: $743–$258). Across the whole sample, smokers spent more than ex-smokers on alcohol ($230;95%CI:$95–$365) and less on meals out ($361;95%CI:$216–$379), groceries ($529;95%CI:$277–$781), education ($456;95%CI:$288–$624), medicine ($71;95%CI:$38–$104), health practitioners ($345;95%CI:$245–$444) and insurance ($318;95%CI:$229–$407).

          Conclusions

          Smoking cessation leads to reallocation of spending across all socioeconomic groups, which could have positive impacts on households and their local communities. Less spending on alcohol by ex-smokers across the whole sample could indicate a joint health improvement associated with smoking cessation.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12889-022-14083-y.

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          Most cited references43

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          Delayed reward discounting and addictive behavior: a meta-analysis.

          Delayed reward discounting (DRD) is a behavioral economic index of impulsivity and numerous studies have examined DRD in relation to addictive behavior. To synthesize the findings across the literature, the current review is a meta-analysis of studies comparing DRD between criterion groups exhibiting addictive behavior and control groups. The meta-analysis sought to characterize the overall patterns of findings, systematic variability by sample and study type, and possible small study (publication) bias. Literature reviews identified 310 candidate articles from which 46 studies reporting 64 comparisons were identified (total N=56,013). From the total comparisons identified, a small magnitude effect was evident (d= .15; p< .00001) with very high heterogeneity of effect size. Based on systematic observed differences, large studies assessing DRD with a small number of self-report items were removed and an analysis of 57 comparisons (n=3,329) using equivalent methods and exhibiting acceptable heterogeneity revealed a medium magnitude effect (d= .58; p< .00001). Further analyses revealed significantly larger effect sizes for studies using clinical samples (d= .61) compared with studies using nonclinical samples (d=.45). Indices of small study bias among the various comparisons suggested varying levels of influence by unpublished findings, ranging from minimal to moderate. These results provide strong evidence of greater DRD in individuals exhibiting addictive behavior in general and particularly in individuals who meet criteria for an addictive disorder. Implications for the assessment of DRD and research priorities are discussed.
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            Use of census-based aggregate variables to proxy for socioeconomic group: evidence from national samples.

            Increasingly, investigators append census-based socioeconomic characteristics of residential areas to individual records to address the problem of inadequate socioeconomic information on health data sets. Little empirical attention has been given to the validity of this approach. The authors estimate health outcome equations using samples from nationally representative data sets linked to census data. They investigate whether statistical power is sensitive to the timing of census data collection or to the level of aggregation of the census data; whether different census items are conceptually distinct; and whether the use of multiple aggregate measures in health outcome equations improves prediction compared with a single aggregate measure. The authors find little difference in estimates when using 1970 compared with 1980 US Bureau of the Census data or zip code compared with tract level variables. However, aggregate variables are highly multicollinear. Associations of health outcomes with aggregate measures are substantially weaker than with microlevel measures. The authors conclude that aggregate measures can not be interpreted as if they were microlevel variables nor should a specific aggregate measure be interpreted to represent the effects of what it is labeled.
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              Factors associated with incomplete childhood immunization in Arbegona district, southern Ethiopia: a case – control study

              Background The prevention of child mortality through immunization is one of the most cost-effective and widely applied public health interventions. In Ethiopia, the Expanded Program on Immunization (EPI) schedule is rarely completed as planned and the full immunization rate is only 24 %. The objective of this study was to identify determinant factors of incomplete childhood immunization in Arbegona district, Sidama zone, southern Ethiopia. Methods A community based unmatched case-control study was undertaken among randomly selected children aged 12 to 23 months and with a total sample size of 548 (183 cases and 365 controls). A multi-stage sampling technique was used to get representative cases and controls. Data was collected using a structured questionnaire and analyzed using SPSS version 16 statistical software. Bivariate and multiple logistic regression analyses were done to identify independent factors for incomplete immunization status of children. Qualitative data were also generated and analyzed using thematic framework. Results The incomplete immunization status of children was significantly associated with young mothers (AOR = 9.54; 95 % CI = 5.03, 18.09), being born second to fourth (AOR = 3.64; 95 % CI = 1.63, 8.14) and being born fifth or later in the family (AOR = 5.27; 95 % CI = 2.20, 12.64) as compared to being born first, a mother’s lack of knowledge about immunization benefits (AOR = 5.51; 95 % CI = 1.52, 19.94) and a mother’s negative perception of vaccine side effects (AOR = 1.92; 95 % CI = 1.01, 3.70). The qualitative finding revealed that the migration of mothers and unavailability of vaccines on appointed immunization dates were the major reasons for partial immunization of children. Conclusion To reduce the number of children with incomplete immunization status, the Arbegona district needs to consider specific planning for mothers with these risk profiles. A focus on strengthening health communication activities to raise immunization awareness and address concerns of vaccine side effects at community level is also needed. This could be achieved through integrating the immunization service to other elements of primary health care. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2678-1) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                anita.lal@deakin.edu.au
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                8 September 2022
                8 September 2022
                2022
                : 22
                : 1706
                Affiliations
                [1 ]GRID grid.1021.2, ISNI 0000 0001 0526 7079, Deakin Health Economics, Institute for Health Transformation, , Deakin University, ; Geelong, Australia
                [2 ]GRID grid.1021.2, ISNI 0000 0001 0526 7079, Biostatistics Unit, Faculty of Health, , Deakin University, ; Geelong, Australia
                [3 ]GRID grid.3263.4, ISNI 0000 0001 1482 3639, Quit, , Cancer Council Victoria, ; Melbourne, Australia
                [4 ]GRID grid.3263.4, ISNI 0000 0001 1482 3639, Cancer Council Victoria, ; Melbourne, Australia
                Article
                14083
                10.1186/s12889-022-14083-y
                9461138
                36076210
                673d6f49-ac0b-401a-9176-7534788515e0
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 3 June 2022
                : 11 August 2022
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000951, Cancer Council Victoria;
                Categories
                Research
                Custom metadata
                © The Author(s) 2022

                Public health
                smokers,quitters,smoking cessation,household expenditure
                Public health
                smokers, quitters, smoking cessation, household expenditure

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