Socio-economic status in relation to smoking: The role of (expected and desired) social support and quitter identity.

Rationale: Smoking behavior differs substantially between lower and higher socioeconomic status (SES) groups. Previous research shows that social support for quitting may be more available to higher-SES smokers, and higher-SES smokers may have stronger nonsmoker self-identities (i.e., can see themselves more as nonsmokers).

Objective: To investigate how SES influences smoking behavior, taking the role of identity processes and social support into account. Method: A cross-sectional online survey study was conducted among 387 daily smokers from lower, middle and higher-SES groups in the Netherlands in 2014. Educational level was used as an indicator of SES. Expected and desired social support for quitting smoking, expected exclusion from the social network when quitting, identity factors and intention to quit were measured.

Results: Smokers from all SES backgrounds desired to receive positive social support if they would quit smoking. Lower-SES smokers expected to receive more negative and practical support than middle or higher-SES smokers. There were no significant differences between SES groups for almost all identity measures, nor on intention to quit. Above and beyond other important influences such as nicotine-dependence, results showed that smokers regardless of SES who expected to receive more positive support tended to have stronger intentions to quit. Moreover, smokers who could see themselves more as being quitters (quitter self-identity) and perceived themselves less as smokers (smoker self-identity), as well as smokers who felt more positive about nonsmokers (nonsmoker group-identity) had stronger intentions to quit. No significant interactions with SES were found.

Conclusion: The results suggest that developing ways to stimulate the social environment to provide adequate support for smokers who intend to quit, and developing ways to strengthen identification with quitting in smokers may help smokers to quit successfully. Findings further suggest that the possible-self as a quitter is more important than the current-self as a smoker.