# The Relationship Between Social Determinants of Health and Cigarette Smoking Behaviors Among Adults in the United States, Behavioral Risk Factor Surveillance System (BRFSS), 2023

## TL;DR

This study shows that social factors like food and housing insecurity are linked to higher rates of smoking and menthol cigarette use among U.S. adults.

## Contribution

The study identifies specific social determinants as predictors of smoking behaviors and cessation attempts using a large national dataset.

## Key findings

- Food and utility insecurity were linked to higher odds of menthol cigarette use.
- All four SDoH factors were associated with increased quit attempts in the past year.
- Adults with adverse SDoH are more likely to smoke and less likely to quit.

## Abstract

Public health relevance—How does this work relate to a public health issue?
Social determinants of health (SDoH) contribute to the excess risk of cigarette smoking.

Social determinants of health (SDoH) contribute to the excess risk of cigarette smoking.

Public health significance—Why is this work of significance to public health?
This study uses a large, nationally representative dataset to examine associations between SDoH and cigarette smoking-related outcomes (i.e., cigarette smoking status, menthol cigarette smoking, and past-year quit attempt) among U.S. adults.Individual SDoH risk factors (i.e., food insecurity, housing insecurity, utility insecurity, and lack of reliable transportation) were significantly associated with making a quit attempt in the past 12 months. Food insecurity and utility insecurity were independent risk factors for using menthol cigarettes.

This study uses a large, nationally representative dataset to examine associations between SDoH and cigarette smoking-related outcomes (i.e., cigarette smoking status, menthol cigarette smoking, and past-year quit attempt) among U.S. adults.

Individual SDoH risk factors (i.e., food insecurity, housing insecurity, utility insecurity, and lack of reliable transportation) were significantly associated with making a quit attempt in the past 12 months. Food insecurity and utility insecurity were independent risk factors for using menthol cigarettes.

Public health implications—What are the key implications or messages for practitioners, policymakers, and/or researchers in public health?
Interventions and screenings aimed at reducing SDoH risk factors (i.e., food insecurity and utility insecurity) may help reduce the prevalence of cigarette smoking, including menthol cigarette smoking, and increase the prevalence of smoking cessation among U.S. adults.

Interventions and screenings aimed at reducing SDoH risk factors (i.e., food insecurity and utility insecurity) may help reduce the prevalence of cigarette smoking, including menthol cigarette smoking, and increase the prevalence of smoking cessation among U.S. adults.

Social determinants of health (SDoH) comprise a broad array of social conditions, such as access to food and housing, that facilitate or impede individual behavior. The aim of this study was to assess the association between SDoH and cigarette smoking-related outcomes among U.S. adults (aged ≥18 years) by using data from the 2023 Behavioral Risk Factor Surveillance System (BRFSS). Cross-sectional data were obtained from the Social Determinants and Health Equity (SD/HE) module, conducted in 33 states, the District of Columbia, and Puerto Rico as part of the 2023 BRFSS. We examined four indicators of adverse SDoH (i.e., food insecurity, housing insecurity, utility insecurity, and lack of reliable transportation) and three cigarette smoking-related outcomes (i.e., cigarette smoking status, menthol cigarette smoking, and past-year quit attempt). All analyses were conducted with SAS 9.4 and used BRFSS sampling weights to adjust for the complex sampling design. Among 45,160 respondents, 2991 (7.8%) were adults who smoked cigarettes in the past month, of whom 570 (16.5%) reported making a quit attempt in the past 12 months. Menthol cigarette use was reported by 634 (22.0%) adults who smoked cigarettes in the past month. In adjusted analyses, each SDoH measure (i.e., food insecurity (aOR = 1.70, 95% CI: 1.19–2.41, p < 0.01), housing insecurity (aOR = 1.66, 95% CI: 1.06–2.59, p < 0.05), utility insecurity (aOR = 1.92, 95% CI: 1.01–3.65, p < 0.05), and lack of reliable transportation (aOR = 1.67, 95% CI: 1.03–2.73, p < 0.05)) was significantly associated with making a quit attempt in the past 12 months. Food insecurity was significantly associated with the odds of current cigarette smoking. Food insecurity and utility insecurity were independent risk factors for using menthol cigarettes. U.S. adults experiencing adverse SDoH are trying to stop smoking at higher rates than adults not experiencing adverse SDoH. Findings demonstrate that SDoH is a strong predictor of cigarette smoking status, menthol cigarette smoking, and past-year quit attempts among U.S. adults.