Tobacco control policies and smoking cessation treatment utilization: a moderated mediation analysis

Background Tobacco policies, including clean indoor air laws and cigarette taxes, increase smoking cessation in part by stimulating the use of cessation treatments. We explored whether the mediating effect of such treatments varies across socio-demographic groups. Methods We used data from 62,165 U.S. adult participants in the 2003 and 2010/11 Current Population Survey-Tobacco Use Supplement (CPS-TUS) who reported smoking cigarettes during the past year. Building on prior structural equation models used to quantify the degree to which smoking cessation treatments (prescription medications, nicotine replacement therapy, counselling/support groups, quitlines, and internet resources) mediated the association between clean indoor air laws, cigarette excise taxes, and recent smoking cessation, we added selected moderators to each model to investigate whether mediation effects varied by sex, race/ethnicity, education, income, and health insurance status. Results For clean indoor air laws, the mediating effect of prescription medication and nicotine replacement therapies varied significantly between racial/ethnic, age, and education groups in 2003. However, none of these moderation effects remained significant in 2010/11. For cigarette excise taxes in 2010/2011, the mediating effect of counseling was stronger in older adults; whereas, the mediating effect of prescription medications tended to be stronger in younger adults. No other moderator reached statistical significance. Smoking cessation treatments did not mediate the effect of taxes on smoking cessation in 2003 and were not included in these analyses. Conclusions Sociodemographic differences in how smoking cessation treatment use mediates between clean indoor air laws and smoking cessation have decreased from 2003 to 2010/11. In most cases, policies appear to stimulate smoking cessation treatment use similarly across varied sociodemographic groups.