Financial Stress and Tobacco Expenditure in Australian Households: A Cross-Sectional Analysis of Prevalence and Association Across Wealth and Income Levels.

Introduction: Despite successful public health campaigns, tobacco use persists as a major cause of preventable illness and death. While tobacco taxation is recognized as an effective control strategy, concerns remain about potential financial strain on lower socioeconomic groups. This study investigates the relationship between household tobacco expenditure and financial stress in Australia, a country with high tobacco taxes and declining smoking rates.

Methods: Household data from the 2015-16 Australian Household Expenditure Survey were analysed (N=10,036). Financial stress was measured using a scale based on nine self-reported indicators. Respondents were asked to report if their household had experienced any of these difficulties, e.g. inability to pay utility bills or going without meals. Negative binomial regression models assessed the association between tobacco expenditure share and financial stress, adjusting for sociodemographic factors, household wealth, and other expenditures.

Results: Financial stress was more prevalent among households that did (45.0%; (95% CI: 42.5, 47.5)) versus did not (25.4%) purchase tobacco. All levels of tobacco expenditure were significantly associated with higher financial stress bivariably, after controlling for covariates. For instance, households in the second-lowest tobacco expenditure share quintile had a higher mean financial stress score than non-purchasing households (RR=1.59, CI, 1.36, 1.85, p<0.001).

Discussion: In Australia, financial stress is prevalent among tobacco-purchasing households and household tobacco expenditure is significantly associated with increased financial stress even at modest levels of spending, i.e. the lower quintiles of tobacco expenditure. These findings underscore the need for targeted policies to mitigate financial strain and support smoking cessation among vulnerable populations.

Implications: This study found that the prevalence of financial stress is higher in Australian households that purchase tobacco, regardless of their spending on tobacco. Although tobacco price increases reduce overall tobacco use, our study shows that increased prices exacerbate strain among financially disadvantaged smokers. Further research into associations between financial well-being and tobacco use is needed, both nationally and internationally. Longitudinal research should also examine the longer-term health and economic impacts mediated by financial stress.