Nicotine Addiction Among Urban Poor Adult Male Smokers in Kuala Lumpur: A Cross Sectional Study

Abstract

Tobacco is the only legal product that kills a large proportion of its consumers when used as intended by its manufacturer. The effect of nicotine as a driving substance to smoking has been established for decades but very little is known on how biopsychosocial determinants relationship affects levels of nicotine addiction in smokers. Therefore, the study was conducted to determine the prevalence of nicotine addiction among low-socioeconomic cigarette smokers in the urban area and to examine the complex relationship of biopsychosocial determinants on nicotine addiction using structural equation modelling analysis. A cross-sectional study enrolling a purposive sampling hard-to-reach 278 current cigarette male smokers from a low-socioeconomic population involving eight randomly selected public housing areasin Kuala Lumpur was carried out using self-administered questionnaires form. The study measured the direct, indirect and total effect of constructs namely socio-economic status, financial wellness, perceived stress, neighbourhood condition, workplace stress, work-family conflict and sleep disturbance on nicotine addiction and identify the effect of a moderator from perceived social support and type of cigarette trade on a specific path in the structural model. The mean age of respondents and smoking duration was 37.7 and 18.1 years respectively. The prevalence of moderate to very high nicotine addiction level was 43.2%. The measurement model indicates that 56% of the nicotine addiction could be estimated from the biopsychosocial determinants involved. The biopsychosocial determinant that directly affects nicotine addiction significantly includes financial wellness (β:-0.203, p=0.013), work-family conflict (β: 0.560, p=0.036), perceived stress (β:0.635, p=0.021) and sleep disturbance (β:0.446, p<0.001). Our finding highlight’s the significant correlation and role of biopsychosocial in mediating the association between socioeconomic status and nicotine addiction and their inter-relationship that influence nicotine addiction. The illegal cigarette trade (β:-0.168, p =0.039) moderating the causal effects by increasing the effects between financial wellness and nicotine addiction while the low perceived social support (β:-0.710, p <0.001) moderating the causal effects by greatly increasing the effect between socioeconomic status and perceived stress. The largest total effects were determined by work-family conflict (β:1.678) and perceived stress (β:1.168). In conclusion, a specific approach emphasized on biopsychosocial determinants need to be implemented as they play a significant role in reducing nicotine addiction and perhaps expedite in smoking cessation among low-socioeconomic urban male smoker.