Cancer Causes & Control

, Volume 24, Issue 10, pp 1849–1863 | Cite as

Psychosocial stress and cigarette smoking persistence, cessation, and relapse over 9–10 years: a prospective study of middle-aged adults in the United States

  • Natalie SlopenEmail author
  • Emily Z. Kontos
  • Carol D. Ryff
  • John Z. Ayanian
  • Michelle A. Albert
  • David R. Williams
Original paper



Year-to-year decreases in smoking in the US have been observed only sporadically in recent years, which suggest a need for intensified efforts to identify those at risk for persistent smoking. To address this need, we examined the association between a variety of psychosocial stressors and smoking persistence, cessation, and relapse over 9–10 years among adults in the United States (n = 4,938, ages 25–74).


Using information provided at baseline and follow-up, participants were categorized as non-smokers, persistent smokers, ex-smokers, and relapsed smokers. Stressors related to relationships, finances, work–family conflict, perceived inequality, neighborhood, discrimination, and past-year family problems were assessed at baseline and follow-up.


High stress at both assessments was associated with greater odds of persistent smoking for stressors related to relationships, finances, work, perceived inequality, past-year family problems, and a summary score. Among respondents who were smokers at baseline, high stress at both time points for relationship stress, perceived inequality, and past-year family problems was associated with nearly double the odds of failure to quit.


Interventions to address psychosocial stress may be important components within smoking cessation efforts.


Cigarette smoking Smoking cessation Smoking persistence Psychosocial stress Longitudinal Midlife in the United States (MIDUS) 



The MIDUS study was supported by a grant from the National Institute on Aging (P01-AG020166) to conduct a longitudinal follow-up of the MIDUS (Midlife in the U.S.) investigation. The original study was supported by the John D. and Catherine T. MacArthur Foundation Research Network on Successful Midlife Development. This research was also supported by a grant from National Cancer Institute (P50-CA148596) to the Harvard Lung Cancer Disparities Center. The first author is supported by a postdoctoral fellowship at the Center on the Developing Child sponsored by the Robert Wood Johnson Foundation.

Conflict of interest

The authors have no financial disclosures or conflicts of interest to report.


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Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Natalie Slopen
    • 1
    • 2
    Email author
  • Emily Z. Kontos
    • 1
  • Carol D. Ryff
    • 3
    • 7
  • John Z. Ayanian
    • 4
  • Michelle A. Albert
    • 5
  • David R. Williams
    • 1
    • 6
  1. 1.Department of Social and Behavioral SciencesHarvard School of Public HealthBostonUSA
  2. 2.Center on the Developing ChildHarvard UniversityCambridgeUSA
  3. 3.Department of Psychology/Institute on AgingUniversity of Wisconsin-MadisonMadisonUSA
  4. 4.Division of General Medicine and Primary Care, Department of Health Care PolicyBrigham and Women’s Hospital, Harvard Medical SchoolBostonUSA
  5. 5.Division of Cardiovascular MedicineHoward University College of Medicine and Howard University HospitalWashingtonUSA
  6. 6.Department of African and African American StudiesHarvard UniversityCambridgeUSA
  7. 7.Institute on AgingUniversity of Wisconsin, MadisonMadisonUSA

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