Considering that approximately 16 million people smoke and 3 million households are estimated to be affected by over-indebtedness in Germany alone, the absence of studies which have investigated the relationship between smoking and an individual’s financial strain as experienced in a situation of over-indebtedness is staggering. On the basis of a cross-sectional survey conducted among over-indebted individuals in Germany, this study investigates smoking prevalence and factors associated with increased tobacco consumption in over-indebted individuals.
A striking result is the high smoking prevalence among over-indebted individuals, with 63% of all respondents reporting daily or occasional tobacco consumption. In comparison, smoking prevalence in the general German population is considerably lower (34%) and even the subpopulation with the highest tendency to smoke (40- to 59-year-old men of low socio-economic status) are significantly less likely to smoke (54.8%) than over-indebted individuals . The findings suggest that smoking is particularly prevalent among over-indebted individuals.
In addition, smokers seem to change their consumption in times of financial hardship with one third reporting an increase in tobacco consumption after onset of over-indebtedness. Health awareness, social embeddedness and perceived social support (in case of not controlling for social embeddedness) were associated with lower risk of increased tobacco consumption whereas duration of over-indebtedness was associated with higher risk. In line with other research showing higher smoking prevalence among men, male respondents were more likely to smoke and had a significantly higher risk to increase their tobacco consumption during over-indebtedness than women.
A number of limitations of the study have to be considered when discussing the data. First, the cross-sectional design which does not allow for causal explanations regarding over-indebtedness, prevalence and changes in smoking constitutes one of the major weaknesses of our study. Participants’ responses regarding changes since onset of over-indebtedness serve as proxies to assess changes over time, but a potential recall bias due to retrospective smoking behavior measures  has to be acknowledged. Moreover, the respective questionnaire item directly linked financial problems to possible changes in smoking patterns and might therefore have provoked anticipated answers. The fact that almost one third of all respondents reported no changes in smoking, however, suggests that respondents did not seem to feel obliged to report changes into any specific direction. Second, all results are based on self-reports. While previous studies suggest that self-reports of smoking provide valid data , the reliance on self-reports for all measures may imply limitations for the interpretation of our data. Third, a potential selection bias due to a low response rate and sampling having to be based on consent might have skewed the results. It needs to be noted, however, that low response rates can be expected when conducting research on those of low socio-economic status .
One of the difficulties in understanding and tackling the problem of smoking in over-indebted individuals is the lack of knowledge about potential pathways between the two factors. In addition to previous research discussing increased stress, lack of social support, and lower rates of successful quit attempts as potential mediators of the correlation between low socio-economic status and smoking [26–28], our study points to a number of factors which might explain why many of over-indebted individuals increase their smoking.
As expected, health awareness is associated with a lower risk of increased tobacco consumption, suggesting that individuals who pay more attention to their health are more likely to be concerned about their tobacco consumption. The duration of over-indebtedness seems to be a crucial factor when analysing changes in tobacco consumption. One possible explanation for the fact that increased tobacco consumption correlates with duration of over-indebtedness might be that increased tobacco consumption is employed as a mechanism to cope with the financial, emotional and social stress caused by over-indebtedness. This hypothesis is supported by previous research which suggests that disadvantaged smokers perceive smoking as a strategy to deal with daily stress [28–30]. Almost all respondents in our study reported to be burdened by their debts, suggesting higher levels of stress among this population and potentially higher urge to develop coping mechanisms to deal with the situation. On the other hand, the study highlights the role of social embeddedness and support for understanding why over-indebted individuals are particularly likely to smoke and increase their tobacco consumption after onset of over-indebtedness. The analysis shows that the risk of increased tobacco consumption is higher among individuals who experience lower levels of social embeddedness and social support. Social embeddedness and social support seem to be crucial factors for coping with financial and emotional strain and constitute protective factors regarding tobacco consumption. Assuming that an individual’s perceived social support correlates with his or her embeddedness in a social structure, the progressive withdrawal of family members and friends might lead to lower levels of perceived social support in over-indebted individuals. As perceived social support decreases, an increase in tobacco consumption can be expected. Although the inverse relationship between social embeddedness/perceived social support and tobacco consumption supports previous research which identifies social support as a protective factor when coping with stress , the considerable research gap about social embeddedness/social support and changes in tobacco consumption and the fact that our findings are based on self-reports highlights the need for further research in this specific area.