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Factors associated with self-assessed increase in tobacco consumption among over-indebted individuals in Germany: a cross-sectional study

Heiko Rueger1*, Heide Weishaar2, Elke B Ochsmann3, Stephan Letzel1 and Eva Muenster1

Author Affiliations

1 Institute for Occupational, Social, and Environmental Medicine, University Medical Center of the University of Mainz, Obere Zahlbacher Strasse 67, Mainz D-55131, Germany

2 Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK

3 Institute for Occupational and Social Medicine; Medical Faculty, RWTH Aachen University, Pauwelstrasse 30, Aachen D-52074, Germany

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Substance Abuse Treatment, Prevention, and Policy 2013, 8:12  doi:10.1186/1747-597X-8-12

Published: 13 March 2013



Over-indebtedness is an increasing phenomenon in industrialised nations causing individual hardship and societal problems. Nonetheless, few studies have explored smoking among over-indebted individuals.


A cross-sectional survey (n=949) on retrospectively assessed changes in tobacco consumption was carried out in 2006 and 2007 among clients of 84 officially approved debt and insolvency counselling centres in Germany (response rate 39.7%). Logistic regressions were performed to explore factors associated with reports of increased smoking after onset of over-indebtedness.


63% of all respondents stated daily or occasional tobacco consumption. Almost one fifth reported an increase in smoking after becoming over-indebted. Females were less likely to report increased smoking than men (aOR 0.66, 95% CI 0.44-0.99) whereas respondents who had been over-indebted for more than 10 years were more likely to report increased smoking than those who had been over-indebted for less than five years (aOR 1.66; 95%-CI 1.00-2.76). The odds of increased smoking were also elevated among those who reported that their families and friends had withdrawn from them as a consequence of their over-indebtedness (aOR 1.82; 95%-CI 1.06-3.14).


The study identifies over-indebted individuals and particularly over-indebted men as a high-risk group of smokers. Low levels of social embeddedness/support were associated with a further increase in smoking after becoming over-indebted. Given recent increases of over-indebtedness, the findings highlight the need to develop appropriate public health policies.

Over-indebtedness; Bankruptcy; Smoking; Financial stress; Social support