A cross-sectional national survey to explore the relationship between smoking and political abstention: Evidence of social mistrust as a mediator

Rationale: Smoking prevalence is well known to vary socioeconomically but has been less studied in relation to political participation. Growing evidence suggests that health disparities and political nonparticipation are intertwined, but the underlying mechanism is unclear. Objective: We investigated the relationship between smoking and voter registration, testing various forms of trust as possible mediators, in U.S. national survey data collected around the 2012 presidential election. Methods: A random half (n = 9757) of adults who completed The Attitudes and Behaviors Survey on Health (TABS) in 2012 (response rate was 58.4% for landline and 24.3% for cell phone) also answered a section on voter registration, voting behavior, and trust in people and selected institutions. Multivariable logistic regression was used to examine the association between smoking and registering to vote and potential mediation by trust in people and various institutions, adjusted for covariates known to be associated with both. Analyses used designbased methods with weights to account for sampling probabilities, nonresponse, and calibration to the U.S. adult population in 2012. Results: Compared with nonsmokers, daily smokers had significantly lower adjusted odds of being registered to vote (aOR: 0.33, 95% CI: 0.21-0.52) and higher adjusted odds of having low trust in people (aOR: 2.50, 95% CI: 1.29-4.83). Low trust in people predicted lower odds of registering to vote (aOR: 0.55, 95% CI: 0.36 to 0.84) and partially mediated the smoking-registration relationship. Conclusion: Lower electoral participation among daily smokers is partly attributable to lower trust in people, a factor that could also affect willingness to use cessation support resources such as quitlines. Low trust and low political participation among daily smokers may have important political and public health consequences.