Background:
Housing cost burden is a well-established social determinant of health, but its influence on health behaviors is less
understood. This study examined the association between housing cost burden and cigarette smoking among U.S.
adults and assessed whether this relationship was moderated by life satisfaction.
Methods:
Data from adults aged ≥18 years (N = 27,715) in the 2023 National Health Interview Survey were analyzed. Housing
cost burden was defined as reporting an inability to pay mortgage, rent, or utility bills in the past 12 months. Current
cigarette smoking was coded as yes (smoked every day or some days) versus no. Life satisfaction was coded as
“satisfied” versus “dissatisfied” with life. A housing cost burden × life satisfaction interaction term with was included to
test moderation effects. Survey-weighted logistic regression models estimated odds ratios (ORs) and 95% confidence
intervals (CIs), adjusting for demographic and psychosocial covariates. Multicollinearity was assessed using variance
inflation factors (VIFs).
Results:
In unadjusted analyses, adults experiencing housing cost burden had significantly higher odds of current cigarette
smoking compared to those without housing cost burden (OR = 2.66; 95% CI: 2.33–3.04). After adjusting for
demographic and psychosocial covariates (age, sex, race, income, marital status, education, depressive symptoms,
and life satisfaction), the association remained significant but was attenuated (OR = 1.65; 95% CI: 1.42–1.91). A
significant interaction between housing cost burden and life satisfaction was observed (p = 0.036). Stratified analysis
revealed higher odds of current smoking among adults who reported being dissatisfied with life (OR= 2.40; 95% CI:
1.56–3.69) compared to those who reported being satisfied (OR= 1.55; 95% CI: 1.32–1.81), indicating effect
modification by life satisfaction. Although the magnitude of association differed by life satisfaction, the relationship
remained statistically significant.
Conclusion:
Housing cost burden is associated with a higher likelihood of current cigarette smoking. Life satisfaction moderates
this relationship, with a potential buffering effect against the impact of housing cost burden. Future longitudinal
research is needed to examine causal pathways. Integrating housing support with mental health and wellness
interventions may help reduce smoking risk among cost-burdened adults.