BACKGROUND: Financial capability is an understudied social determinant of health (SDoH). Bank account ownership, an indicator of financial capability, has been linked to better health. No research has explored how bank account ownership relates to health behaviors, such as tobacco use.
OBJECTIVES: To examine participant characteristics, intervention use, and intervention outcomes among subgroups of unbanked and banked participants enrolled in a randomized controlled trial (RCT) that integrated financial coaching and SDoH referrals into smoking cessation treatment for low-income individuals (N = 257). DESIGN: Secondary analysis of an RCT.
INTERVENTIONS: The parent RCT provided a multi-component intervention (N = 136) that included smoking cessation coaching, nicotine replacement therapy, money management coaching, and referral to financial empowerment services and other SDoH resources. A waitlisted control group (N = 121) received usual care.
MEASURES: Bivariate analyses compared baseline characteristics and multivariable logistic regression compared intervention use by banking status. Within unbanked and banked subgroups, logistic regression examined treatment group differences (intervention vs. control) in self-reported 7-day abstinence and financial stress at 6 months.
RESULTS: At baseline, 36% (n = 92) of participants were unbanked. Unbanked participants had lower income and education, higher unemployment, and greater financial distress (all p < 0.05). Intervention use did not differ by banking status (p > 0.05). At 6 months, unbanked participants had high abstinence rates in the intervention and control groups (ITT 21% vs. 13%, p > 0.05) and no significant treatment group differences in financial stress (p > 0.05). Among banked participants, the intervention group reported higher abstinence than the control group (ITT 19% vs. 6%, p = 0.01) and reduced financial stress across multiple domains (all p = 0.01).
CONCLUSIONS: A significant portion of participants in the RCT were unbanked, but being unbanked was not a barrier to smoking cessation. The intervention reduced financial stress among banked participants only. Further research is needed to develop interventions that can support unbanked individuals’ health and financial well-being.
Banking status as a moderator of outcomes in a randomized controlled trial targeting financial stress and smoking
Journal of General Internal Medicine [Epub 2025 Dec 2]. doi: 10.1007/s11606-025-10064-0.