Background and Purpose: Low-income smokers are disproportionately impacted by smoking-related morbidity and mortality. Smokers who identify as having low-income have higher rates of tobacco use, have a more difficult time quitting, and are less likely to successfully quit. The health inequities among low-income smokers are due in large part to smoking cessation recommendations and interventions that have not been adequately tailored to address the specific needs of low-income communities. This study aims to explore the contexts, factors, behaviors, and perspectives regarding smoking and quitting among a sample of low-income smokers.

Methods: Participants were recruited from the San Francisco Health Network that primarily serve low-income individuals. Researchers completed targeted recruitment using a combination of advertising (e.g., flyers) and snowball (e.g., chain referral) sampling strategies. Participants completed an individual semi-structured interview in which they shared their experiences, attitudes, and behaviors related to smoking and quitting. The semi-structured interview was iteratively refined during research team meetings by research psychologists and study team members with expertise in smoking cessation treatment. Interviews were conducted by two trained research staff, lasted approximately 60-minutes, and were audio recorded. Data analysis was guided by thematic analysis, informed by Social Cognitive Theory.

Results: The sample consisted of 25 participants. Analyses generated several insights related to smoking and quitting within a low-income context. We identified several themes: Socioenvironmental factors that reinforce smoking; smoking as a coping mechanism for psychological distress; deliberate avoidance and denial of known personal health, financial, and social consequences caused by smoking; and cigarettes acting as a security blanket. Participants also identified barriers to quitting (e.g., cravings) and provided peer advice (e.g., self-help) related to smoking cessation.

Conclusions: The interplay between socioeconomic factors, smoking, and cessation efforts is highly complex. However, findings from this study underscore the importance of developing culturally responsive interventions for low-income populations. In an effort to reduce tobacco-related disparities, future studies are needed to determine the most effective and culturally responsive strategies for addressing smoking cessation in this vulnerable population.