Stuck in the catch 22: attitudes towards smoking cessation among populations vulnerable to social disadvantage

Abstract

Aim To explore how smoking and smoking cessation is perceived within the context of disadvantage, across a broad cross‐section of defined populations vulnerable to social disadvantage. Design Qualitative focus groups with participants recruited through community service organizations (CSO). Setting Metropolitan and regional settings in Queensland, Australia. Focus groups were held at the respective CSO facilities. Participants Fifty‐six participants across nine focus groups, including people living with mental illness, people experiencing or at risk of homelessness (adult and youth populations), people living with HIV, people living in a low‐income area and Indigenous Australians. Measurements Thematic, in‐depth analysis of focus group discussions. Participant demographic information and smoking history was recorded. Findings Smoking behaviour, smoking identity and feelings about smoking were reflective of individual circumstances and social and environmental context. Participants felt ‘trapped’ in smoking because they felt unable to control the stressful life circumstances that triggered and sustained their smoking. Smoking cessation was viewed as an individual's responsibility, which was at odds with participants' statements about the broader factors outside of their own control that were responsible for their smoking. Conclusion Highly disadvantaged smokers' views on smoking involve contradictions between feeling that smoking cessation involves personal responsibility, while at the same time feeling trapped by stressful life circumstances. Tobacco control programmes aiming to reduce smoking among disadvantaged groups are unlikely to be successful unless the complex interplay of social factors is carefully considered.

A Multiple Component Intervention to Assist Young Pregnant Smokers to Cease Smoking: A Randomised Controlled Pilot Study

“…Women who consented to this study wanted to cease smoking but had competing areas of foci which took priority (such as use of illicit drugs and sexual abuse) [8,28]. Our experience was that as a woman's use of illicit drugs in pregnancy decreased their smoking increased.…”

“…Our experience was that as a woman's use of illicit drugs in pregnancy decreased their smoking increased. We also noted the impact of having a child removed by child protection services post birth, contributed to stress which triggered smoking [8]. We acknowledge the multicomponent intervention did not empower women to address these harms individually [25] and suggest this approach is central if health professionals are to develop comprehensive smoking cessation programs for this vulnerable cohort.…”

“…In 2010 the proportion of the Australian population 14 years and older who identified themselves as tobacco smokers was 15% [1,2]. However, there are a number of sub populations where smoking remains high: the unemployed; socially disadvantaged; those with psychological issues; those who use alcohol and other drugs; and Aboriginal and Torres Strait Islanders [1][2][3][4][5][6][7][8][9].…”

An Exploration of Young Australian Women's Smoking Cessation Goals across the Trajectory of Pregnancy and Post Birth

“…However, there was a fine line between using cigarettes to control life and being controlled by cigarettes [16]. Furthermore, women had competing issues such as dealing with AOD use which took priority over their smoking [32]. Rather than one barrier to achieving a smoking goal, there often appeared to be many areas of disadvantage which challenged a woman's attempts to cease smoking [33].…”

“…Smoking plays a central role in socialising and social bonding [18,32]. Smoking for these Australian women was perceived to be the norm as the presence of smokers in their lives challenged them from acting on their smoking cessation goals.…”