# Rethinking Smoking and Quitting in Low-Income Contexts: A Qualitative Analysis with Implications for Practice and Policy

## TL;DR

This study explores why smoking remains high among low-income people and suggests that tailored public health approaches are needed to help them quit.

## Contribution

The study provides new qualitative insights into the sociocultural and environmental factors influencing smoking and quitting behaviors in low-income populations.

## Key findings

- Smoking among low-income individuals is influenced by complex sociocultural and environmental factors.
- Participants expressed motivation to quit but faced significant roadblocks and lacked effective support.
- Tailored, patient-centered approaches are needed to address the unique challenges of low-income smokers.

## Abstract

Despite a general decline in smoking rates among the U.S. population, smoking among low-income populations remains disproportionately high, likely due to the social determinants of health. To inform tailored approaches and responsive public health policies, the aim of this study was to qualitatively explore the sociocultural contexts, attitudes, and behaviors regarding smoking and quitting in a sample of low-income adults who smoke. In-depth, semi-structured qualitative interviews were conducted with 20 adults. Participants were recruited through local safety-net primary care clinics and community sites. A thematic analytic approach was utilized to analyze transcribed interviews. In exploring smoking and quitting within the context of low-income individuals, the following six themes were identified: caught between health and tobacco use; the nuances of context; roadblocks to quitting; motivation without movement; a temporary escape; and one size does not fit all. Insights into sociocultural and environmental contexts that shape smoking and quitting among low-income individuals revealed a complex interplay of factors that perpetuate smoking behavior and make it difficult to achieve sustained cessation. The study findings point to the importance of patient-centered and collaborative approaches that tailor smoking cessation efforts to the unique needs and lived experiences of low-income people who smoke.