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

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  • Monique T. Cano

    (Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA
    Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA 94143, USA
    Institute for International Internet Interventions for Health, Palo Alto University, Palo Alto, CA 94304, USA)

  • Oscar F. Rojas Perez

    (Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA)

  • Sara Reyes

    (University of Nebraska Medical Center, Omaha, NE 68198, USA)

  • Blanca S. Pineda

    (Institute for International Internet Interventions for Health, Palo Alto University, Palo Alto, CA 94304, USA)

  • Ricardo F. Muñoz

    (Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA 94143, USA
    Institute for International Internet Interventions for Health, Palo Alto University, Palo Alto, CA 94304, USA)

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.

Suggested Citation

  • Monique T. Cano & Oscar F. Rojas Perez & Sara Reyes & Blanca S. Pineda & Ricardo F. Muñoz, 2025. "Rethinking Smoking and Quitting in Low-Income Contexts: A Qualitative Analysis with Implications for Practice and Policy," IJERPH, MDPI, vol. 22(7), pages 1-18, July.
    • Handle: RePEc:gam:jijerp:v:22:y:2025:i:7:p:1122-:d:1702805
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    3. Lee, J.G.L. & Henriksen, L. & Rose, S.W. & Moreland-Russell, S. & Ribisl, K.M., 2015. "A systematic review of neighborhood disparities in point-of-sale tobacco marketing," American Journal of Public Health, American Public Health Association, vol. 105(9), pages 8-18.
    4. Shervin Assari & Ritesh Mistry, 2018. "Educational Attainment and Smoking Status in a National Sample of American Adults; Evidence for the Blacks’ Diminished Return," IJERPH, MDPI, vol. 15(4), pages 1-12, April.
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