A qualitative study exploring Australian socioeconomically disadvantaged smokers’ responses to increasing cigarette prices

Background: Substantial research supports increasing tobacco taxes to achieve smoking cessation among low socioeconomic status groups. However, few studies have explored the resulting experience of deprivation and financial stress among those who maintain smoking despite increasing costs. Aims: This study aimed to explore how socioeconomically disadvantaged smokers manage smoking costs on limited budgets, and the impact this has on material deprivation, financial stress and cessation cognitions. Methods: Qualitative semi-structured interviews were conducted with 20smokers recruited from a Social and Community Service Organisation providing crisis welfare assistance to disadvantaged people in New South Wales, Australia. Interviews explored the perceived impact of tobacco costs among socioeconomically disadvantaged smokers, including the effects on essential household expenditure, smoking behaviour and quit cognitions. Interviews were audio-taped, transcribed verbatim and analysed using thematic framework analysis. Results: Limited budgeting and financial planning led to instances of smoking-induced deprivation and financial stress. Participants reported struggling to pay bills and going without meals or substituting food choices. Use of price-minimisation strategies, such as switching product types and reducing consumption were viewed as short-term solutions when money was tight. Participants reported tobacco price increases were good for preventing uptake, but that larger price rises and subsidised cessation aids were needed to help them quit smoking. Conclusions: Socioeconomically disadvantaged smokers may reduce essential living and household spending to maintain smoking as tobacco prices rise. Tobacco control policy should consider impact on the financial and material well-being of socioeconomically disadvantaged smokers who may find it difficult to quit unassisted. Translational research aspect: Highly disadvantaged groups face significant tobacco-related health and welfare inequalities, and there is a need for T2research to understand the strategies these groups use to maintain smoking in order to develop socially responsible policy.