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

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.