University of New South Wales (UNSW), National Drug and Alcohol Research Centre (NDARC), 22-32 King Street, Randwick, NSW, 2031, Australia.
Wolfson Institute of Preventive Medicine, Queen Mary University of London, EC1M 6BQ, London, UK.
Int J Equity Health. 2017 Nov 13;16(1):196. doi: 10.1186/s12939-017-0689-5.
The social gradient in smoking rates persist with an overrepresentation of smoking and its associated harms concentrated within lower socioeconomic status (SES) populations. Low-SES smokers are motivated to quit but face multiple barriers when engaging a quit attempt. An understanding of the current treatment service model from the perspectives of treatment-seeking low-SES smokers is needed to inform the design of alternative smoking cessation support services tailored to the needs of low-SES populations. This qualitative study aimed to: i) explore low-SES smokers' recent quitting experiences; ii) assess factors that impact treatment engagement; and iii) determine the acceptability and feasibility of alternative approaches to smoking cessation.
Low-SES participants (n = 24) previously enrolled in a smoking cessation RCT participated in either a semi-structured focus group or in-depth telephone interview. Data was obtained and analysed using thematic analysis from October 2015 to June 2016. Analysis was deductive from the interview guide and supplemented inductively.
Participants expressed feelings of guilt and shame around their smoking behaviour and experienced stigmatisation for their smoking. Guilt, shame, and stigmatisation negatively impacted treatment seeking behaviours with most avoiding current quit services. Costs of pharmacotherapy and treatment adherence were commonly cited barriers to treatment success. Electronic-cigarettes were perceived to be unsafe due to uncertainty on their legal status and regulatory restrictions. Technology-based text-messaging quit support was endorsed as a more favourable alternative compared to existing behavioural treatment services.
Stigmatisation was commonly endorsed and acted as an impediment to current treatment utilisation. Electronic-cigarettes may present a viable harm reduction alternative, but their likely uptake in socioeconomically disadvantaged groups in Australia is limited by smokers' uncertainty about their regulation and legality. Mobile phone based cessation support may provide an alternative to telephone counselling and overcome the stigmatisation low-SES smokers face while trying to quit.
吸烟率的社会梯度仍然存在，吸烟及其相关危害在社会经济地位较低（SES）人群中更为普遍。SES 较低的吸烟者有戒烟的动机，但在尝试戒烟时会面临多种障碍。需要从寻求治疗的 SES 较低的吸烟者的角度了解当前的治疗服务模式，以便为 SES 较低的人群量身定制替代的戒烟支持服务。这项定性研究旨在：i）探讨 SES 较低的吸烟者最近的戒烟经验；ii）评估影响治疗参与的因素；iii）确定替代戒烟方法的可接受性和可行性。
SES 较低的参与者（n=24）之前参加了一项戒烟 RCT，他们参加了半结构化焦点小组或深入的电话访谈。数据是从 2015 年 10 月到 2016 年 6 月通过主题分析获得和分析的。分析是从访谈指南中演绎出来的，并通过归纳法进行补充。
参与者对自己的吸烟行为感到内疚和羞耻，并因吸烟而受到歧视。内疚、羞耻和污名化对治疗寻求行为产生了负面影响，大多数人避免了目前的戒烟服务。药物治疗的费用和治疗的依从性是常见的治疗成功障碍。由于对其法律地位和监管限制的不确定性，电子烟被认为是不安全的。基于技术的短信戒烟支持被认为是一种比现有行为治疗服务更有利的替代方案。
污名化普遍存在，并成为当前治疗利用的障碍。电子烟可能是一种可行的减少危害的替代方案，但由于吸烟者对其监管和合法性的不确定性，它们在澳大利亚社会经济地位较低的群体中可能的采用受到限制。基于移动电话的戒烟支持可能提供一种替代电话咨询的方法，并克服 SES 较低的吸烟者在试图戒烟时面临的污名化。
