Prevention Research Center for Healthy Neighborhoods, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH 44106, USA.
Center for Community Health Equity Research, Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA 01003, USA.
Int J Environ Res Public Health. 2022 Jun 16;19(12):7424. doi: 10.3390/ijerph19127424.
Low-income U.S. adults experiencing food insecurity have a disproportionately high prevalence of cigarette smoking, and quantitative studies suggest that food insecurity is a barrier to quitting. To guide effective tobacco control strategies, this study aimed to understand the experiences, perceptions, and context of tobacco use and cessation among low-income populations experiencing food insecurity.
We conducted in-depth, semi-structured interviews with 23 adults who were currently smoking cigarettes and were experiencing food insecurity, mostly living in rural settings. Participants were recruited through food-pantry-based needs assessment surveys and study flyers in community-based organizations. The interview guide explored participants' histories of smoking, the role and function of tobacco in their lives, their interest in and barriers to quitting, as well as lived experiences of food insecurity. We used reflexive thematic analysis to analyze transcribed interviews.
Within a broader context of structural challenges related to poverty and financial strain that shaped current smoking behavior and experiences with food insecurity, we identified the following five themes: smoking to ignore hunger or eat less; staying addicted to smoking in the midst of instability; smoking being prioritized in the midst of financial strain; life stressors and the difficulty of quitting smoking and staying quit; and childhood adversity at the intersection of food insecurity and tobacco use.
The context of tobacco use among adults with food insecurity was highly complex. To effectively address tobacco-related disparities among those who are socially and economically disadvantaged, tobacco control efforts should consider relevant lived experiences and structural constraints intersecting smoking and food insecurity. Findings are applied to a conceptualization of clustering of conditions contributing to nicotine dependence, food insecurity, and stress.
美国低收入成年人经历粮食不安全的比例过高，吸烟率也过高，定量研究表明粮食不安全是戒烟的障碍。为了指导有效的烟草控制策略，本研究旨在了解粮食不安全的低收入人群的烟草使用和戒烟的经历、看法和背景。
我们对 23 名目前吸烟且经历粮食不安全的成年人进行了深入的半结构化访谈，他们大多居住在农村地区。参与者是通过食品储藏室的需求评估调查和社区组织的研究传单招募的。访谈指南探讨了参与者的吸烟史、烟草在他们生活中的作用和功能、他们对戒烟的兴趣和障碍，以及他们经历粮食不安全的情况。我们使用反思性主题分析来分析转录的访谈。
在与贫困和财务压力相关的结构性挑战的更广泛背景下，这些挑战塑造了当前的吸烟行为和粮食不安全经历，我们确定了以下五个主题：吸烟以忽略饥饿或少吃；在不稳定中保持对吸烟的依赖；在财务压力中优先吸烟；生活压力和戒烟和保持戒烟的困难；以及粮食不安全和烟草使用的交叉点处的童年逆境。
粮食不安全的成年人中吸烟的背景非常复杂。为了有效解决处于社会和经济劣势地位的人在与烟草相关的差异，烟草控制工作应考虑相关的生活经历和与吸烟和粮食不安全交叉的结构限制。研究结果适用于导致尼古丁依赖、粮食不安全和压力的条件聚类的概念化。
