Smoking and stress: the double-edged sword of living in a disadvantaged area

Background: Primary care-based smoking cessation interventions are often less effective amonglow-SES groups. Higher stress levels may explain the lower quit rate and higher prevalence ofsmoking in low-SES groups, and why the relative smoking prevalence rate is not declining at anequitable rate (same prevalence rate as higher SES groups). To understand these issues, thispaper sought answers to two questions: is stress perceived by ex-smokers and current smokers asa barrier to quitting; and does stress act as a barrier to quitting in relation to other barriers indisadvantaged areas?Methods: This paper seeks to understand the lived experiences from participants in 2 focusgroups and 11 in-depth interviews, who reside in the most disadvantaged area in metropolitanAdelaide, regarding stress as a barrier to smoking cessation.Results: The data pointed to stress as an ever-present aspect of life for people in low-SES areasfor many reasons, most stemming from the social environment. Perceived stress was also foundto be a major barrier to smoking cessation, more so for current smokers.Conclusions: The data analysis revealed that people in low-SES areas maybe living inenvironments with increased levels of perceived stress, making them more likely to start, andless likely to quit, smoking. It is argued that the “middle-ground” be taken in a structure-agencyapproach regarding smoking cessation, recognising the potential of social systems to create stresswhilst also recognising that individuals have the capacity to change aspects of their lives (e.g. toquit smoking). Without the awareness of such an approach, primary care efforts at smokingcessation may only serve to increase current inequities in smoking prevalence rates.