Complex Factors Impacting Smoking Behavior in Cancer Survivors with Food Insecurity

Objectives: Tobacco use remains prevalent among people with social needs, such as food insecurity. In this study, we aimed to understand the complex experiences of low-income cancer survivors with food insecurity who smoke tobacco, to identify the unique smoking cessation needs for this group. Methods: We conducted in-depth, semi-structured qualitative interviews with 40 adults experiencing food insecurity who continued smoking after a cancer diagnosis. Interviews focused on smoking behaviors, cessation interest, cancer experiences, and financial circumstances. We analyzed the data using reflexive thematic analysis. Results: In this sample of cancer survivors (50% female, mean age 42 years, 60% black/African American, 32% with lung cancer), experiences of food insecurity were interwoven with financial hardship exacerbated by cancer treatment. Three themes illustrated a complexity of intersecting factors in this group: (1) smoking and cancer-related stress; (2) cancer and smoking‐related emotions and beliefs; and (3) cancer treatment and self‐efficacy to quit. Conclusions: Low-income cancer survivors face unique challenges and stressors that impact smoking and smoking cessation. Research towards developing tailored, coordinated, and ongoing smoking cessation efforts may involve attention to individual-level, healthcare-level, and structural-level barriers to cessation.