Exploring the perspectives and experiences of food-insecure adults who are also tobacco dependent: a qualitative study in North East England.

Introduction: Smoking and tobacco dependence remain the single biggest preventable cause of death and illness in England. A disproportionally high number of adults using tobacco products also experience poverty and food insecurity. Those in the lowest socioeconomic groups are both more likely to use tobacco and more likely to experience food insecurity. Due to the 'cost-of-living-crisis', there is a need for more qualitative research in tobacco dependence and food insecurity. Yet, there is a lack of qualitative UK-based research examining how these two issues are linked for the people experiencing them. This study explores the perspectives and experiences of tobacco dependency among adults who also experience food insecurity. Methods: Semi-structured interviews were conducted with adults who were experiencing food insecurity and identified as tobacco dependent in 2023. 19 participants (female n=12) were recruited from two North East England food aid organisations. Interviews explored previous and current patterns of tobacco use, experiences of food insecurity and of budgeting personal finances. Data were analysed using thematic analysis. Results: We identified three themes in the following topic areas: how participants planned and structured their tobacco dependence, the financial constraints of tobacco dependence among food insecurity and how they ensure the ability to afford purchasing tobacco products, and the perceived advantages and disadvantages of tobacco dependence. Conclusion: To conclude among people who were food insecure, tobacco use was strongly influenced by their circumstances and the social and material stressors they face. These aspects are potentially important considerations when developing smoking cessation support for people who are food insecure.