“You Cannae Just Take Cigarettes Away from Somebody and No' Gie Them Something Back”: Can Social Marketing Help Solve the Problem of Low-Income Smoking?

Abstract

Smoking levels have not declined among those living in disadvantaged communities in the UK, presenting a major public health concern. Drawing on qualitative and quantitative data, this article suggests that core concepts of social marketing provide a meaningful framework for identifying appropriate smoking cessation interventions and policy responses. Understanding the consumer reveals that tobacco meets many needs in the struggle to cope with limited income intensified by poorly resourced local infrastructure and limited opportunities. An almost overwhelming range of threats to cessation includes the impact of disadvantage, strong prosmoking norms and environments, and, unsurprisingly, the tobacco industry's reinforcement of continued smoking. Important opportunities include smokers' underlying wish to be nonsmokers, positive responses to new approaches, and gradual amelioration of problems for which smoking provides a coping mechanism. Finally, what is the meaningful exchange that can be offered to smokers in the challenging quitting process? Better health or more money alone are unlikely to be accepted as realistic benefits. Instead, integrated long-term support is required, reflecting the long-term reinforcement strategies of the tobacco industry. At a macro level, policies address hardship. At a community level, increased resources and training give workers tangible products and greater confidence. At a micro level, smokers need tailored “packages” of support, addressing personal barriers to success.