Abstract
Intersecting socially marginalized identities and unique biopsychosocial factors place women with substance use disorders (SUDs) experiencing myriad disadvantages at higher risk for smoking and stigmatization. Here, based on our work with women receiving care for SUDs in four participating treatment/women-serving centers (N = 6 individual clinics), we: (1) describe the functions of smoking for women with SUDs; and (2) explore participants’ experiences of a comprehensive tobacco-free workplace (TFW) program, Taking Texas Tobacco-Free (TTTF), that was implemented during their SUD treatment. Ultimately, information gleaned was intended to inform the development of women-tailored tobacco interventions. Data collection occurred pre- and post-TTTF implementation and entailed conducting client (7) and clinician (5) focus groups. Using thematic analysis, we identified four main themes: “the social context of smoking,” “challenges to finding support and better coping methods,” “addressing underlying conditions: building inner and outer supportive environments,” and “sustaining support: TFW program experiences.” Women reported that: smoking served as a “coping mechanism” for stress and facilitated socialization; stigmatization hindered quitting; non-stigmatizing counseling cessation support provided alternative coping strategies; and, with clinicians, the cessation opportunities TTTF presented are valuable. Clinicians reported organizational support, or lack thereof, and tobacco-related misconceptions as the main facilitator/barriers to treating tobacco addiction. Effective tobacco cessation interventions for women with SUDs should be informed by, and tailored to, their gendered experiences, needs, and recommendations. Participants recommended replacing smoking with healthy stress alleviating strategies; the importance of adopting non-judgmental, supportive, cessation interventions; and the support of TFW programs and nicotine replacement therapy to aid in quitting.
Highlights
The rate of cigarette smoking among adults in the United States (US) has declined since 1965, reaching an all-time low rate of 13.7%, smoking remains the leadingInt
Study findings demonstrate how implementing a comprehensive, multi-level smoking cessation intervention informed by the meanings of smoking for women experiencing disadvantage in treatment for substance use disorders (SUDs) and their needs and preferences regarding quitting, can better respond to the complexities of tobacco dependence among this group to enhance supportive and effective cessation
The components women identified as necessary to help them quit—the provision of nicotine replacement therapies (NRT), and non-shaming, compassionate, and supportive strategies that assisted them in developing self-awareness and self-compassion and understanding of the connections between their drug and tobacco use—were aligned with the Taking Texas Tobacco-Free (TTTF) program that responded to the context of smoking within their lives
Summary
The rate of cigarette smoking among adults in the United States (US) has declined since 1965, reaching an all-time low rate of 13.7%, smoking remains the leadingInt. Res. Public Health 2021, 18, 5764 cause of preventable morbidity and mortality [1] and has been shown to disparately impact subgroups experiencing disadvantage (e.g., women); being recognized as a social justice issue affecting public health [2,3]. Public Health 2021, 18, 5764 cause of preventable morbidity and mortality [1] and has been shown to disparately impact subgroups experiencing disadvantage (e.g., women); being recognized as a social justice issue affecting public health [2,3] Disadvantaged subgroups include those experiencing social inequities and discrimination based social categories, e.g., gender, race/ethnicity, Indigeneity, class, sexuality, and ability. Men have historically smoked at higher rates than women, but this gender gap favoring women is shrinking
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