Quitting smoking can be challenging, and a new study reveals that Black adults may struggle more due to several social determinants of health (SDOH). The study, which was published in the Journal of Racial and Ethnic Health Disparities, found that unmet social needs are drivers for Black adults struggling to quit smoking. These social determinants include financial insecurity, lack of transportation, housing issues, and food insecurity.
These findings can give healthcare providers a greater understanding of why some patients have a harder time quitting.
Five hundred Black American adults were surveyed, and many reported facing challenges that affect their everyday lives. Researchers examined how these unmet needs affected smokers’ ability to quit, including the obstacles they faced, how difficult quit attempts were, and whether they believed they could remain smoke-free.
The study’s premise reflects how smoking is intertwined with poor social and economic conditions. While fewer Black Americans smoke compared to other groups, Black people often experience worse outcomes, including higher rates of smoking-related illnesses, such as heart disease and stroke. At the same time, research consistently shows that Black smokers do attempt to quit, the same as — if not more often — than white smokers, yet are less likely to achieve long-term success.
When people are trying to manage their day-to-day lives, something like smoking cessation may not seem like a priority. Compared to feeding your children, trying to live in and afford stable housing, and even battling local crime and neighborhood safety issues, quitting may not be high on the list. Someone in this environment may have a more difficult time taking advantage of counseling sessions or filling prescriptions for cessation medications. Or simply, they may not be in the mindset to make a change.
Stress also plays a significant role, and the chronic stress associated with SDOH can increase nicotine cravings and make quitting more difficult. Smoking is often used as a coping mechanism, particularly among individuals facing ongoing economic or social pressures.
These SDOH have a major influence on health outcomes and the ability to comply with treatment plans. Despite this knowledge, smoking cessation programs have historically focused on individual behavior while paying less attention to the social environment surrounding that behavior.
When a patient struggles to quit smoking despite repeated attempts, providers may be tempted to attribute the challenge solely to a lack of motivation or nicotine addiction. However, this study suggests that clinicians should consider whether unmet social needs are interfering with treatment adherence. A patient who misses follow-up appointments may lack reliable transportation. Someone who does not fill a prescription for smoking cessation medication may be facing financial constraints. Others may be dealing with housing insecurity, caregiving responsibilities, or food shortages that understandably take precedence over a quit plan.
Addressing these issues does not mean clinicians must solve every social problem themselves. Rather, it requires recognizing social needs and connecting patients with appropriate resources. Screening tools for food insecurity, housing instability, and transportation challenges can help identify barriers early. Additionally, referrals to community organizations, social workers, patient navigators, and assistance programs may improve a patient’s ability to engage with cessation treatment.
Culturally tailored interventions are also important. Earlier research has found that smoking cessation programs developed without consideration of cultural differences may be less effective for Black participants. Other studies have demonstrated the value of culturally relevant counseling and targeted treatment approaches in improving cessation outcomes among Black smokers.
The broader lesson is that smoking cessation cannot be viewed in isolation from the social context in which smoking occurs. Efforts to reduce tobacco-related health disparities will require more than prescribing medications or recommending quit lines. They will require healthcare systems to recognize how social and structural factors shape health behaviors and treatment outcomes.
For providers, that means asking not only whether a patient wants to quit smoking, but also whether they have the resources and support necessary to succeed. For policymakers and health systems, it means investing in programs that address social needs alongside traditional cessation services.
As the new study demonstrates, helping Black adults quit smoking may depend as much on addressing unmet social needs as it does on addressing nicotine addiction itself. By understanding the role of social determinants of health, healthcare providers can develop more equitable and effective approaches to tobacco treatment, ultimately improving both smoking cessation rates and long-term health outcomes.
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