Cost of living/cost of smoking: a demonstration study of cooperative action learning to understand and address smoking in deprived communities within the cost-of-living crisis

Smoking is responsible for over 8 million deaths globally per annum. While socially disadvantaged communities are disproportionately affected, few interventions effectively reach these groups. We progressed a Participatory Action Research (PAR) study on smoking-related health inequalities in the context of the current UK cost-of-living crisis. We worked with people living in deprived neighbourhoods in rural northeast Scotland. The objective was to engage affected communities together with the health authority in cooperative action learning. Community-based participants (n=9) engaged in a series of workshops (n=8) adopting roles as co-researchers, collecting and arranging new data and evidence. We then connected with service providers in a series of additional workshops (n=3) to analyse and interpret the data, appraise local action, and reflect on the process. Community partners identified a convergence between increased stress owing to the crisis, and increased availability, affordability, and acceptability of tobacco-related products, namely e-cigarettes. The situation was compounded by lack of awareness of available cessation services. A shared action agenda was developed prioritising: (a) the stress-related root causes of smoking; (b) inclusive access to cessation support; (c) incentivised cessation with locally framed messaging; and (d) deliberative dialogue between communities and service providers. There was a high level of engagement, openness and honesty, and the strategic relevance of the process was acknowledged. The study provides holistic understandings of health and hardship and demonstrates that existing services can be enhanced with community intelligence. We provide practical methods to support policy commitments to community health emphasising mutual empowerment between service users and providers.