Background: Primary care-based smoking cessation interventions are often less effective among low-SES groups. Higher stress levels may explain the lower quit rate and higher prevalence of smoking in low-SES groups, and why the relative smoking prevalence rate is not declining at an equitable rate (same prevalence rate as higher SES groups). To understand these issues, this paper sought answers to two questions: is stress perceived by ex-smokers and current smokers as a barrier to quitting; and does stress act as a barrier to quitting in relation to other barriers in disadvantaged areas?

Methods: This paper seeks to understand the lived experiences from participants in 2 focus groups and 11 in-depth interviews, who reside in the most disadvantaged area in metropolitan Adelaide, regarding stress as a barrier to smoking cessation.

Results: The data pointed to stress as an ever-present aspect of life for people in low-SES areas for many reasons, most stemming from the social environment. Perceived stress was also found to be a major barrier to smoking cessation, more so for current smokers.

Conclusions: The data analysis revealed that people in low-SES areas maybe living in environments with increased levels of perceived stress, making them more likely to start, and less likely to quit, smoking. It is argued that the “middle-ground” be taken in a structure-agency approach regarding smoking cessation, recognising the potential of social systems to create stress whilst also recognising that individuals have the capacity to change aspects of their lives (e.g. to quit smoking). Without the awareness of such an approach, primary care efforts at smoking cessation may only serve to increase current inequities in smoking prevalence rates.