Objective: To describe and compare the lived experiences of food insecurity, including the food choices, of people who currently smoke and people who formerly smoked in rural communities.

Design: Secondary analysis of qualitative in-depth interviews.

Participants: N = 32 food insecure participants of which 23 currently smoke and nine formerly smoked in rural Massachusetts.

Analysis: Participants' demographic data were analyzed using t-tests for continuous variables and chi square tests for categorical variables in SPSS. We used Braun & Clarke reflexive thematic analysis and coded the data using NVivo after two coders collaboratively developed a codebook. We evaluated responses from food insecure participants’ choice to use $10 towards a sandwich or cigarettes. Lastly, we created word clouds to describe participants' food and beverage choices during the previous day and the food and beverage choices from grocery stores and/or free food and meal services.

Results: On average, participants were 44 years old, primarily female (71.9%), and nonHispanic white (62.5%). A total of 7 themes represented the lived experiences of food insecurity among people who currently smoke and formerly smoked. Three themes were specific to participants who currently smoke: A.1) Using Cigarettes to Replace Food in the Context of Food Insecurity, A.2) Buying Cigarettes Instead of Food, Other Necessities, or Entertainment, and A.3) Concerns of Weight Gain Impeding Smoking Cessation. Four themes were seen among participants who currently smoke and formerly smoked B.1) The Interplay of Mental and Physical Illness, Food Insecurity, and Smoking Histories, B.2) Psychosocial Stressors, Health Issues, and Financial Strain Forming a Cycle that Exacerbates Food Insecurity, B.3) Navigating Low-Cost Food Access As a Part of Experiencing Food Insecurity B.4) Showing Resilience Through Food Insecurity Coping Strategies. Food choices were similar among participants who currently smoke and participants who formerly smoked, including a mix of nutrient-dense and high-fat and processed foods. The responses to the hypothetical scenario varied; most people chose a sandwich (47.8%).

Conclusions: On comparing the lived experiences of food insecurity, including food choice, of participants who currently smoke and formerly smoked, we found that participants with a few exceptions mostly shared a multitude of complex challenges and employed various coping strategies to address both food insecurity and their various life adversities and had similar food choices. Future research could describe and compare the lived experiences of food insecurity among participants who currently smoke, formerly smoked, and never smoked in both urban and rural settings.