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Smoking pockets, smoking islands – work in progress with ‘hardened smokers’. Frances Thirlway PhD student Centre for Medical Humanities School for Medicine & Health Durham University Supervisors: Professor Jane Macnaughton Dr Andrew Russell Dr Sue Lewis

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smoking pockets smoking islands work in progress with hardened smokers

Smoking pockets, smoking islands – work in progress with ‘hardened smokers’


PhD student

Centre for Medical Humanities

School for Medicine & Health

Durham University


Professor Jane Macnaughton

Dr Andrew Russell

Dr Sue Lewis

what are smoking islands
What are smoking islands ?
  • Socio-economic gradient in smoking (Jarvis & Wardle 2005)
  • Smokers are concentrated in particular neighbourhoods

= ‘smoking islands’ (Thompson et al 2007)

  • Why does this matter ? Because...

‘Not fully understanding and accounting for socio-spatial disparities in smoking is...hampering tobacco control efforts’ (Poland et al 2006)

            • Poland et al characterise the social context of smoking as ‘the next frontier in tobacco control’ (2006)

= ‘where, when and with whom’ we smoke

my research so far
My research so far...
  • What qualitative research has been done on cigarette smoking in social context ?
  • What does it tell us ?
  • Studies of teenagers and young adults were excluded
  • tobacco use other than cigarettes was excluded
a systematic search
A systematic search
  • Search terms were variations on Smoking + qualitative + NOT teenager
  • Social context was not included at this stage to avoid missing relevant studies
  • Web of Knowledge, Medline, CINAHL, PsycINFO, EMBASE, , Anthropology Plus, JSTOR and IBBS
  • 7,445 articles found
  • 537 articles retained and reviewed in more detail
  • What did they cover ?
which smokers have been studied
Which smokers have been studied ?

Pregnancy & motherhood 80

Women 57

Indigenous/Aboriginal/First Nation/

Native Americans 47

Poverty and deprivation 43

Other ethnic minority groups in US 27

Mental health 25

COPD/Cancer/Diabetes/HIV & AIDS 22

African American 21

Smoke-free/second-hand smoke 18

Armed Forces 8

Prisoners 7

Latinos 6


UK ethnic minorities 5

Drugs 3

Homelessness 1

how many studies looked at smoking in social context
How many studies looked at smoking in social context ?
  • Divided studies up into public context/private context
  • Found 13 studies which looked at the social context of smoking in the public sphere

= where, when and with whom

  • Excluded studies often did little more than ask people their reasons for smoking which were... enjoyment, stress relief and boredom relief
  • These studies typically found that high-prevalence groups smoke more because they have... fewer pleasures, more stress and more boredom !
what key themes emerged from these studies
What key themes emerged from these studies ?
  • time and the smoker
  • Smoking spaces and places
  • the embodiment of smoking
time and the smoker
Time and the smoker
  • To look at smoking in social context, studies looked at smoking in and over time, using life grids, diaries etc.
  • Relevance of the smoker’s time perspective and future orientation (Adams & White 2009, Lawlor et al 2003)
  • The daily ritual of smoking (Laurier 2000)
  • Smoking over the life course (Parry 2002)
smoking places and spaces
Smoking places and spaces
  • Does denormalisation have any effect in smoking islands ? (= high prevalence neighbourhoods, but also prisons, psychiatric units, the military etc.)
  • Second-hand smoke and the policing of private space (homes, cars)
  • Smoke free legislation and the privatisation of smoking : a private pleasure or one shared with friends?
smoking in the body
Smoking in the body
  • Very few studies examined the physical reality of smoking: inhaling and exhaling, taking smoke into the body, holding fire (Dennis 2009)
  • Studies which referred to the physicality of smoking only referred to stigma and spoilt identity: the smoker’s feelings of guilt, dirt, contamination, having to wash away the smell from mouth, hair and clothes (Haines et al 2010)
  • Gillies & Willig (1997): 'a more positive construction of the body, emphasising 'pleasure, strength, vitality', should replace views of the body as a 'dominant, controlling force (as in a discourse of addiction) or as a separate entity in need of regulation and repression (as in a construction of self-control).
  • Ettore  (1994): the experience of pleasure associated with the use of [drugs] needs to be replaced instead of denied, with strategies promoting sport or meditation as alternative forms of physical enjoyment.
conclusion what do we already know
Conclusion: what do we already know ?
  • Smokers are concentrated in deprived neighbourhoods and in special populations suffering from poverty and/or discrimination, stigma, mental illness etc.
  • Their reasons for smoking are the same as those of more prosperous smokers, but they are more addicted and find it harder to quit

What does this study add ?

  • Very few qualitative studies have looked at smoking in social context, and more specifically at embodied smoking in time and space
  • Cessation services can benefit from a better understanding of where, when and with whom smoking takes place for high-prevalence groups, and tailor interventions accordingly.
how can we act on what we know
How can we act on what we know?
  • Time and the smoker: influencing time perspective (improving self-esteem, treating depression, CBT)
  • Smoking places and spaces: addressing the normative smoking that exists in many neighbourhoods, institutions and populations. Group or population-level interventions may be more effective than individual cessation services here.
  • Smoking in the body: approaches that acknowledge the body might involve sport and exercise interventions
  • Addressing structural injustice: If we are serious about smoking cessation, we have a responsibility to address the poverty, inequality and discrimination which drive the need to self-medicate (also see Cooperstock & Lennard 1979).

Adams J., White M.(2009)” Time perspective in socio-economic inequalities in smoking and bodymassindex”. Health Psychology 2009; 28: 83–90.

Cooperstock, R., Lennard, H. L., (1979), “Some social meanings of tranquilizer use”. Sociology of Health & Illness, 1: 331–347

Dennis, S. (2005) “Four Milligrams of Phenomenology: An Anthrophenomenological Analysis of Smoking Cigarettes.“ Popular Culture Review Journal 15 (4): pp. 41-57.

Ettorre, E. (1994) `Substance use and women's health', in S. Wilkinson and C. Kitzinger (eds), Women and Health: Feminist Perspectives, Taylor and Francis, London.

Gillies, V. and C. Willig (1997). "'You get the nicotine and that in your blood': Constructions of addiction and control in women's accounts of cigarette smoking." Journal of Community & Applied Social Psychology7(4): 285-301.

Haines, R. J., J. L. Oliffe, et al. (2010). "'The missing picture': tobacco use through the eyes of smokers." Tobacco Control19(3): 206-212.

Jarvis M and Wardle J, “Social Patterning of individual health behaviours: the case of cigarette smoking”. In: Marmot M, Wilkinson R. Eds. Social Determinants of Health. Oxford, England: Oxford University Press, 2nd edition 2005

Laurier, E., L. McKie, et al. (2000). "Daily and lifecourse contexts of smoking." Sociology of Health & Illness22(3): 289-309.

Lawlor, D., Frankel, S., et al (2003) “Smoking and ill-health: does lay epidemiology explain the failure of smoking cessation programs among deprived populations ?” American Journal of Public Health 93 (3): 266-270

Parry, O., C. Thomson, et al. (2002). "Cultural context, older age and smoking in Scotland: qualitative interviews with older smokers with arterial disease." Health Promotion International17(4): 309-316.

Poland, B., K. Frohlich, et al. (2006). "The social context of smoking: the next frontier in tobacco control?" Tobacco Control15(1): 59-63.

Thompson, L., J. Pearce, et al. (2007). "Moralising geographies: stigma, smoking islands and responsible subjects." Area39: 508-517.