Responsibility and resistance : children and young people’s accounts of smoking in the home and car

Following the implementation of the smokefree law in 2006, which formed part of the Smoking, Health and Social Care (Scotland) Act 2005, smoking in enclosed public spaces has been prohibited in Scotland. The law has led to a number of improvements in public health but does not cover homes and cars where children are primarily exposed. Secondhand smoke (SHS) exposure is associated with particularly significant risks to child health, yet few studies have explored children’s perspectives on SHS and smoking in the home and car. Comprising a qualitative exploration of the views and experiences of 38, 10- to 15-year-olds of SHS in the home and car, this thesis begins to address this gap. It addresses the nature and extent of children’s involvement in negotiating smoking restrictions, compares the understandings, experiences and involvement among participants living in communities of contrasting socioeconomic profiles and considers the implications for health promotion interventions aimed at reducing children’s exposure to SHS in the home and car. Informed by a Childhood Studies perspective, the study focuses, both in methods and content, on the voices and agency of the participants. Recruited from two Edinburgh communities with contrasting socioeconomic profiles, the participants were interviewed either individually, in pairs or in small focus groups about their understandings of SHS, smoking restrictions in their homes and cars and their role in negotiating them. Home floor plans constructed by the participants were used to prompt discussion and also served to identify spatial and temporal home smoking restrictions. Both discursive and thematic techniques were used in analysis. The thesis details the participants’ overt and covert strategies to resist family members’ smoking, demonstrating the active roles that participants describe in their accounts. While acknowledging SHS as a health risk and using an embodied language of disgust to describe it, the participants’ main concern was for their smoking family members’ health, rather than their own. Many participants also challenged the stigma surrounding smoking parents by detailing the ways in which their parents restricted where, how much and with whom they smoked. Parents were described as especially careful in protecting small children from SHS. While most participants described such protective practices, those from the disadvantaged area reported less stringent smoking restrictions that were more challenging to negotiate. Participants’ resistant (to smoking) and defensive (of parents who smoke) accounts may stem from the growing stigma associated with smoking, particularly smoking in the presence of children. Such findings highlight the importance of a sensitive and asset based public health response that acknowledges parents’ attempts to protect their children from SHS and recognises the potential of the active role of children in family negotiations around smoking in the home and car

Stigma and Smoking in the Home:Parents' Accounts of Using Nicotine Replacement Therapy to Protect Their Children from Second-Hand Smoke

Evidence and campaigns highlighting smoking and secondhand smoke risks have significantly reduced smoking prevalence and denormalised smoking in the home in Scotland. However, smoking prevalence remains disproportionally high in socioeconomically disadvantaged groups. Using stigma as a theoretical lens, this article presents a thematic analysis of parents' accounts of attempting to abstain from smoking at home, using nicotine replacement therapy (NRT), in disadvantaged areas of Edinburgh and the Lothians. Smoking stigma, particularly self-stigma, underpinned accounts, with two overarching themes: interplaying barriers and enablers for creation of a smoke-free home and reconceptualisation of the study as an opportunity to quit smoking. Personal motivation to abstain or stop smoking empowered participants to reduce or quit smoking to resist stigma. For those struggling to believe in their ability to stop smoking, stigma led to negative self-labelling. Previously hidden smoking in the home gradually emerged in accounts, suggesting that parents may fear disclosure of smoking in the home in societies where smoking stigma exists. This study suggests that stigma may act both as an enabler and barrier in this group. Reductions in smoking in the home were dependent on self-efficacy and motivations to abstain, and stigma was entwined in these beliefs

Disadvantaged Parents' Engagement with a National Secondhand Smoke in the Home Mass Media Campaign:A Qualitative Study

Mass media campaigns can be effective in tobacco control but may widen health inequalities if they fail to engage disadvantaged smokers. This qualitative study explored how parents with young children living in disadvantaged circumstances engaged with a national campaign which aimed to raise awareness of the importance of smokefree homes. Individual semi-structured interviews were carried out with 17 parents before and after the Scottish 2014 “Right Outside” mass media campaign. A conceptual framework exploring meaningful exposure (recall and understanding), motivational responses (protecting children from secondhand smoke (SHS)) and opportunities to act (barriers) was used to thematically analyse the findings. Campaign recall and engagement, and motivation to protect children were high. Parents identified with the dramatized scenario and visual impact of SHS harm to children in the TV advertisement. Some reported changed smoking practices. However, supervising young children in limited accommodation when caring alone constrained opportunities to smoke outside. Instead, parents described actions other than smoking outside that they had taken or were planning to take to create smokefree homes. Mass media campaigns using emotive, real-life circumstances can be effective in engaging parents about SHS. However, the behavioural impact may be limited because of difficult home environments and circumstances

Grandmothers’ care practices in areas of high deprivation of Scotland:the potential for health promotion

In many families grandparents play an essential role by providing secondary care for grandchildren. The family is a key setting for promoting children’s health; however, studies describing health initiatives with grandparents are rare. Grandparents could play an important role in promoting health for their grandchildren within their families and communities. The aim of this study was to examine the care practices of grandparents in families living in areas of high deprivation, and to consider the extent to which grandparents could be at the centre of health-promoting initiatives for children. A family practices approach was used to examine care practices within the framework of family resource (assets/capitals) use. In-depth interviews were carried out with grandmothers (n = 15) and mothers (n = 15) living in areas of high deprivation in Scotland. The results are presented as three economies of family living—political, moral and emotional. Grandparent care was described as a form of social capital, central to the wellbeing of the families, and enabled parents to access education and employment. Grandparent care was supported through families’ ability to access cultural amenities and green space (political). Grandparents’ care practices were described as either being responsible or fun (moral). Love appeared to be at the centre of grandparents’ care (emotional). The strengths and weaknesses of this framework were examined in relation to developing initiatives with grandparents. With further development work, grandparents could be the focus of health initiatives with their grandchildren with the support of appropriate policies and resources within their communities

A review of the effectiveness of interventions, approaches and models at individual, community and population level that are aimed at changing health outcomes through changing knowledge attitudes and behaviour

This document is the summary of a ‘review of reviews’, which aims to bring together a large body of evidence and provide a critical and structured overview of the effectiveness of interventions and models to change attitudes, knowledge and behaviours in six different areas. This overview will provide researchers, policy and decision-makers, and practitioners with accessible, good quality evidence in these topic areas

People's experiences of cancer within the first year following diagnosis. Final Report

The aim of the study was to explore the experiences of people affected by cancer in the first year following diagnosis with breast, lung, colorectal, prostate or gynaecological cancer. This was a descriptive qualitative study conducted over a period of 18 months during which three serial, longitudinal semi-structured interviews with 66 people, their nominated partner/carer1 (n=43) and healthcare professional (n=20) were conducted. The study included 18 people with colorectal cancer, 12 women with breast cancer, 9 women with gynaecological cancer, 17 people with lung cancer and 10 men with prostate cancer. The sampling strategy was not designed to derive a representative sample but to enable the researchers to understand experience of cancer and cancer care from men and women with a different cancer diagnosis and who had different socio-economic backgrounds and lived either in a rural or urban area. A conscious effort was made to include people from different ethnic minority groups but this was unsuccessful because no or very small numbers of people from these groups were diagnosed with cancer during the period of recruitment in the cancer centres where healthcare professionals were recruiting for the study

Barriers to hospital deliveries among ethnicminority women with religious beliefs in China:A descriptive study using interviews and survey data

Background: China has made great progress in improving hospital delivery-the coverage of hospital delivery has increased to above 95% in most regions- some regions lag behind owing to geographic and economic inequality, particularly the poor ethnic minority areas of the Sichuan Province. This study explores factors which may influence hospital delivery from multiple perspectives, with implications for practice and policy. Methods: A framework analysis approach was used to identify and categorize the main barriers and levers to hospital delivery. Our analysis draws on basic information from the sampled counties (Butuo and Daofu). Results: The hospital delivery rate was below 50% in the two sampled areas. In both areas, the “New Rural Cooperative Medical Scheme” and “Rural hospital delivery subsidy” were introduced, but only Butuo county had a transportation subsidy policy. Socioeconomically disadvantaged women in both counties who delivered their babies in hospitals could also apply for financial assistance. A lack of transport was among the main reasons for low hospital delivery rates in these two counties. Furthermore, while the hospital delivery costs could be mostly covered by “New Rural Cooperative Medical Scheme” or “Rural Hospital Delivery Subsidy”, reimbursement was not guaranteed. People in Daofu county might be affected by their Buddhism religion for hospital delivery. Women in Butuo following the Animism religion would refuse delivery in hospitals because of language barriers. Traditional lay beliefs were the main factor that influenced hospital delivery; their understandings of reproductive health varied, and many believed that childbirth should not be watched by strangers and that a home delivery was safe. Conclusions: This study has highlighted a number of barriers and levers to hospital delivery in rural poor ethnic minority areas which could inform and improve the access and rate of hospital delivery rate; thereby reducing health inequalities in maternal and child health in China