Defending the Absurd? Interpretations of Smokers and

Smoking

Jude McCool,1 Janet Hoek2, Richard Edwards2, Ninya Maubach2, 1 University of Auckland; 2 University of Otago

Overview

Smoking remains a serious preventable public health problem

• Use of denormalisation as a tobacco control strategy• Industry exposure• Re-adjustment of social norms regarding smoking

• Examination of smoking in an increasingly intolerant social environment• Findings from qualitative study exploring smokers’

social identities

Tobacco Denormalisation

• De-normalising strategies expose the industry’s behaviour• Toxic product peddled by an

unscrupulous industry (Lee et al., 2004)

• Suppression of research (Bero, 2005; Hammond et al., 2006a)

• Creation of doubt regarding medical evidence (Smith, 2006, Hurt and Robertson, 1998)

• Use of litigation to impede policy measures (Ibrahim and Glantz, 2006)

Tobacco Denormalisation

• Denormalisation also reframes smoking as socially unacceptable (Alesci et al., 2003, Alamar

and Glantz, 2006)

• “Spoiled identity” of smokers depicts smokers as:• Malodorous, selfish people • Disproportionate users of public

health services, and employer liabilities (Chapman and Freeman, 2008)

• Smoking becomes unattractive and unlikely to enhance social standing (Hoek et al., 2011)

Social Identity and Smoking Denormalisation Young adults use smoking imagery and tobacco

brands to co-create identities (Pollay, 2000)

“important, if complex, relationships between the image of smoking and the images that young people hold of themselves and to which they aspire” (Amos et al., 1997)(p. 848)

• Social identity theory recognises importance of group membership of specific groups (Taifel and Turner, 1979, Kobus, 2003, Moffat and Johnson, 2001)

• Smoking a defining behaviour that signifies group membership (Stewart-Knox et al., 2005, Fry et al., 2008)

Social Identity and Smoking Denormalisation • De-normalisation decreases appeal of identifying

with smoking• Increases attractiveness and accessibility of

smokefree groups. • “If you behave in this way, what will others think of

you, and how will you feel about yourself?” (Pechmann

et al., 2003) (p. 195)

• Denormalisation campaigns challenge value offered by smoking offer and stimulate more negative perceptions • 10% increases in smoking’s social unacceptability

reduced consumption by 3.7% at the State level (Alamar and Glantz, 2006).

BUT...

Denormalisation supports public health goals

YET• Raises questions about the

transition from smoking acceptability to unacceptability• How does this affect

smokers and non-smokers (Trappitt, 2010)

• Could stigma result, and is this acceptable (Bayer, 2008a, Bayer, 2008b, Bayer and Stuber, 2006,

Bell et al., 2010, Burris, 2008)

Research Questions

• RQ1: How are smokers and smoking perceived in an environment where smoking has become an increasingly unacceptable social behaviour?

• RQ2: To what extent could this environment stigmatise smokers?

Methodology

• 14 group discussions and 4 in-depth interviews • 86 participants (18-24)• Sample included smokers and non-smokers

• New Zealand European, Māori and Pasifika ethnicities

• Discussion explored:• Views on smoking;• Status as smokers or non-smokers• Differentiation between smokers and non-smokers

• Transcripts analysed using thematic analysis • Identified idea elements and relationships between

these to develop themes (Braun and Clarke, 2006)

Findings

Logic and reason• Non-smokers found smokers a social enigma

• Hard to understand smoking, given strong smokefree messaging

• “To be quite honest, it does make me kind of look down on people who smoke a bit more, like, because I do believe there is so much evidence out there that it is so bad for your health the fact that they’re making that decision is – I don’t know, I think it’s just kind of like weird that someone would choose to do that to themselves. And so I don’t respect them as much at all”.

Findings: Logic and Reason

• Non-smokers saw smoking as a personal choice, and smokers as less than rational

• “I just think that they’re kind of stupid if they’re still doing it, and it’s the warning – it’s blatantly right in front of their noses and then if they’re ignoring it, then they’re not thinking right, they’re not thinking straight”.

Findings: Social Disapproval

Smoking an act of flagrant disrespect for health

• A deficiency in common decency

• Expressed open disapproval

• “if it does smell really bad you do the whole kind of wee bit of a cough as you walk past, just to y ‘know, make sure that they know that you don’t really approve of it. I know it probably sounds a bit mean, but it’s – I do feel strongly about it”.

Findings: Social Disapproval

• Smokers focussed on immediacy and overlooked potential dangers:

• “And I know that a lot of bad health things can come from it but you don’t think about that, eh? At the time when you’re young, you don’t think oh it’s going to happen to me … you just don’t – it doesn’t cross your mind.”

• Deeply resented non-smokers’ challenges: • “God they are a pain in the ass. They keep ranting

and ranting about the bad things of smoking… The non-smoker hates the smell of it. If they don’t like it they can go away.”

Findings: Social Disapproval

Smokers recognised (and reciprocated) non-smokers’ rejection of them:

• “some people [non-smokers] can come across as a little stuck up… they sort of turn up their nose up at you.. if you’re off having a smoke … or if you’re smoking round them they sort of act – make a big show of like, y’know, having smoke being around them and stuff”

• “It’s not caring. Y’know, and not – not having to care, ‘cause we’re young at the moment maybe ... smoking’s just another way to, just maybe symbolise that, or to show other people that y’know, I’m cool eh, I smoke. Which is kind of sad when you say that out loud [laughs]...”.

Findings: Addiction and Compassion

Some non-smokers saw smoking as complex and were more empathic:

• “I don’t really judge them for smoking, but you can tell they can – they get kind of pissed off about the fact that they have an addiction to it”.

Understood addiction compromised choices: • “I think that they often are so addicted, though, that

they aren’t consciously making that choice every time that they do smoke”

Smokers spoke of addiction: • “When I am stressed or, I don’t know, that addiction

kicks in… smoking isn’t good for you, but I can’t help it”

Discussion and Implications

Most non-smokers made explicit and surreptitious judgements of smokers

• Differentiated between themselves and smokers by extending traditional stereotypes• Saw their smokefree status

as the logical response to a harmful behaviour

• Saw smokers as flawed and themselves as superior (Chapman and Freeman 2008; Stewart-Knox et al., 2005; Fry et al., 2008)

Discussion and Implications

Smokers recognised their minority status and social risks they faced

• For some, this reinforced a desired ‘outsider’ identity

• For others, diminished the experience of smoking

Smokers not unaware of risks to social persona, but lived for the moment

• Avoided questions Pechmann et al. (2003) raised• Yet, aware of derision and empathic concern they

elicit 

Conclusions

• Interventions that widen gulf between smokers and non-smokers may have unintended consequences:• May foster smokers’ solidarity and increase

resistance to change.

• Instead, need to consider how to enable movement from smoker to non-smoker identity• Broader the perceived divide between the two

groups, the greater the challenge

• Interventions could promote greater empathy, recognise the power of addiction, and avoid stigma

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