‘Waiting until they got home’: Gender, smoking and tobacco exposure in households in Scotland☆
Introduction
Despite overall declining smoking rates in developed countries, levels of smoking remain high in the poorest communities, linked to multiple social and economic disadvantages, ill health, and poor life-expectancy (Graham et al., 2006, Marsh and McKay, 1994). As smoking relates to embedded cultural and social norms within communities and households (Poland, 2000), some groups, particularly people living in poverty and disadvantage, remain ‘hard to reach’ (Parry, Bancroft, Gnich, & Amos, 2001). Indeed, research suggests that although population based interventions, such as media campaigns and legislation, may change wider social attitudes towards smoking, they do not necessarily reduce health inequalities (Thomson, Wilson, & Howden-Chapman, 2006). Furthermore, research into the introduction of comprehensive tobacco control policies indicate that women and girls, particularly those on low incomes, may be adversely affected, leading to a call for the development of gender-sensitive policies (Dedobbeleer et al., 2004, Greaves and Jategaonkar, 2006). Gender has been identified as a key determinant of smoking behaviour, with teenage girls in many developed countries more likely to take up smoking than teenage boys, and women who have children more likely to smoke than women without children (Dedobbeleer et al., 2004, Graham, 1994, Graham, 2003, Greaves and Jategaonkar, 2006).
One of the concerns about the introduction of legislation to ban smoking in public places in Scotland was that levels of home smoking would increase, leading to increased exposure of household members to second-hand smoke. An early study by Borland, Mullins, Trotter, and White (1999) found that the introduction of workplace restrictions in the state of Victoria, Australia, did not increase household smoking, and a more recent study in Ireland and the UK found reduced levels of smoking (Hyland et al., 2008). However these studies also found that there was less of a reduction in exposure in households where both adults smoked. Research has consistently found that children who live with non-smokers experience the highest reductions in exposure to second-hand smoke as a result of smoke-free policy initiatives, whereas there is comparatively little change for children who live with smokers (Akhtar et al., 2007, Borland et al., 1999, Jarvis et al., 2000). Notably, in Scotland exposure declined significantly post-legislation for children whose parents were non-smokers or where only the father smoked but not where both parents or only the mother smoked (Akhtar et al., 2007). The exposure of children to tobacco smoke has been linked not only to poor health outcomes in childhood and an increased risk of developing life-threatening conditions in later life (Cook and Strachan, 1998, Muller, 2007, Strachan and Cook, 1998), but also to poor performance at school and other cognitive and behavioural problems (Eskenazi & Castorina, 1999). Therefore it is important to understand why some parents continue to smoke in their homes in order to develop more effective initiatives on reducing children’s exposure to second-hand smoke, particularly the most disadvantaged children whose parents are most likely to smoke and whose homes have fewer smoking restrictions (Muller, 2007).
Sociological perspectives in smoking research have highlighted the personal, emotional and structural barriers smokers experience when attempting to quit smoking (Graham et al., 2006). Some smokers have described how smoking supports them to perform particular daily tasks, such as getting up in the morning, as a reward for cleaning the house, or by helping them think over issues at work (McKie, Laurier, Taylor, & Lennox, 2003). Structural barriers relate to aspects of people’s wider social environments, such as limitations of poverty, low literacy or the built environment. For example some parents of young children have limited choices regarding their smoking. In one study, they felt unable to move their smoking outside to protect their children as they were concerned about leaving babies and young children unsupervised in their homes, even for short periods (J. Robinson & Kirkcaldy, 2007). Research suggests that changing smoking behaviours are linked to gender (Bottorff et al., 2006, Dedobbeleer et al., 2004), and that the barriers to quitting smoking, or smoking outside the home, are experienced differently by mothers and fathers, reflecting the gendered roles of caring embedded within social relationships (Graham, 1994, Greaves and Jategaonkar, 2006, Greaves et al., 2007, Royce et al., 1997, Thompson et al., 2004). In the UK, smoking rates are highest for people living on a low income, such as manual workers and those who are unemployed. Furthermore, more people aged 20–35 years are more likely to smoke, and smoke more, than people in younger or older age groups, which is also the time when many people are involved in the bearing and caring for children (S. Robinson & Lader, 2007).
Therefore, it is likely that the introduction of smoking legislation will affect different people in different ways, including their levels and patterns of home smoking (Graham, 1993, Greaves et al., 2006, Lader, 2006, Marsh and McKay, 1994). In considering the social context of smoking, Poland (2006) identifies the study of relative power as a key dimension for researching the how and the why of smoking behaviours. Drawing on the accounts of people who still smoke in their homes, and are living with non-smokers, in this article we apply a gender analysis to further explore who, when and why people still expose other adults and children to second-hand smoke in home environments, and how this intersects with changing public health policy and shifting social attitudes.
Section snippets
Research design and methods
In March 2006, the Scottish Government introduced legislation to ban people smoking in enclosed public places. NHS Health Scotland commissioned two qualitative studies to explore the impact of the legislation at both individual and community levels. ‘Evaluation of the Smoke-free legislation in Scotland: Qualitative Community Study’ (Martin, Ritchie, & Amos, 2008) was a longitudinal study that used semi-structured in-depth interviews to explore participants’ changing smoking behaviours,
Findings
One of the most notable findings from the gender based analysis of those who still smoked inside their homes was the lack of impact the smoke-free legislation had on the lives of most female home smokers. Of the 30 people who smoked in their homes and lived with a non-smoker, 18 were women and 12 were men, and more of the women lived with children (11 out of 18) compared to the men (6 out of 12). Although the numbers are too small to be representative, a greater number of women from
Smoking and paid work
Several home smokers undertook paid work outside their homes, although men were more likely to work full-time and regular hours than women, who tended to work shorter hours and part-time. Both men and women reported smoking less at work as a direct result of the smoking legislation, as they had reduced opportunities to smoke. This man describes how he had adjusted his smoking in advance of the legislation, and so tended to use the same opportunities he had to smoke outside his workplace:
I never
Restricted and unrestricted lives and home smoking
Men who smoked in the home talked about how they were able to adapt to the changing social landscape by changing their smoking behaviours:
I don’t think it changes, if you really want to have a big drink when you’re in the mood for a big drink, then you have a big drink it won’t affect just because you can’t smoke or you’re smoking less. (CS34M)
These accounts by men contrasted with those of women, who associated their unchanged smoking behaviours with their more restricted and limited working
Doing without
Another way in which women accounted for the lack of impact of the smoking legislation on their lives was linked to their ability to go for long periods without smoking when visiting public places. This woman, while a heavy smoker, described how she waited until she got home before she had a cigarette:
I got to cafes and meet friends at least once a week and we go for a cuppa you know. I am not at the pub a great…in fact I think I have probably only been in the pub maybe once since you were last
Discussion
Overall, although many of the men and women in these two studies described how they had altered their smoking patterns as the result of changing social norms and the introduction of the smoke-free legislation, the majority of women who lived with non-smokers reported that their home smoking remained largely unchanged. This suggests that while the de-normalisation of smoking in public places protects the majority of non-smokers, there is disadvantaged minority of non-smokers, particularly
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Both studies and the GBA were funded by NHS Health Scotland. The views expressed in this paper are those of the authors and not necessarily those of the funder. We would like to thank all those who participated in the studies; Richard Phillips for his work on the Homes study; the interviewers Irene Miller, Fiona Rait, and Fenella Hayes; and Sally Haw for her advice and support.