THE THE ““SOCIALSOCIAL”” IN THE IN THE SOCIAL CONTEXT OF SOCIAL CONTEXT OF

SMOKINGSMOKING

Katherine Frohlich, Ph.D.Katherine Frohlich, Ph.D.Presented to: Presented to:

Institute for Social and Preventive Medicine, Institute for Social and Preventive Medicine, University of Bern, SwitzerlandUniversity of Bern, Switzerland

July 7, 2006July 7, 2006

What is the problem?What is the problem?

A growing concentration of smoking among socially A growing concentration of smoking among socially and economically marginalized groups. and economically marginalized groups.

Diverse sources of resistance to tobacco control.Diverse sources of resistance to tobacco control. This concentration of smoking among particular This concentration of smoking among particular

groups, as well as the sources of resistance, cannot groups, as well as the sources of resistance, cannot stem just from individual-level behaviour alone. stem just from individual-level behaviour alone.

Some examples of the problemSome examples of the problem

P re v a le n c e o f c ig a re t te s m o k in g a m o n g a d u lts b y s e x a n d s o c io -e c o n o m ic g ro u p

2 0

2 9

3 6

1 9 2 0

3 1

0

5

1 0

1 5

2 0

2 5

3 0

3 5

4 0

M a n a g e r ia l a n d p ro fe s s io n a l In te rm e d ia te R o u t in e a n d m a n u a l

% M e n W o m e n

G re a t B r ita in 2 0 0 3 . S o u rc e G H S 2 0 0 3 /0 4

Smoking prevalence by sex and socio-Smoking prevalence by sex and socio-economic group 1974-2003economic group 1974-2003

0

10

20

30

40

50

60

1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002

Men n on -m an u alMen m an u alW om en n on -m an u alW om en m an u al

%

Profess iona l II III NM III M IV Unsk illed0

10

20

30

40

50

60

70

Qui

t rat

io %

SMOKING CESSATION BY SOCIAL CLASSIN GREAT BRITAIN: GHS 1973 - 2003

1973

2003

SOCIAL CLASS

What does the What does the “social“social”” refer to in therefer to in the social social context of smoking?context of smoking?

Beyond individual behaviours (Beyond individual behaviours (addictions, or addictions, or “lifestyle” model) “lifestyle” model)

Beyond social influences (social norms, peer Beyond social influences (social norms, peer pressure)pressure)

Beyond social environment (tends to focus on units Beyond social environment (tends to focus on units of analysis, often based on the ecological model)of analysis, often based on the ecological model)

Problems with understanding the social Problems with understanding the social context of smokingcontext of smoking

The social context is not easily defined or measuredThe social context is not easily defined or measured The literature that we drew on can seem relatively The literature that we drew on can seem relatively

inaccessible to practitioners and researchersinaccessible to practitioners and researchers Do we want to come up with a metatheory or a Do we want to come up with a metatheory or a

bricolage of conceptual lenses and concepts?bricolage of conceptual lenses and concepts?

The objectives of our projectThe objectives of our project

to identify diverse theoretical analytic traditions that to identify diverse theoretical analytic traditions that could be best drawn upon to illuminate theorization could be best drawn upon to illuminate theorization of the social context in general, and tobacco of the social context in general, and tobacco consumption in particular;consumption in particular;

to determine key concepts from these traditions that to determine key concepts from these traditions that would help explain the unequal distribution of would help explain the unequal distribution of smoking and; smoking and;

to test these concepts through in-depth interviews to test these concepts through in-depth interviews with smokers. with smokers.

Our key theoretical tenetsOur key theoretical tenets

collective lifestylescollective lifestyles power relationspower relations identity & consumptionidentity & consumption place place the bodythe body pleasurepleasure

Collective lifestylesCollective lifestyles

Cockerham et al, 1997 (Cockerham et al, 1997 (The Sociological QuarterlyThe Sociological Quarterly); ); Frohlich et al, 2001 (Frohlich et al, 2001 (Sociology of Health & IllnessSociology of Health & Illness).).

Drawing on Giddens & Bourdieu, ‘collective Drawing on Giddens & Bourdieu, ‘collective lifestyles’ are seen as ‘social practices’ of social lifestyles’ are seen as ‘social practices’ of social groups embedded in ‘styles of life’ that are an groups embedded in ‘styles of life’ that are an expression of a (recursive) relationship between expression of a (recursive) relationship between people’s social conditions and their social practices. people’s social conditions and their social practices.

Lifestyle as expression of ‘habitus’ - practices and Lifestyle as expression of ‘habitus’ - practices and schemes of perception, preference and taste.schemes of perception, preference and taste.

Grabb, E.G. (1997) Theories of sociGrabb, E.G. (1997) Theories of social inequalitiy: Classical and Contemal inequalitiy: Classical and Contemporary Perspectives (3rd ed). Toronporary Perspectives (3rd ed). Toronto, ON: Harcourt Brace.to, ON: Harcourt Brace.

Power relationsPower relations Power is the capacity to act (power to).Power is the capacity to act (power to). Power is the capacity to prevail over others (power Power is the capacity to prevail over others (power

over).over). Grabb (1997) identifies three fundamental bases of Grabb (1997) identifies three fundamental bases of

power: control of material resources (means of power: control of material resources (means of production, wealth), control of human resources production, wealth), control of human resources (labour power), and control of ideas (ideology, (labour power), and control of ideas (ideology, hegemony, and cultural dominance). hegemony, and cultural dominance).

Focusing on power relations draws attention to the Focusing on power relations draws attention to the ways in which the social and geographic patterning ways in which the social and geographic patterning of smoking parallels the effects of other processes of of smoking parallels the effects of other processes of marginalisation and disadvantage marginalisation and disadvantage

Identity/ConsumptionIdentity/Consumption

Lifestyle / styles of life are embedded in consumption Lifestyle / styles of life are embedded in consumption selected from among what is economically and selected from among what is economically and socially feasible/practical in order to construct & socially feasible/practical in order to construct & maintain social identity that both establishes and maintain social identity that both establishes and expresses differenceexpresses difference

Agnew, J. (1993). Representing spaAgnew, J. (1993). Representing space: Space, scale and culture in socice: Space, scale and culture in social science. In: Duncan J. Ley D. edital science. In: Duncan J. Ley D. editors. Place/Culture/Representation. ors. Place/Culture/Representation. London: Routledge, 1993. p. 251-2London: Routledge, 1993. p. 251-27171

PlacePlace

3 elements of place (Agnew, 1993).3 elements of place (Agnew, 1993).– locale:locale: settings in which social relations are settings in which social relations are

constitutedconstituted– location:location: effects upon locales of social & effects upon locales of social &

economic processes operating at wider scaleseconomic processes operating at wider scales– sense of place:sense of place: local ‘structure of feeling’, local ‘structure of feeling’,

attachment to place, experience of placeattachment to place, experience of place

The bodyThe body

Mauss; Bourdieu; socio-biologyMauss; Bourdieu; socio-biology embodiment of class / genderembodiment of class / gender examples: physique, gaitexamples: physique, gait

PleasurePleasure

‘‘promethean pleasure of ‘holding fire’’promethean pleasure of ‘holding fire’’ Klein (1993), Klein (1993), Cigarettes Are SublimeCigarettes Are Sublime pleasure of bodily competence associated with pleasure of bodily competence associated with

‘smoking well’‘smoking well’ health promotion’s ambivalent relationship to desire health promotion’s ambivalent relationship to desire

& pleasure& pleasure

Preliminary results : PowerPreliminary results : Power

#12/370#12/370Q: You said that smokers are being treated as second class Q: You said that smokers are being treated as second class

citizens. citizens. A: I’m just saying that a certain selection of the population A: I’m just saying that a certain selection of the population

((treats smokers as second class citizenstreats smokers as second class citizens). You know you could ). You know you could compare it to the religious right…..You know for some reason compare it to the religious right…..You know for some reason oh for the next twenty years we’re going to target smokers. oh for the next twenty years we’re going to target smokers.

#8/36#8/36A: ….like I don’t smoke that much. That regularly. I don’t smoke A: ….like I don’t smoke that much. That regularly. I don’t smoke

throughout the day. I don’t smoke until I’m finished work. I throughout the day. I don’t smoke until I’m finished work. I never smoke at work. I guess my experience with smoking is never smoke at work. I guess my experience with smoking is maybe a little different from someone who, you know, smokes maybe a little different from someone who, you know, smokes all the time. all the time.

Preliminary Results: IdentityPreliminary Results: Identity

#2/p.6#2/p.6A: My one brother he just says, what else am I going to do? …A: My one brother he just says, what else am I going to do? …

he’s like me, we’re going to die anyway, so I might as well he’s like me, we’re going to die anyway, so I might as well enjoy life. It might not be what other people think is a better enjoy life. It might not be what other people think is a better quality, but to us its our life.quality, but to us its our life.

#3/298#3/298A: …well nobody ever thinks that I smoke. Nobody would A: …well nobody ever thinks that I smoke. Nobody would

ever…When people find out that I smoke they’re completely ever…When people find out that I smoke they’re completely shocked. Always. Like they’re just like, what? You smoke? shocked. Always. Like they’re just like, what? You smoke? Because it totally, like I said earlier, contradicts basically Because it totally, like I said earlier, contradicts basically everything else about my lifestyle. Um, I am very concerned everything else about my lifestyle. Um, I am very concerned about what I eat. What I put in my body. I don’t eat processed about what I eat. What I put in my body. I don’t eat processed foods. I don’t eat fast food… foods. I don’t eat fast food…

Preliminary results : PlacePreliminary results : Place

#12/434#12/434A: …as I was saying before the war veterans, those are the people A: …as I was saying before the war veterans, those are the people

I feel for. You’re taking away a large part of their social life, I feel for. You’re taking away a large part of their social life, getting together once a week or even once a month to go to a getting together once a week or even once a month to go to a Legion or an army/navy club. You’re going to turn these Legion or an army/navy club. You’re going to turn these people into shut-ins and they are just going to fade away and people into shut-ins and they are just going to fade away and die because they’re going to lose that only social contact they die because they’re going to lose that only social contact they have. have.

#2/726#2/726A: I can’t actually think of any friends really who smoke A: I can’t actually think of any friends really who smoke

inside….Most people are all outside now. Somehow it makes inside….Most people are all outside now. Somehow it makes people feel better.people feel better.

Preliminary results: The bodyPreliminary results: The body

#4/518#4/518

A: A: You know my…my favourite answer is well if you can You know my…my favourite answer is well if you can guarantee me that I won’t gain weight then I’ll quit smoking…guarantee me that I won’t gain weight then I’ll quit smoking…Really it all comes back to that in the end. And, ah, yah find Really it all comes back to that in the end. And, ah, yah find me a diet that I can lose weight and quit smoking all at the me a diet that I can lose weight and quit smoking all at the same time and I’ll be there.same time and I’ll be there.

#3/178#3/178A: I smoke certain types of cigarettes that don’t stain your fingers. A: I smoke certain types of cigarettes that don’t stain your fingers.

So you can see my fingers don’t look like a smokers. I don’t So you can see my fingers don’t look like a smokers. I don’t have any nicotine residue or yellow nails or any of that. have any nicotine residue or yellow nails or any of that.

Preliminary results: PleasurePreliminary results: Pleasure

#5/612#5/612A: You know I don’t really know if I enjoy any of them A: You know I don’t really know if I enjoy any of them

anymore….It’s getting to the point where it’s not an enjoyment anymore….It’s getting to the point where it’s not an enjoyment it’s more of a habit….I’ll eat an apple and I enjoy that a heck of it’s more of a habit….I’ll eat an apple and I enjoy that a heck of a lot more than having a cigarette.a lot more than having a cigarette.

#8/165#8/165A: Like if I’ve had a hard day at work and like I walk from work A: Like if I’ve had a hard day at work and like I walk from work

and it’s like a twenty-five minute walk and I sort of walk home and it’s like a twenty-five minute walk and I sort of walk home and clear my head and like have a cigarette I like that cigarette and clear my head and like have a cigarette I like that cigarette because it’s sort of….it’s very relaxed. because it’s sort of….it’s very relaxed.

Concluding with reflexivityConcluding with reflexivity

attention to the tacit knowledge and perspectives that attention to the tacit knowledge and perspectives that practitioners bring to their workpractitioners bring to their work

an openness to being transformed by the experience of an openness to being transformed by the experience of engaging with smokers from very different social engaging with smokers from very different social backgrounds who may question our (tobacco control) backgrounds who may question our (tobacco control) practicespractices

a questioning of ‘‘received knowledge’’ (what we hold a questioning of ‘‘received knowledge’’ (what we hold to be self evident and true)to be self evident and true)

a curiosity about—and openness towards—other a curiosity about—and openness towards—other perspectives and ways of seeingperspectives and ways of seeing

an awareness of power relations and one’s own social an awareness of power relations and one’s own social location and positionalitylocation and positionality