Claudia Martin

Housing conditions and ill health.

Lack of empirical evidence that living in damp houses has detrimental effects on health may partly be due to inadequate research. A preliminary study was therefore carried out of a random sample of council owned residences in a deprived area of Edinburgh, a respondent from consenting households being interviewed to obtain a profile of the physical and mental health of all adults and children. In addition, information was gathered about other factors that might be important, particularly smoking and selective bias in the allocation of tenants to houses. Independent measures of dampness were made by environmental health officers. No conclusive effects of damp on the health of adults were identified. Nevertheless, children living in damp houses, especially where fungal mould was present, had higher rates of respiratory symptoms, which were unrelated to smoking in the household, and higher rates of symptoms of infection and stress. Housing should remain an important public health issue, and the effects of damp warrant further investigation.

Smoking in the home after the smoke-free legislation in Scotland: qualitative study

Objective To explore the accounts of smokers and non-smokers (who live with smokers) of smoking in their homes and cars after the Scottish smoke-free legislation; to examine the reported impact of the legislation on smoking in the home; and to consider the implications for future initiatives aimed at reducing childrens exposure to secondhand smoke in the home. Design and setting A qualitative cross sectional study involving semistructured interviews conducted across Scotland shortly after the implementation of the legislation on 26 March 2006. Participants A purposively selected sample of 50 adults (aged 18-75) drawn from all socioeconomic groups, included smokers living with smokers, smokers living with non-smokers, and non-smokers living with smokers. Results Passive smoking was a well recognised term. Respondents had varied understandings of the risks of secondhand smoke, with a few rejecting evidence of such risks. Children, however, were perceived as vulnerable. Most reported that they restricted smoking in their homes, with a range of restrictions across social classes and home smoking profiles. Spatial, relational, health, and aesthetic factors influenced the development of restrictions. Children and grandchildren were important considerations in the development and modification of restrictions. Other strategies were also used to militate against secondhand smoke, such as opening windows. The meaning of the home as somewhere private and social identity were important underlying factors. Respondents reported greater restrictions on smoking in their cars. There were diverse views on the smoke-free legislation. Few thought it had influenced their smoking in the home, and none thought it had affected how they restricted smoking in their homes. Conclusions These data suggest two normative discourses around smoking in the home. The first relates to acceptable social identity as a hospitable person who is not anti-smoker. The second relates to moral identity as a caring parent or grandparent. Awareness of the risks of secondhand smoke, despite ambivalence about health messages and the fluidity of smoking restrictions, provides clear opportunities for public health initiatives to support people attain smoke-free homes.

But it just has that sort of feel about it, a leper—Stigma, smoke-free legislation and public health

INTRODUCTION The Scottish smoke-free legislation has had considerable success, with high compliance resulting in significant health benefits and the increased denormalization of smoking. International literature on the impact of smoke-free legislation has mostly focused on the success of such policies. Relatively little consideration has been given to the potentially negative, albeit unintended, consequences of smoke-free policies within different social and cultural contexts, in particular the increased stigmatization of smokers. METHODS A 3-wave longitudinal qualitative study in 4 localities in Scotland using repeat in-depth interviews. Participants comprised a panel of 40 current and recent ex-smokers, interviewed before and after implementation of the legislation in 2 socioeconomically advantaged and 2 disadvantaged localities in Scotland. RESULTS Smokers perceived the smoke-free legislation to have increased the stigmatization of smoking. By separating, albeit temporarily, those who were smoking from those who were not had led to increased felt stigma. This had led to a social milieu that fostered self-labeling and self-stigmatization by smokers of their own smoking behavior, even when they were not smoking. While there was little reported direct discrimination, there was a loss of social status in public places. Smokers attempted to ameliorate stigmatization by not smoking outside, reducing going out socially, joining in the stigmatization of other smokers, and/or acknowledging the benefits of smoke-free environments. DISCUSSION The unintended negative consequences of smoke-free legislation for some suggest that tobacco control strategies need to consider how smokers who experience increased stigma are supported by public health to address their smoking while continuing to create smoke-free environments.

Psycho-social stress and puerperal depression

This study assessed the role of psycho-social stress in the development of psychiatric disorder during pregnancy and after childbirth. The samples were a consecutive series of women admitted to a psychiatric Mother and Baby Unit with a depressive illness and a random sample of women who had recently given birth. Whereas prepartum-onset disturbances were found to be overwhelmingly stress-related, women with a postpartum onset of depression were considerably less likely to have experienced a recent stress event or difficulty before onset. The relative lack of psycho-social antecedents among women who became ill within 2-3 weeks of giving birth strengthens the argument that puerperal depression may have a distinct, possibly biological aetiology.

The social context of change in tobacco consumption following the introduction of ‘smokefree’ England legislation: A qualitative, longitudinal study

Legislation implemented in England on 1st July 2007 to prohibit smoking in enclosed public places aimed primarily to limit exposure to second-hand smoke, thereby reducing smoking-related morbidity and mortality. We conducted a qualitative study between April 2007 and December 2008 in six contrasting localities in two metropolitan areas in the north and south of England, which examined the impact of the legislation on individuals, families and communities. Using a multi-level longitudinal case study design, we collected data at community and individual levels, from three months prior to the legislation to a year after its enactment through a range of methods, including semi-structured interviews with panel informants and observations in locality settings. Drawing on theoretical understandings of the relationship between structure, agency and practice, this paper examines the social and cultural contexts of change in tobacco consumption. Observations in a variety of community settings identified reduced smoking in public places post-legislation. More than half of panel informants reported decreased consumption at one year post-legislation; a minority had quit, maintained or increased their smoking levels. The dominant pattern of reduced consumption was attributed primarily to constraints imposed by the legislation. This suggests that the law may have provided an impetus for some smokers to cut down or quit. Smoking behaviour was, however, strongly influenced by the social networks in which smokers were embedded, indicating that, while individuals had the power to act, any changes they made were largely shaped by social structural factors. Our findings support the need for a comprehensive tobacco control strategy that takes account of the complex array of contextual factors that constrain and enable smoking.

Public places after smoke-free—A qualitative exploration of the changes in smoking behaviour

The social context of smoking behaviours is explored after the introduction of Scottish smoke-free legislation. A longitudinal qualitative study was conducted in four contrasting localities. Whilst post-legislation changes in smoking behaviour were evident in all four localities, they were most apparent in the disadvantaged localities. Changes in the patterns of smoking were linked to the ways in which people interacted in social contexts and how people re-negotiated habitual smoking behaviours in public spaces. Pre-legislation differences in the communities appeared to influence the extent of these changes. Cultural and social contexts are important in shaping smoking behaviours and locating change within public places.

The re-shaping of the life-world: male British Bangladeshi smokers and the English smoke-free legislation

Objective. To explore how male Bangladeshi smokers adapted to the English smoke-free legislation. Design. We draw on data derived from the Evaluation of Smoke-free England (ESME), a qualitative, longitudinal study conducted between 2007 and 2008 in two English metropolitan areas. Repeat interviews (n=34) were conducted before and after the legislation with 15 male Bangladeshi panel informants and from two focus groups: one with Bangladeshi men and the other with Bangladeshi women. Results. Bangladeshi smokers who participated in this study had largely accommodated to the smoke-free legislation and most had reduced their consumption of cigarettes, albeit to a modest degree. However, at the same time some Bangladeshi smokers appeared to have increased their use of shisha, a popular alternative method of smoking tobacco in this community. Smoke-free legislation also had an impact on the social and cultural forces that shape smoking behaviour in this group. In particular, family homes continued to be a key space where tobacco is consumed, although the legislation may have helped to shift the balance in favour of forces that oppose smoking and against enduring cultural pro-smoking norms. Smoking in public was also less socially acceptable, especially in the vicinity of local mosques and at community events. In some older groups, however, smoking remains a deeply embedded social habit which can undermine smokers’ efforts to quit. Conclusion. For maximum impact, tobacco control interventions aimed at whole populations may need to be supplemented by culturally sensitive measures in local areas where there is a high concentration of Bangladeshi people. Similar considerations may apply to other minority communities with a high prevalence of smoking.

Health-related behaviour in a small Scottish community.

A survey of health-related behaviours was carried out in a small Scottish town. A random sample stratified by age and sex was drawn from the records of the sole local health centre. A previously validated questionnaire was sent by post with a covering letter from the general practitioners and a reply paid envelope. An overall response rate of 71.3% was achieved. The results indicated very high rates of smoking for women with manual jobs, but differences between men in manual & non manual groups were not significant. Younger women reported higher alcohol consumption than older women, but there were no significant differences between occupational groups or employed and unemployed men. Only a minority of respondents reported regular consumption of high fibre products, low fat milk and polyunsaturated margarine and few claimed to undertake vigorous exercise. In general health-related behaviours showed little association with self-rated health. Whilst the data confirm the importance of socio-demographic factors in certain behaviours they also indicate that these are inadequate to predict the pattern of such behaviours within a community.

Response to Baker, J., Mitchell, R., Pell, J., Cross-sectional study of ethnic differences in the utility of area deprivation measures to target socioeconomically deprived individuals, Social Science & Medicine 85 (2013) 27-31.

Baker et al. carried out a cross-sectional analysis of data from the Health Survey for England 2004 (HSE 2004) to examine whether area deprivation measures provided a good basis for targeting public health interventions for people in ethnic minorities. They concluded that there was no evidence that area based targeting would disadvantage ethnic minority groups. We argue that this is far too sweeping a conclusion, and that in particular if extrapolated to Scotland would be seriously misleading. As the authors point out, the findings are likely to be accounted for by two observations about ethnic minority populations, taken together: