Gary Fry

Why do young adult smokers continue to smoke despite the health risks? A focus group study

The focus of this article is on constructions of health and illness in relation to smoking. Specifically, we were interested in how culturally embedded health promotion messages were discussed and understood by our young smokers–and how continued smoking was rationalised in the context of a thoroughgoing anti-smoking climate. To investigate accounts of smoking maintenance, we conducted focus group discussions (N = 22 groups) with young adults from both high school and university settings. Techniques from discourse analysis were used to identify significant patterns of talk around health and smoking, and three main repertoires were elicited. First, the health risks of smoking were downplayed in several ways (e.g. by citing other risky activities). Second, the putative health benefits of smoking were emphasised (e.g. stress relief). Third, smoking was construed as a temporary, youthful phenomenon, which would cease upon entering responsible adulthood. The implications of these three interlocking repertoires are discussed in relation to smoking maintenance, and suggestions for targeted health promotion are made.

Smoking in the lived world: How young people make sense of the social role cigarettes play in their lives

This qualitative study explored how young people (16- to 24-year olds), both smokers and non-smokers, talk about the social role of smoking in their everyday lives. In 22 focus group interviews, 47 high school children and 40 university undergraduates participated. On the basis of analyses, it is proposed that the perceived need to smoke cannot be reduced to addiction; cigarettes appear to play a complex social role in young peoples lives. In order to resist smoking, participants highlighted the need to provide an excuse to peers, and some reasons (e.g. an interest in sport for boys) were considered more legitimate than others. Cigarettes (certain brands) were also claimed to be used as a way of controlling other peoples perception of smokers, and also to serve as a social tool (for instance, to fill in awkward gaps in conversation). Additionally, smoking was argued to be subject to context (e.g. some schools possess a pro-smoking ethic, while others and universities are anti-smoking). Finally, it was claimed that stopping smoking is difficult since all of the foregoing social factors cannot easily be avoided. The findings of this study compliment and enrich existing social psychological approaches to smoking in young people, and lay the basis for anti-smoking campaigns which take into account the complex social role cigarettes play in the lives of young people.

Direct, mediated and moderated impacts of personality variables on smoking initiation in adolescents

Role of ‘Big Five’ personality traits as predictors of smoking and moderators of the intention-smoking relationship was tested. Five hundred and fifty-three adolescents (aged 11–12) completed measures of self-reported past smoking, gender, intentions to smoke, perceived behavioural control, family smoking, friends smoking at times 1 and 2 (6 months apart). At time 3, 2 years later, the same adolescents completed measures of the Big Five and self-reported smoking (a subset of 300 also provided an objective smoking measure). At time 4, two years after time 3, a sub-sample of 122 adolescents provided a self-report measure of recent smoking. Simple correlations indicated significant direct effects of conscientiousness (self-reported smoking, times 3 and 4), extraversion (time 4 smoking) and neuroticism (all smoking measures) on smoking. Logistic regression showed intention, and the interaction between conscientiousness and intention to significantly predict both self-reported and objectively assessed smoking (both at time 3) after controlling for other variables. Multiple regression showed intentions, family smoking and the interaction between conscientiousness and intention to significantly predict self-reported smoking at time 4 after controlling for other variables. The findings indicate that the impact of personality variables on smoking is through mediated (through cognitions) and moderated (conscientiousness by intention interaction) pathways.

Gender differences in smoking: A longitudinal study of beliefs predicting smoking in 11–15 year olds

This longitudinal study investigated differences in beliefs and perceived behavioural control between smokers and non-smokers in a large sample of adolescents. Positive and negative instrumental beliefs, normative beliefs, perceived behavioural control (PBC) and smoking status were assessed in the same participants at 11, 13 and 15 years of age. Prospective analyses among non-smokers revealed that for boys, negative instrumental beliefs in non-smokers at age 11 predicted smoking at age 15 years. For girls, normative beliefs and PBC in non-smokers at age 11 predicted smoking status at age 13; normative beliefs at age 11 predicted smoking at age 15; and positive instrumental beliefs and normative beliefs at age 13 predicted smoking status at age 15. Cross-sectional data revealed that smokers were significantly more likely than non-smokers to endorse positive instrumental beliefs, less likely to agree with negative instrumental belief items, more likely than non-smokers to perceive social pressure to smoke, and less likely to report control over smoking, and that female smokers reported less control over smoking and fewer negative instrumental beliefs than all other groups including male smokers at age 13. The need for belief-based preventative interventions that are age- and gender-relevant is discussed.

Appearance concerns and smoking in young men and women: going beyond weight control

Aim: This study was designed to investigate the link between appearance concerns and smoking in young men and women. Methods: A total of 244, 17–34-year-olds completed the Multidimensional Body-Self Relations Questionnaire Appearance Sub-Scales (MBSRQ-AS). Findings: Smokers scored significantly lower than non-smokers on appearance evaluation and appearance evaluation predicted smoking status in both men and women. Overweight preoccupation, self-classified weight and appearance orientation did not predict smoking status for either gender. Conclusions: It is concluded that smoking cessation interventions need to target general concerns about appearance in addition to concerns over weight control, and that campaigns focused around appearance concerns need to be targeted towards men as well as women.

The Potential of ICT in supporting Domiciliary Care in England

The report begins with a brief overview of the social care system in England, providing in particular evidence about unpaid carers (mostly family members, but sometimes friends or neighbours) and the paid home care workers, who support older, sick or disabled people of all ages in their own homes. The variety of ways in which ICT (including telecare) has begun to be used to support those involved in providing domiciliary care is then described, highlighting both major publicly-funded initiatives and investments, and some of the approaches embraced by voluntary and private sector organisations. Eight concise case studies are provided to illustrate more in depth the range of different ways in which these new developments are contributing to the support available to carers and care workers, including through online dialogue and debate among carers. The last part of the report addresses the particular focus on immigrant and ethnic minority carers and care workers, presenting some evidence from the range of available statistical data on this topic (and notes the limitations of the available statistics). Finally, the authors offer some conclusions and cautious recommendations.

Citizen Carer : Carer's allowance and conceptualisations of UK citizenship

Carers make a considerable contribution to the health and social care of sick or disabled people, reducing the strain on health and social care systems. This has been recognised through support mechanisms, including (in the UK) a payment for caring (Carers Allowance – CA). This article draws upon data from a study of carers receiving CA. Utilising a citizenship perspective, it examines respondents’ perspectives on their role in the UK and shows how CA provides not only financial support but also contributes to normative conceptualisations of citizenship. The data highlight the primacy of paid work in UK citizenship, as well as the stigma associated with receiving welfare benefits. The article concludes by claiming that changes to the UK benefit system need to take into account a ‘recognition’ aspect, reformulating what is considered a worthwhile contribution to society.

Researching telecare: the importance of context

Purpose The purpose of this paper is to present a research method which offers insights into the factors which affect the optimal use and implementation of telecare, or which may lead to its rejection by older people with support needs – factors pertinent to those involved in the design and delivery of both telecare research studies and of services. Design/methodology/approach The methodology outlined, influenced by Chicago School and Science and Technology Studies, emphasises the importance of context when examining social phenomena, such as the use of technology. The multi-method approach identified key patterns which provide insights into how telecare was used by a sample of older adults, including information on its suboptimal use and rejection. Findings The study of telecare use in real-life situations – and the investigation of other complex social interventions – requires an approach which fully considers the importance of context in explaining social phenomena. The main value of the method and findings lies in the insights offered to designers of larger studies which seek to generalise results, including telecare randomised control trials, as well as for those involved in the delivery of telecare services to achieve optimal adoption and use. Originality/value The study methods described combined ethnographic, longitudinal and qualitative methodologies and creative research tools in an innovative way to allow exploration of how context affects the uptake and use of telecare.

Developing a framework for gathering and using service user experiences to improve integrated health and social care: the SUFFICE framework.

BackgroundMore people than ever receive care and support from health and social care services. Initiatives to integrate the work of health and social care staff have increased rapidly across the UK but relatively little has been done to chart and improve their impact on service users. Our aim was to develop a framework for gathering and using service user feedback to improve integrated health and social care in one locality in the North of England.MethodsWe used published literature and interviews with health and social care managers to determine the expected service user experiences of local community-based integrated teams and the ways in which team members were expected to work together. We used the results to devise qualitative data collection and analysis tools for gathering and analyzing service user feedback. We used developmental evaluation and service improvement methodologies to devise a procedure for developing service improvement plans.FindingsWe identified six expected service user experiences of integrated care and 15 activities that health and social care teams were expected to undertake. We used these to develop logic models and tools for collecting and analysing service user experiences. These include a narrative interview schedule, a plan for analyzing data, and a method for synthesizing the results into a composite ‘story’. We devised a structured service improvement procedure which involves teams of health and social care staff listening to a composite service user story, identifying how their actions as a team may have contributed to the story and developing a service improvement plan.ConclusionsThis framework aims to put service user experiences at the heart of efforts to improve integration. It has been developed in collaboration with National Health Service (NHS) and Social Care managers. We expect it to be useful for evaluating and improving integrated care initiatives elsewhere.