Judith Bush

Understanding influences on smoking in Bangladeshi and Pakistani adults: community based, qualitative study

Abstract Objective: To gain detailed understanding of influences on smoking behaviour in Bangladeshi and Pakistani communities in the United Kingdom to inform the development of effective and culturally acceptable smoking cessation interventions. Design: Qualitative study using community participatory methods, purposeful sampling, one to one interviews, focus groups, and a grounded approach to data generation and analysis. Setting: Newcastle upon Tyne, during 2000-2. Participants: 87 men and 54 women aged 18–80 years, smokers and non-smokers, from the Bangladeshi and Pakistani communities. Results: Four dominant, highly inter-related themes had an important influence on smoking attitudes and behaviour: gender, age, religion, and tradition. Smoking was a widely accepted practice in Pakistani, and particularly Bangladeshi, men and was associated with socialising, sharing, and male identity. Among women, smoking was associated with stigma and shame. Smoking in women is often hidden from family members. Peer pressure was an important influence on smoking behaviour in younger people, who tended to hide their smoking from elders. There were varied and conflicting interpretations of how acceptable smoking is within the Muslim religion. Tradition, culture, and the family played an important role in nurturing and cultivating norms and values around smoking. Conclusion: Although there are some culturally specific contexts for smoking behaviour in Bangladeshi and Pakistani adults—notably the influence of gender and religion—there are also strong similarities with white people, particularly among younger adults. Themes identified should help to inform the development and appropriate targeting of smoking cessation interventions. What is already known on this topic Smoking is common among Bangladeshi and Pakistani men in Britain but rare among the women Smoking is particularly common in Bangladeshi men Socioeconomic status is thought to influence smoking uptake in Bangladeshi men Influences on smoking in South Asians in Britain are poorly understood What this study adds Smoking among Pakistani and Bangladeshi men is strongly seen as socially acceptable—a “normal” part of being a man Smoking in Bangladeshi men is more deeply socially ingrained than in Pakistanis, contributing to group cohesion and identity Smoking in Bangladeshi and Pakistani women is associated with a strong sense of cultural taboo, stigma, and non-acceptance Islam forbids addiction and intoxicants, but opinions differ on whether the Muslim religion allows smoking Culturally sensitive smoking cessation interventions for Bangladeshis and Pakistanis are needed

Physical activity in pregnancy: a qualitative study of the beliefs of overweight and obese pregnant women

BackgroundWhilst there has been increasing research interest in interventions which promote physical activity during pregnancy few studies have yielded detailed insights into the views and experiences of overweight and obese pregnant women themselves. The qualitative study described in this paper aimed to: (i) explore the views and experiences of overweight and obese pregnant women; and (ii) inform interventions which could promote the adoption of physical activity during pregnancy.MethodsThe study was framed by a combined Subtle Realism and Theory of Planned Behaviour (TPB) approach. This enabled us to examine the hypothetical pathway between beliefs and physical activity intentions within the context of day to day life. The study sample for the qualitative study was chosen by stratified, purposive sampling from a previous study of physical activity measurements in pregnancy. Research participants for the current study were recruited on the basis of Body Mass Index (BMI) at booking and parity. Semi-structured, in-depth interviews were conducted with 14 overweight and obese pregnant women. Data analysis was undertaken using a Framework Approach and was informed by TPB.ResultsHealthy eating was often viewed as being of greater importance for the health of mother and baby than participation in physical activity. A commonly cited motivator for maintaining physical activity during pregnancy is an aid to reducing pregnancy-related weight gain. However, participants often described how they would wait until the postnatal period to try and lose weight. A wide range of barriers to physical activity during pregnancy were highlighted including both internal (physical and psychological) and external (work, family, time and environmental). The study participants also lacked access to consistent information, advice and support on the benefits of physical activity during pregnancy.ConclusionsInterventions to encourage recommended levels of physical activity in pregnancy should be accompanied by accessible and consistent information about the positive effects for mother and baby. More research is required to examine how to overcome barriers to physical activity and to understand which interventions could be most effective for overweight/obese pregnant women. Midwives should be encouraged to do more to promote activity in pregnancy.

Public views on the links between air pollution and health in Northeast England.

We investigated how public perceptions of the links between air pollution and health varied with contextual factors describing individuals and their locality. Information was collected via postal surveys on 2744 adults resident in five neighborhoods in Northeast England. Perceptions were compared by individual factors (health status, age, and gender) and locality factors (relative deprivation, proximity to industry and district-Teesside or Sunderland, with different amounts of heavy industry). There was relatively little variation in views about air pollution and health links between neighborhoods. The greatest contrasts were found when comparing those living near or further from industry and between the two districts. Any differences were related more to awareness of illness in the neighborhood thought to be affected by air pollution, rather than belief that a particular disease was linked to air pollution. Chronic illness status and age were sometimes found to be associated with perceptions of disease affected by air pollution, but gender and material deprivation were not central to differences in risk perceptions among the population studied. In understanding public perceptions about the links between air quality and health, research should focus on the characteristics of places as well as of people.

Quitting smoking and experience of smoking cessation interventions among UK Bangladeshi and Pakistani adults: the views of community members and health professionals.

Objective: To explore attitudes to quitting smoking and experience of smoking cessation among Bangladeshi and Pakistani ethnic minority communities. Design: Qualitative study using community participatory methods, purposeful sampling, interviews and focus groups, and a grounded approach to data generation and analysis. Setting: Newcastle upon Tyne, UK, 2000–2002. Participants: 53 men and 20 women aged 18–80 years, including smokers, former smokers, and smokers’ relatives, from the Bangladeshi and Pakistani communities; and eight health professionals working with these communities. Results: Motivation to quit was high but most attempts had failed. “Willpower” was the most common approach to quitting. For some, the holy month of Ramadan was used as an incentive, however few had been successful in quitting. Perceived barriers to success included being tempted by others, everyday stresses, and withdrawal symptoms. Few participants had sought advice from health services, or received cessation aids, such as nicotine replacement therapy (NRT) or buproprion. Family doctors were not viewed as accessible sources of advice on quitting. Health professionals and community members identified common barriers to accessing effective smoking cessation, including: language, religion and culture; negative attitudes to services; and lack of time and resources for professionals to develop necessary skills. Conclusions: High levels of motivation do not seem to be matched by effective interventions or successful attempts to quit smoking among Bangladeshi and Pakistani adults in the UK. There is a need to adapt and test effective smoking cessation interventions to make them culturally acceptable to ethnic minority communities. UK tobacco control policies need to give special attention to the needs of ethnic minority groups.

Keeping the public informed? Public negotiation of air quality information:

Air quality information has been made available to the public in the UK since 1990. However, relatively little work has been done to explore the impact of this information and the ways in which it ...

Impacts of participating in confidential enquiry panels: a qualitative study

Objective  To describe the impacts of participating in confidential enquiry panels for the Confidential Enquiry into Stillbirths and Deaths in Infancy.

Carcass disposal and siting controversy: Risk, dialogue and confrontation in the 2001 foot-and-mouth Outbreak

Abstract This paper examines controversy during the 2001 foot-and-mouth outbreak after mass carcass burial sites were selected at two sites in northeast England, and focuses on shortcomings in public consultation surrounding the carcass disposal policy. The slaughter of six million animals necessitated a national disposal strategy on a hitherto unknown scale. The belated decision to concentrate carcass disposal in a small number of mass burial sites provoked more opposition in the two ex-mining localities selected in the northeast than anywhere else. In both cases local liaison committees were established to manage dialogue between residents and public authorities. We argue that, although seen by the authorities primarily as a vehicle for risk communication and public reassurance, for residents these functioned chiefly as a vehicle for holding public authorities to account. These divergent purposes were overshadowed by the chaotic circumstances in which the early stages of the mass burial policy were implemented, and the way in which the carcass disposal policy was dictated by the operation of the slaughter policy, whose draconian form precluded any but the most cursory public consultation.

Expertise and Scientific Uncertainty: Understanding Trust Amongst Professional Stakeholders in Environment and Health

There is a substantial literature on notions of public trust in relation to risks from environmental and technological hazards. Rather less work has sought to explore trust in terms of professional interstakeholder relations in this context. Drawing on a case study for northern England, we consider dimensions of trust amongst those with a ‘professional’ involvement in the arena of environmental hazards and public health. We explore specifically the interrelated themes of scientific uncertainty and expertise, which were central to the shaping of trust relations. Against a background of indeterminacy in the scientific search for causality in environment–health relationships, the empirical work on which the paper is based is also set in a context of change and insecurity in organisational terms. The notion of ‘independence’ was brought into question through aspects of role demarcation while concerns about levels of expertise were superimposed with a sense of exclusion of community groups from ‘official’ environment–health debates. We argue that a simple deficit approach was being adopted on the part of salaried professionals towards community involvement in such debates.