Lucy McCullough

Preventing Smoking in Young People: A Systematic Review of the Impact of Access Interventions

Aims: To examine existing evidence on the effectiveness of interventions that are designed to prevent the illegal sale of tobacco to young people. The review considers specific sub-questions related to the factors that might influence effectiveness, any differential effects for different sub-populations of youth, and barriers and facilitators to implementation. Methods: A review of studies on the impact of interventions on young people under the age of 18 was conducted. It included interventions that were designed to prevent the illegal sale of tobacco to children and young people. The review was conducted in July 2007, and included 20 papers on access restriction studies. The quality of the papers was assessed and the relevant data was extracted. Results: The evidence obtained from the review indicates that access restriction interventions may produce significant reductions in the rate of illegal tobacco sales to youth. However, lack of enforcement and the ability of youth to acquire cigarettes from social sources may undermine the effectiveness of these interventions. Conclusions: When access interventions are applied in a comprehensive manner, they can affect young people’s access to tobacco. However, further research is required to examine the effects of access restriction interventions on young people’s smoking behaviour.

Substance use by women using domestic violence shelters.

This study investigated the connections between stressors, substance use, and experience of violence among women (N = 125) who accessed help from domestic violence shelters in British Columbia, Canada between October 2001 and June 2003. Changes in substance use and stressors following a shelter stay were explored, using both qualitative and quantitative methods. Women generally decreased their use of alcohol and stimulants, and this change was found to be integrally connected to social and structural supports made available to them. Future research that augments current stress models of addiction by considering social and structural factors that come into play in womens substance use and domestic violence is suggested. The studys limitations are noted.

Agency lost and recovered: A social constructionist approach to smoking addiction and recovery

Deterministic, disease models of addiction assume human agency is co-opted by a biologically-driven compulsion to engage in the addictive behaviour. A central tenet of counselling, on the other hand, is that clients are agents of their own change [Beatch, R., Bedi, R.P., Cave, D., Domene, J.F., Harris, G.E., Haverkamp, B.E., & Mikhail, A.-M. 2009. Counselling psychology in a Canadian context: Report from the executive committee for a Canadian understanding of counselling psychology. Ottawa, Ontario: Counselling Psychology Section of the Canadian Psychological Association. Retrieved from http://www.cpa.ca/cpasite/userfiles/Documents/sections/counselling/CPA-CNPSY-Report-Final%20nov%2009.pdf]. Our essay explores this agency divide between theory and practice, and proposes that attention to agentic language [Davies, J.B. (1997). Drugspeak: The analysis of drug discourse. London: Informa Health Care; Wittgenstein, L. (1968). Notes for lectures on “private experience” and “sense data”. The Philosophical Review, 77, 275–320; Zidjaly, N. (2009). Agency as an interactive achievement. Language in Society, 38, 177–200] and use of discursive therapy techniques (e.g. narrative therapy, [White, M., & Epston, D. (1990). Narrative means to therapeutic ends. New York, NY: W.W. Norton]) from a social constructionist perspective [Burr, V. (2003). Social constructionism (2nd ed.). New York, NY: Routledge; Burr, V. (1995). An introduction to social constructionism. London: Routledge; Gergen, K.J. (1994). Realities and relationships: Soundings in social constructionism. Cambridge, MA: Harvard University Press]) can help reconcile the agency divide. Agency is conditionally defined as the biologically and socio-culturally-mediated capacity to act [Ahearn, L.M. (2001). Why agency now? Annual Review of Anthropology, 30, 109–137]. Furthermore, all human action has a reciprocal relationship in shaping, enacting and responding to our biological substrates and socio-cultural context. Brief narratives from smokers are presented and analysed within the anti-smoking policy environment where they live. Smokers claim agency for themselves as they make personal meaning of their smoking, and disclaim agency as they submit to dominant explanations of smoking as an addiction or a disease. These agentic turns can be found in how the smokers talk about addiction. This spectrum of responsible agency appears to be mediated by social expectations and context. The smokers’ narratives are used as a springboard to (1) further explicate a social constructionist approach to the agency paradox in addiction and (2) to show how counsellors may listen for agentic language and use discursive therapeutic approaches in treating addiction.

Physician advice for smoking cessation in primary care: time for a paradigm shift?

General practitioners are often exhorted to routinely counsel patients who smoke about quitting in light of current evidence-based medicine (EBM) guidelines suggesting that such brief interventions provide an easy and effective way of increasing quit rates. Drawing on semi-structured interviews conducted with 25 smokers and 10 general practitioners (GPs) in British Columbia, Canada, this article explores smokers’ and GPs’ perspectives on smoking cessation interventions in primary care settings. Study findings indicate that both patients and GPs believe smoking is best broached when it is patient-initiated or raised in the context of smoking-related health issues, and there was a broader consensus that the role of doctors is to provide education and information rather than coercing smokers to quit. However, smokers wanted further recognition of the difficulties of quitting smoking and many questioned the competence of GPs to deal with addiction-related issues. Similar barriers to smoking cessation were raised by smokers and GPs – primarily inadequate time and resources. Based on these findings, we argue that the assumption that primary care consultations provide an important venue for encouraging smokers to quit deserves reconsideration based on the complexity of this issue, the circumstances in which most GPs practice, and the danger of alienating smokers. Questions are raised about whether current EBM guidelines are an adequate tool for guiding individual clinical interactions between GPs and smokers.