Sarah Cunningham-Burley

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.

Epinephrine auto‐injector use in adolescents at risk of anaphylaxis: a qualitative study in Scotland, UK

Cite this as: M. Gallagher, A. Worth, S. Cunningham‐Burley and A. Sheikh, Clinical & Experimental Allergy, 2011 (41) 869–877.

Contrasting lives, contrasting views? understandings of health inequalities from children in differing social circumstances

Childrens differing socio-economic, cultural and familial circumstances and experiences are part of the pathways implicated in health and illness in adulthood. However, in the existing, mainly survey based, work childrens own voices tend to be absent and adult-defined data about health and illness accumulated. Little is known about the social and cultural processes, in childrens very different childhoods, which underpin and ultimately constitute these epidemiological findings. This paper reports findings from a qualitative study examining the socio-economic and cultural contexts of childrens lifestyles and the production of inequalities in health, carried out in a large Scottish city. Two rounds of semi-structured interviews, using a range of child-friendly techniques (photographs, drawings, vignettes), were carried out with 35 girls and boys aged 9-12 years living in two contrasting but contiguous areas, one relatively advantaged and one relatively disadvantaged. Thirty of their parents were also interviewed and community profiling and observational work undertaken. Children and parents described often starkly contrasting lives and opportunities, regularly involving material differences. However, children appeared to locate inequalities as much in relationships and social life as in material concerns; in this their direct experiences of relationships and unfairness were central to their making sense of inequality and its impact on health. Although children from both areas highlighted several different inequalities, including those related to material resources, they also spoke of the importance of control over their life world; of care and love particularly from parents; of friendship and acceptance by their peer group. Many children challenged straightforward causal explanations for future ill-health, privileging some explanations, such as psychological or lifestyle factors. The accounts of children from both areas displayed considerable resilience to and downplaying of the effects of both relationship and material inequalities; also showing how familial and personal challenges, such as bullying, divorce, learning difficulties, cut across structurally based differences.

Defining the ‘social’: towards an understanding of scientific and medical discourses on the social aspects of the new human genetics

The way in which ‘the social’ is treated in discourses about the new human genetics is an important marker of the interests and relative power of the groups it concerns. Scientists and clinicians are powerful players in such discussions and seem to be able to direct attention towards the social implications of genetics, often viewed as beneficial, rather than to the science and technology itself. This can serve to protect their cognitive authority by promoting the benefits of their work and marginalising more critical commentaries. Here, three aspects of some written accounts of the social aspects of genetics are considered: the social use and abuse of genetics; eugenics and genetic determinism; and professional responsibilities and expertise. We consider the dominant and minority discourses within these accounts and reflect on the stances taken by clinical and molecular geneticists and public health specialists. We argue that these discourses create strategic boundaries between science and society which protect scientists’ cognitive authority, but that critical leverage can nevertheless be garnered when these boundaries become blurred. This might be usefully combined with social scientists’ empirical and theoretical analyses of the new human genetics, in order to facilitate more sophisticated and inclusive policy discussions and decisions.

Public Knowledge and Public Trust

As health care applications derived from human genetics research are likely to move increasingly from ‘clinic to community’, there is growing interest not just in how patients understand and take up health-related genetic information but also in the views of the wider population, as well as a range of professional groups. In this paper, issues relating public knowledge and public trust are raised and discussed in an attempt to move forward debates about public involvement in genomic research and the role of sociologists within interdisciplinary teams. As the field of public understanding of science has developed, we have seen a shift from a focus on the lack of scientific literacy as problem to a recognition of the range of different knowledges that people have and use as they confront science and technology in their everyday lives. As a mood for dialogue pervades many institutions in their relations with ‘publics’, attention must now be paid to the way in which knowledge and expertise is expressed, heard and acted upon in dialogic encounters. There is increasing concern about public trust in science and calls to increase public confidence, particularly through more open engagement with a range of publics. However, lack of trust or loss of confidence may be constructed as problems rather than reflecting empirical reality, where more complex relationships and attitudes prevail. Lack of trust is often privatized, deeply rooted in lived experience and routinely managed. Trust relations are generally characterized by ambivalence, uncertainty and risk, and are always provisional. Drawing on selected literature and empirical research to review and illustrate this field, this paper argues that scepticism or ambivalence on the part of publics are not necessarily problems to be overcome in the interest of scientific progress, but rather should be mobilized to enhance open and public debates about the nature and direction of genomics research, medicine, and the related social and ethical issues. Just as there can be no resolute expression of public knowledge or public opinion, it is unlikely that there is a resolute expression of public trust in genomics. However, ambivalence and scepticism can be harnessed as powerful resource for change, whether through the mobilization of public knowledges or the development of greater reflexivity within scientific institutions. This demands a sharing of power and greater public involvement in the early stages of policy formation and scientific and medical agenda setting.

Young people, biographical narratives and the life grid: young people’s accounts of parental substance use

Research into potentially sensitive issues with young people presents numerous methodological and ethical challenges. While recent studies have highlighted the advantages of task-based activities in research with young people, the literature on life history research provides few suggestions as to effective and appropriate research tools for encouraging young people to tell their stories. This article explores the contribution that may be made to such research by the life grid, a visual tool for mapping important life events against the passage of time and prompting wide-ranging discussion. Critical advantages of the life grid in qualitative research include: its visual element, which can help to engage interviewer and interviewee in a process of constructing and reflecting on a concrete life history record; its role in creating a more relaxed research encounter supportive of the respondent’s ‘voice’; and facilitating the discussion of sensitive issues. In addition, the way in which use of the grid anchors such narratives in accounts of everyday life, often revealing interesting tensions, is explored. These points are discussed with reference to an exploratory study of young people’s experience of parental substance use.

Mapping the New Molecular Landscape: Social Dimensions of Epigenetics

Epigenetics is the study of changes in gene expression caused by mechanisms other than changes in the DNA itself. The field is rapidly growing and being widely promoted, attracting attention in diverse arenas. These include those of the social sciences, where some researchers have been encouraged by the resonance between imaginaries of development within epigenetics and social theory. Yet, sustained attention from science and technology studies (STS) scholars to epigenetics and the praxis it propels has been lacking. In this article, we reflexively consider some of the ways in which epigenetics is being constructed as an area of biomedical novelty and discuss the content and logics underlying the ambivalent promises being made by scientists working in this area. We then reflect on the scope, limits and future of engagements between epigenetics and the social sciences. Our discussion is situated within wider literatures on biomedicine and society, the politics of “interventionist STS”, and on the problems of “caseness” within empirical social science.

Mapping the New Molecular Landscape

Epigenetics is the study of changes in gene expression caused by mechanisms other than changes in the DNA itself. The field is rapidly growing and being widely promoted, attracting attention in diverse arenas. These include those of the social sciences, where some researchers have been encouraged by the resonance between imaginaries of development within epigenetics and social theory. Yet, sustained attention from science and technology studies (STS) scholars to epigenetics and the praxis it propels has been lacking. In this article, we reflexively consider some of the ways in which epigenetics is being constructed as an area of biomedical novelty and discuss the content and logics underlying the ambivalent promises being made by scientists working in this area. We then reflect on the scope, limits and future of engagements between epigenetics and the social sciences. Our discussion is situated within wider literatures on biomedicine and society, the politics of “interventionist STS”, and on the problems of “caseness” within empirical social science.

Generation Scotland: consulting publics and specialists at an early stage in a genetic database's development

A preliminary consultation about Scotlands first family-based, population DNA database (Generation Scotland) involved 10 focus groups with diverse publics and a series of 17 interviews with key stakeholders in various locations in Scotland throughout 2003/2004. Unlike similar consultations on genetic databases, this took place at the concept phase of the proposed genetic research. We report on the specific concerns that arose around participation, access, use, feedback and public consultation. Broadly, we find differences between specialists and focus groups are mostly of degree and not of kind, although the specialists were more confident in some areas (e.g. governance). Given the salient and recurring nature of these issues when compared with the UK Biobank consultations, for example, we suggest that the efforts to consult have not been matched with equal effort on policy or institutional response. So, following from this, we offer compelling reasons for introducing more robust legislation and regulation.

Smokers’ and ex-smokers’ understanding of electronic cigarettes: a qualitative study

Objective To explore among a diverse range of smokers and recent ex-smokers, particularly those from disadvantaged groups, how nicotine-containing products, particularly electronic cigarettes (e-cigarettes), are understood and experienced. Methods Qualitative study of 64 smokers and ex-smokers in Central Scotland. Twelve focus groups and 11 individual interviews were carried out with a range of purposively selected groups. Results Nicotine replacement therapies and e-cigarettes were regarded as being very different products. Nicotine replacement therapies were viewed as medical products for smokers who want to quit, while e-cigarettes emerged as an ambiguous product whose meanings are still being negotiated. Participants’ attitudes and intentions about smoking and quitting were especially important in shaping their understanding of these products. Four main interpretations of e-cigarettes were identified: a more satisfying replacement for smoking, an ambiguous but potentially useful device, a less desirable cigarette and a threat to smoking cessation. The acceptability of continued nicotine addiction and the similarity of e-cigarettes to conventional cigarettes were central themes on which participants held conflicting views. There was considerable uncertainty among participants around the constituents and safety of e-cigarettes. Conclusions Different groups of smokers bring diverse expectations, requirements and concerns to their evaluations and therefore to the potential use of nicotine-containing products. The ambiguity around e-cigarettes in public health debates and medical practice is reflected in the positions and concerns of smokers. There is a need for both clear, up-to-date trustworthy information about their benefits and risks, and stronger regulation.