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Open Veldheer Dissertation-Final-3 The Pennsylvania State University The Graduate School School of Behavioral Sciences and Education WHAT HAVE LOW INCOME SMOKERS LEARNED FROM A LIFETIME OF EXPOSURE TO PUBLIC HEALTH PEDAGOGY? A NARRATIVE INQURY A Dissertation in Lifelong Learning and Adult Education by Susan J. Veldheer © 2018 Susan J. Veldheer Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Education May 2018 ii The dissertation of Susan J. Veldheer was reviewed and approved* by the following: Robin Redmon Wright Associate Professor of Lifelong Learning and Adult Education Dissertation Advisor Chair of Committee Karin Sprow Forté Assistant Professor of Teaching, Lifelong Learning, and Adult Education Jonathan Foulds Professor of Public Health Sciences and Psychiatry Eugene J. Lengerich Professor of Public Health Sciences Elizabeth J. Tisdell Professor-In-Charge, Lifelong Learning and Adult Education *Signatures are on file in the Graduate School. iii ABSTRACT Though the prevalence of smoking continues to decline overall each year, in segments of the population, such as those with low income or low education levels, the prevalence of smoking is almost double that of the general population. The slower rates of decline in these groups are possibly due to the unexpected ways that public health messages are received, understood, and assimilated into the lives of individuals in these groups. This qualitative study used narrative inquiry methods to understand what 15 low income smokers with less than a bachelor’s degree have learned from a lifetime of exposure to public health pedagogical messages and how this learning may have contributed to their smoking behavior. This study was informed by critical theory which assumes that power and influence within society are unequally distributed, and experiential learning and public pedagogy which consider what people learn from public sites. Data were analyzed by using the constant comparative method to code the data into themes and by re-storying the participant narratives. The findings from this study suggest, for the most part, participants were accepting of many public health pedagogies including things such as indoor smoking bans and paying more in cigarette taxes, and they were willing to comply with most messages. However, some of the messages that participants’ received from public health pedagogies and public health professionals were received in unintended ways. Most importantly, they had negative or mis- educative experiences that caused them to either doubt, resist, or rebel. Finally, some experiences prompted participants to distrust public health professionals who they perceived as having power in society and who they felt were treating them unfairly, judging them, or providing them with suboptimal care. Many mis-educative experiences revolved around failing iv to successfully quit smoking and the participants did not identify any public health pedagogies that challenged these mis-educative experiences. This study makes a contribution to the growing body of public pedagogy literature by suggesting that learning does occur through public sites and that personal experiences can either lead to confirmation or resistance to messages individuals receive. The findings also suggest that public health professionals should work to restore the trust of smokers while also exploring new public pedagogical messages designed to challenge the mis-educative quitting experiences that smokers have accumulated throughout their lives. v Table of Contents List of Figures ............................................................................................................................... xi List of Tables ............................................................................................................................... xii Acknowledgements .................................................................................................................... xiii CHAPTER 1 .................................................................................................................................. 1 Background of the Problem .................................................................................................. 3 Traditional Public Health Intervention Evaluation ........................................................... 6 Experiential Learning Theory and Public Pedagogy ......................................................... 7 Theoretical Framework ................................................................................................................ 9 Experiential Learning and Public Pedagogy ..................................................................... 10 Critical Theory ..................................................................................................................... 13 Research Problem, Purpose, and Questions...................................................................... 14 Methodology Overview ............................................................................................................... 16 Significance .................................................................................................................................. 18 Assumptions ................................................................................................................................ 20 Definition of Terms .............................................................................................................. 21 Chapter 1 Summary ............................................................................................................ 23 CHAPTER 2 ................................................................................................................................ 25 Review of the Literature ............................................................................................................. 25 Goals and Objectives of the Project .......................................................................................... 26 Historical Evolution of Public Health ....................................................................................... 27 The Structure of Public Health .......................................................................................... 28 Tobacco Regulatory Science as Public Health .................................................................. 29 vi Traditional Public Health Communication Theories and Philosophies ......................... 31 Theoretical Framework ....................................................................................................... 35 Critical Theory ..................................................................................................................... 36 Experiential Learning ......................................................................................................... 42 Public Pedagogy ................................................................................................................... 46 History of Tobacco-related Public Pedagogy ........................................................................... 59 Literature Review Method .................................................................................................. 66 Review of the Literature: Public Health Pedagogy ................................................................. 68 Dominant Societal Discourse: Laws, Regulations, and Litigation .................................. 68 Informal Institutions and Public Spaces ............................................................................ 78 Mass Media Campaigns and Popular Culture .................................................................. 78 Public Intellectualism .......................................................................................................... 83 Research Gaps ............................................................................................................................. 85 Implications for Field of Adult Education ................................................................................ 86 Implications for Public Health and Tobacco Regulatory Science .......................................... 87 Chapter 2 Summary ................................................................................................................... 88 CHAPTER 3 ................................................................................................................................ 89 Methodology ......................................................................................................................... 89 Research Paradigm: Qualitative Research ....................................................................... 90 Narrative Inquiry ................................................................................................................. 93 Background of the Researcher ........................................................................................... 98 Detailed Study Methods ........................................................................................................... 101 Participant Selection and Recruitment ............................................................................ 101 vii Exclusion Criteria ..................................................................................................................... 103 Recruitment .......................................................................................................................
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