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Tobacco Roads: an Exploration of the Meaning and Situatedness of Smoking

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Tobacco Roads: an Exploration of the Meaning and Situatedness of Smoking Tobacco Roads: An Exploration of the Meaning and Situatedness of Smoking among Homeless Adult Males in Winnipeg by Michelle Bobowski A Thesis submitted to the Faculty of Graduate Studies of University of Manitoba In partial fulfillment of the requirements of the degree of MASTER OF NURSING Faculty of Nursing University of Manitoba Winnipeg, Manitoba Copyright © 2012 by Michelle Bobowski i ABSTRACT Homeless individuals are some of the most marginalized Canadians and most likely to use tobacco daily. The transient nature of homeless smokers contributes to marginalization within health care as well as tobacco control strategies. The purpose of this study was to describe acquisition and smoking behaviors of homeless individuals as a first step in developing essential research evidence to inform tobacco control strategies relevant to this vulnerable population. This ethnographic study investigated the everyday reality of 15 male homeless individuals living in the Salvation Army Shelter in Winnipeg. Tobacco use was explored against their environmental and social contexts, homeless smokers used an informal street-based economy for acquisition, and smoking behaviors were high risk for infectious diseases with sharing and smoking discarded cigarettes. Tobacco control strategies that consider homeless individuals have the potential to reduce morbidity and mortality along with diminishing inequitable health burdens with this population. ii ACKNOWLEDGMENTS I am heartily thankful to my supervisor, Dr. Annette Schultz, whose encouragement, guidance and support has taken me from my first tobacco class in 2007 to this final level of writing. Dr. Schultz you have enabled me to develop an understanding of Tobacco Control and have fostered my passion for knowing more and more about the topic of smoking. Thank you for introducing me to this vast and exciting world that has taken me to National and International Tobacco conferences, and has taken my thinking to places unimaginable. It has been an honor to present my findings at tobacco conferences knowing that you have supported my work. Thank you for allowing me to follow my curiosity to visit this uncharted topic area – original research is prized by many Master Students and I am privileged to research and learn through your vast knowledge. It is a pleasure to thank my committee who made this thesis possible, Dr. Fergusson from the Faculty of Social Work and Dr. Scruby from the Faculty of Nursing. Dr. Ferguson, Thank you for being my External Committee Member and for challenging my thinking to consider the Social Determinants of Health in Manitoba, this strengthened my research and broadened my understanding of Aboriginal Culture and my participants. Dr. Scruby, I knew from the moment I met you and discovered our commonality of Saskatchewan that a connection was made. Thank you for your support through this process from Integrative Practicum to Thesis Defense. I am overwhelmed by your kind iii approach and thoughtful emails; I appreciated our meetings and marvel at your insight into my topic and your answers to all my questions. To Lori Giles-Smith and Lenore Finlay, The U of M Librarians at the Grace General Hospital, without you this work would not be here, thank you for greeting me with smiles and providing me with books and tissues when I was teary. Thank you for finding 1000’s of articles and books for me, and I am sure you have taken care of many overdue fines unbeknownst to me. I am indebted to all my work colleagues at the Grace General Hospital who supported me; thank you for asking me over the years how is your thesis? And asking questions and maybe even feigning interest when I talked to you for hours, you offered me viewpoints that I had not considered, and often reinforced the importance of this work for Psychiatric Nursing. To the Nay-Sayers, you strengthened my study as I pleaded my position and the significance of this research. To Dee Dee Olinyk and Candice Ball-Cohen, thank you for your proofing and editing skills over the years. To my new workmates in my new role as Mental Health Nurse Educator, thank you for helping me with my transition, inviting me for coffee and Christmas Parties, and encouraging the completion of this thesis. To Dr. Scanlan, your open door to your office and your home will always be memorable. Thank you for the opportunity to work for you as your Research Assistant on multiple projects, this allowed me to build essential skills necessary to complete my thesis. Thank you for fulfilling my numerous requests for references – I got the job! You always made me feel important. iv Dr. Clarke, it is without hesitation that I thank you for the opportunity to be your Teaching Assistant and believing in my presentation skills and judgment in marking, thank you for sharing your wisdom ,advice and home – I hope one day I will be as well regarded and published as you, I will miss our lunches and discussions. Darlene Young, my transcriptionist, you captured more than the voices of the participants, you gave me their spirit on paper, and I am very grateful for the hours of time you have given me with your work. Ontario Tobacco Reduction Unit (OTRU), Thank you for the recognition of my poster at the 7th National Conference on Tobacco or Health in Toronto, November 1-3, 2011, it was a great honor to be acknowledged and rewarded with the Graduate Student Poster Award of my early findings of this research. Registered Nurses Association of Ontario (RNAO), thank you for encouraging my presentation for your Webinar with my preliminary findings, thank you for your invitation to be involved in your Smoking Cessation Best Practice Champions Network. University of Manitoba, Thank you for the Graduate Nursing Student Financial Award in 2009. To my momma, a big “todah robah” to my momma, thank you for helping me pack the snack packs for the participants, I am glad you were here and told me to go that day! I love you….and this is for you! To my Sister and Brother in-law, Valecha and Bernie, You always say that I am the smart sister, well….how come it took me 4 years? You will always be the artistic sister – now go paint and illustrate that children’s’ Cree Counting book! Bernie, thank you for listening with great interest to all my tales. v To my Beshert, my common-law, my roommate, Bryan Wallace, From the moment you said “just take one class” you should have known where this would end! Your tolerance for broken computers and sniveling, and your praise and advice on how to survive have followed me every day through this process - you were always right! No longer will you be asking “When will you be done?” – If you are reading this now honey bunny – I am done! I love you more than these words. Xoxo To Brandon, Thank you for playing your trumpet at times when I was not working, and forgoing sleepovers so that I could do my research. Now it is your turn for University! To Bryan’s Parents, thank you for always listening to my stories and the care packages and snacks. To my homeless participants in Winnipeg, thank you for your voices, may your suffering lessen each day, may you find that which you are looking for… and may you sleep well tonight, be feed well in the morning and smoke safely. With love and gratitude, Michelle Bobowski vi DEDICATION “For the dead and the living, we must bear witness” -Ellie Wiesel It is my great privilege and honor to dedicate this work to my father Yitzhak Ben- Yahtza, "May his soul be bound up in the bonds of eternal life" - who believed that I should get an education because no one could take it away. To a “Mensh” and righteous person who taught me the basis of survival and social justice which was unbeknownst to me at the time. To a man who supported those who could not for themselves, and who gave sandwiches to a homeless man. To him I owe my insight as he bought me books beyond my age, and taught me the perils and joys of the world, and who forever and a day wanted me to write a book. Baruch Hashem. vii WHERE ART MEETS SCIENCE The essence of qualitative work is immersing oneself in the world of the participant; this immersion grew from my experiences of working with psychiatric patients in a hospital setting. In reflecting on the meaning of smoking for this population I have composed the following poem: Tobacco Butt Garden Tobacco butt garden you live outside the door, Located at the Grace Hospital on the psych ward. Cancer stick garden you litter the lawn, We say goodbye to the tulips they are forever gone. It is a gift without a card from an anonymous donor, A partially smoked butt for a new owner. Dart garden you go against the rules, For a patient without smokes you are a real jewel. As a nurse I am the cigarette police, As a patient who smokes you forgo the big feast. Smoke butt garden to nurses who don’t care, You resemble a grave yard of memories and missed prayer. Cigarette garden you tell a story of chaos and strong emotion, Histories in each drag holding much devotion and commotion. Your litter is strewn on the yard with abandonment, You repulse the visitors and nurses, yet it makes you feel affluent. The nurses you disgust do not see your beauty, They ignore your presence and neglect their duty. Cig butt garden you are immune to attack, My message is clear your cigarettes are coated with bacteria plaque I paint this picture and weave this tale, To give you a fighting chance, a life with an extended time scale.
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