Open access Research BMJ Open: first published as 10.1136/bmjopen-2018-023951 on 31 December 2018. Downloaded from “Tell them you smoke, you’ll get more breaks”: a qualitative study of occupational and social contexts of young adult smoking in Scotland Hannah Delaney,1 Andrew MacGregor,1 Amanda Amos2 To cite: Delaney H, ABSTRACT Strengths and limitations of this study MacGregor A, Amos A. “Tell Objective To explore young adults’ perceptions and them you smoke, you’ll get experiences of smoking and their smoking trajectories in ► This is one of the few qualitative studies to explore more breaks”: a qualitative the context of their social and occupational histories and study of occupational and smoking uptake and trajectories in British young transitions, in a country with advanced tobacco control. social contexts of young adult adults. Design Indepth qualitative interviews using day and smoking in Scotland. BMJ Open ► We recruited young adults aged 20–24 years old life grids to explore participants’ smoking behaviour and 2018;8:e023951. doi:10.1136/ with diverse smoking histories, and educational and trajectories in relation to their educational, occupational bmjopen-2018-023951 occupational trajectories. and social histories and transitions. ► The indepth interviews used both day and life grids ► Prepublication history and Setting Scotland. additional material for this to explore current and previous smoking patterns Participants Fifteen ever-smokers aged 20–24 years old paper are available online. To in relation to social, occupational and educational in 2016–2017. view these files, please visit contexts. Results Participants had varied and complex educational/ the journal online (http:// dx. doi. ► As has been found in previous studies, recruiting a employment histories. Becoming and/or remaining org/ 10. 1136/ bmjopen- 2018- purposive sample in this age group was challeng- a smoker was often related to social context and 023951). ing. The time between taking part in the Scottish educational/occupational transitions. In several contexts Health Surveys and the qualitative interviews was Received 9 May 2018 smoking and becoming a smoker had perceived benefits. 1–3 years, increasing the likelihood of changed ad- Revised 17 October 2018 These included getting work breaks and dealing with dresses and phone numbers. Accepted 29 October 2018 stress and boredom, which were common in the low-paid, unskilled jobs undertaken by participants. In some social http://bmjopen.bmj.com/ contexts smoking was used as a marker of time out and reducing the social acceptability of smoking sociability. (smokefree public places and cars).1 These Conclusions The findings indicate that while increased tobacco control, including smokefree policies, and social measures have significantly impacted on disapproval of smoking discourage smoking uptake and youth smoking. Smoking prevalence in Scot- increase motivations to quit among young adults, in tish 15-year-olds halved between 2008 and 2 some social and occupational contexts smoking still has 2015, from 15% to 7%. 3 perceived benefits. This finding helps explain why smoking However, as in many countries, smoking uptake continues into the mid-20s. It also highlights uptake in the UK continues into the mid-20s. on September 29, 2021 by guest. Protected copyright. the importance of policies that reduce the perceived Also the decline in smoking among those desirability of smoking and that create more positive aged 16–24 years old has been less than in working environments for young adults which address the younger age groups, from 28% in 2008 to types of working hours and conditions that may encourage 21% in 2016 in Scotland.4 This age group is smoking. highlighted in the Scottish Tobacco Control 5 6 © Author(s) (or their Strategy and in the English Tobacco Plan as employer(s)) 2018. Re-use being of concern, as over a third of smokers permitted under CC BY. INTRODUCTIOn aged 16–24 years old started smoking at age Published by BMJ. Reducing smoking uptake is a key goal of 16 or over.5 Similarly, a US longitudinal study 1ScotCen Social Research, tobacco control strategies. In the UK recent found that 18% of ever-smokers under 30 Edinburgh, UK 7 2Usher Institute of Population governmental action has included reducing years started smoking between 18 and 21, and Health Sciences and Informatics, tobacco promotion (banning point-of-sale in the European Union 41% of ever-smokers The University of Edinburgh, displays; standardised packaging), reducing started regular (weekly) smoking between 18 Edinburgh, UK cigarettes’ affordability (taxation, banning and 25.3 Understanding the smoking beliefs, Correspondence to small packs) and availability (increasing age behaviour and social contexts of young adults Professor Amanda Amos; of sale), increasing awareness of health risks is vital for developing effective strategies to Amanda. Amos@ ed. ac. uk (media campaigns, health warnings), and reduce smoking in this key age group. Delaney H, et al. BMJ Open 2018;8:e023951. doi:10.1136/bmjopen-2018-023951 1 Open access BMJ Open: first published as 10.1136/bmjopen-2018-023951 on 31 December 2018. Downloaded from Young adulthood can be a time of increased autonomy 16–24 years old in Scotland. It aimed to explore, through and freedom to explore different identities and indepth interviews, young adults’ perceptions and expe- behaviours before more stable roles and responsibilities riences of smoking, and smoking trajectories, in the in later adult life.8 Young adults often move in and out context of their social and occupational histories/transi- of smoking,9 and health behaviours can be taken up, tions. It also aimed to increase our understanding of why, consolidated or abandoned.10 11 This period of fluidity in a country with the most advanced tobacco control in presents an opportunity to prevent never smokers or Europe,29 smoking uptake continues into the mid-20s. those who regard themselves as ‘social’ smokers from becoming regular smokers, and to encourage smokers to quit.12–14 Qualitative studies have found that identity METHODS construction and presentation of self, which Goffman15 This paper presents the qualitative findings from a conceptualised as staging a performance that is expected mixed-methods study involving (1) secondary analysis of in certain situations and that is credited with desired the 2012–2015 annual Scottish Health Surveys (SHeS)4 attributes by other actors in that context, are important examining smoking young adults aged 16–24 years old by in understanding young adults’ smoking.16–21 The tran- sociodemographic factors and (2) qualitative interviews sitions of young adulthood, which traditionally involve with purposively selected 2014–2015 survey respondents leaving school, leaving the parental home, taking up in 2016–2017. SHeS is Scotland’s most robust national full-time employment, starting cohabitation and having data set on smoking.4 children,22 also shape smoking behaviour. Wiltshire Purposive sampling of SHeS respondents aged et al’s23 study of Scottish aged 16–19 years old highlighted 16–24 years old was undertaken to recruit participants the impact of transitions from school to work, further who had consented to be recontacted for follow-up education or unemployment on becoming and staying a research. Preliminary analysis (SHeS data set, 2012–2015) smoker. Smoking was perceived by smokers as a lubricant of the 2012–2015 survey data showed that smoking prev- for social relations and a marker of an acceptable identity alence varied by age (16% in those aged 16–19 years old in new occupational or social contexts, which reinforced vs 26% in those aged 20–24 years old) and economic and increased smoking. Studies in the USA, New Zealand activity, with those aged 20–24 years old in full-time educa- and UK have found that smoking and drinking are highly tion reporting the lowest smoking prevalence (20%), associated, particularly among young adults who typically compared with 25% in the employed and 42% in the spend more time than older adults socialising with friends NEET (Not in Education, Employment, Training) cate- in bars, clubs and at parties.14 20 21 23 24 gories. The sampling aimed to recruit a diverse sample It was expected that the UK’s smokefree legislation with differing smoking and occupational histories using might particularly impact on this age group through the following criteria: smoking status (ever-smoked), age reducing opportunities to smoke in educational, occu- at qualitative interview (20–24), gender and economic http://bmjopen.bmj.com/ pational and leisure settings, requiring smokers to go activity. Invitation letters, information sheets and consent outside to smoke, thereby disrupting the perceived forms were sent to 85 eligible SHeS respondents. social role and value of smoking in these contexts.23 This Fifteen returned consent forms and were interviewed in change has added importance for smokers who despite December 2016–April 2017. Only 13 individuals refused often high consumption levels, usually when drinking to be interviewed. Nine invitations were returned as ‘no alcohol, do not regard themselves as ‘proper’ smokers longer at this address’. In 48 cases there was no response and risk becoming regular smokers.12 13 21 25 26 Rooke to invitation letters and up to five calls and texts. Partici- 27 et al’s qualitative study of the English smokefree legisla- pants received a £20 high street voucher. on September 29, 2021 by guest. Protected copyright. tion found that