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RESEARCH REPORT
doi:10.1111/add.12435
Children’s resistance to parents’ smoking in the home and car: a qualitative study Neneh Rowa-Dewar1, Amanda Amos1 & Sarah Cunningham-Burley2 UK Centre for Tobacco and Alcohol Studies, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK1 and Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK2
ABSTRACT Background and Aims Reducing second-hand smoke exposure in the home is a key tobacco control goal, yet few studies have explored children’s views and experiences of this. This study aimed to explore children’s accounts of family members’ smoking in the home and car and the impact of their socio-economic circumstances. Design Individual and friendship group interviews using topic guides and visual stimulus methods. Setting Two communities in Edinburgh, Scotland, one socio-economically advantaged, one socio-economically disadvantaged. Participants Thirty-eight children aged 10–15 years who had a close family member who smoked. Measurements Focus group and interview topic guides. Findings Participants in both communities expressed a strong dislike of family members’ smoking and concern about the potential impact on the smoker’s health. Participants described overt and covert acts of resistance, including challenging relatives about their smoking, expressing disgust and concern, hiding or destroying cigarettes. Some acts were carried out in collusion with a non-smoking parent and/or sibling. Resistant acts were constrained by expectations of negative responses, which appeared to increase with age, wider social norms around smoking and whether or not the young person smoked. Conclusions Some children and young people in the United Kingdom, irrespective of socio-economic status, may actively oppose parents’ smoking in the home and car, although their influence may be limited by their position in the family and social norms. Keywords
Car, children, home, parents, qualitative, second-hand smoke.
Correspondence to: Neneh Rowa-Dewar, UK Centre for Tobacco and Alcohol Studies, Centre for Population Health Sciences, University of Edinburgh, Edinburgh EH8 9AG, UK. E-mail: [email protected] Submitted 20 August 2013; initial review completed 26 September 2013; final version accepted 25 November 2013
INTRODUCTION Mounting evidence of the health risks of exposure to second-hand smoke (SHS) has led to the adoption of smoke-free legislation in enclosed public places in many countries, including the United Kingdom [1], with consequent improvements in public health [2]. Due to their smaller airways, fast breathing rates and immature immune systems, children are more susceptible to the adverse health effects of SHS exposure [3]. These include a range of illnesses, from middle ear disease and lower respiratory tract infection, to increasing the severity of asthma and bacterial meningitis [4]. In countries with comprehensive smoke-free legislation, such as the United Kingdom, children are now most likely to be exposed to SHS in homes and cars. While smoking prevalence has declined in the United Kingdom, the decline has been greatest in © 2013 Society for the Study of Addiction
socio-economically advantaged groups, leading to increased social inequalities in smoking. Children’s exposure to SHS has also declined [5], but children from socio-economically disadvantaged households remain most at risk, reflecting higher parental smoking prevalence and fewer home smoking restrictions [5–8]. Among the most disadvantaged children, only 26.3% reported a smoke-free home and 51.7% a smoke-free family car, compared to 72% of the most advantaged children who reported a smoke-free home and 83% a smoke-free car [9]. Described as ‘the next frontier in tobacco control’ ([10], p. 1098), health promotion campaigns have targeted parents and other family members to reduce children’s SHS exposure in the home and car. Children’s inability to protect themselves from SHS has been highlighted in the literature [11]. However, studies have rarely reported children’s own perspectives on SHS. While this Addiction, 109, 645–652
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may reflect a focus upon very young children in most SHS studies, this absence can reinforce assumptions of children being passive in response to parents’ smoking and their own SHS exposure. To our knowledge, only two studies have explored children’s experiences and views on their parents’ smoking and SHS [12–15]. While conducted more than 20 years ago, Michell reports the emotive and strong feelings that Scottish 10–14-year-old children expressed about other people’s smoking [12– 14]. These highlighted their sense of injustice about being near people who smoked and concerns about the health of their family members. More recently, Woods and colleagues examined the views of children in England aged 4–8 years in a study that included focus groups and draw-and-write techniques [15]. Children in this study also reported dislike of SHS exposure and some understanding of its health risks to themselves and smokers. Younger children responded particularly negatively and emotively to being among smokers; older participants expressed more concerns about the health of the smoker and their own health. Commenting on their findings, Woods et al. [15] expressed surprise about participants’ apparent reluctance to communicate their dislike of smoking to family members and to take direct action to ‘remove themselves from the situation. Instead, they rely upon the actions of their parents to protect them from environmental tobacco smoke’. Both studies demonstrate that children dislike SHS and this can cause considerable concern, but their responses to parental smoking were unexplored. Conducted several years before the smoke-free laws in the United Kingdom (2006–07), these studies also could not capture any normative changes in how smoking and SHS is now perceived [16]. While there is a dearth of research eliciting child accounts of responses to family smoking, studies that examine adult accounts of negotiating smoking and SHS suggest that such interactions may be underpinned by power relations [17–22]. Responses to partners’ smoking included attempts to induce guilt by highlighting child health problems, exemplifying the tensions that smoking around children can provoke and/or reflect [21,22]. Glimpses of children’s involvement in smoking negotiations exist in these studies, where parents report that children ‘nag’ them to quit [8], call them ‘smelly’ [10], or walk out of rooms when they smoke [17]. While, to some extent, adults appear to acknowledge these protests, children’s views remain indirect and peripheral in the literature. The study reported in this paper aimed to explore the accounts of children with family members who smoke to contribute children’s perspectives to existing understandings of family negotiations surrounding smoking. © 2013 Society for the Study of Addiction
The study was informed by a Childhood Studies perspective that conceptualizes children as actively shaping the world around them [23]. It also reflects recent debates on the need to develop more nuanced perspectives on child agency which challenge previous assumptions of children as vulnerable, passive and voiceless [24] through exploring the constraints placed upon children’s ability to act such as context and power [25,26]. This paper examines children’s responses to family members’ smoking and the ways in which these are constrained or facilitated in advantaged and disadvantaged communities with different smoking prevalence and norms.
METHODS Sample and recruitment The data were gathered between 2007 and 2009 by N.R.-D. from 38 participants aged 10–15 years. Participants lived in two Edinburgh communities at opposite ends of the socio-economic spectrum. The socioeconomically disadvantaged community is one of the most disadvantaged in Edinburgh, consists of mainly council housing and has high unemployment and smoking prevalence. The advantaged area is among the most advantaged in Edinburgh, and has low unemployment and smoking prevalence. Participants were recruited from local child and youth groups, 27 from the disadvantaged community and 11 from the advantaged community. Twenty-seven were girls and 11 were boys. Six were smokers. All participants were white, reflecting the predominant area ethnic composition (Table 1). Children with one or two parents who smoked were recruited initially. Recruitment from the advantaged area proved challenging, as few children said their parents smoked. Thus, in the final sample, four participants from the advantaged area and two from the disadvantaged area were recruited who had other close family members who smoked in their home.
Ethics Ethical approval was gained from the University of Edinburgh School of Health Social Science Research Ethics Committee. Potential participants were invited by N.R.-D. verbally and in writing to participate in a study about their views and experiences of ‘other people’s smoke’. Participants signed a consent form which clarified that they did not have to take part and could withdraw at any point. Parents and carers received written information about the study after their children had consented to participate and were given the option to withdraw their child, an option none took. Addiction, 109, 645–652
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Table 1 Participants’ characteristics. Age (years)
Smoking status
Participant characteristics
10–12
13–15
Smoker
Non-smoker
Girls
5 12 2 2 21
4 6 0 7 17
0 2 0 4 6
9 16 2 5 32
Boys
Advantaged Disadvantaged Advantaged Disadvantaged
Total
Data collection Participants took part in an individual interview, or a paired or group interview with their friends, depending on their choice. This resulted in three individual interviews, four paired interviews and eight groups with three or four participants. While individual interviews are often a preferred method in qualitative research [27], the experience of ‘being questioned’ can be intimidating. Providing a choice of how to participate in the study, and the presence of peers, can partially compensate the asymmetrical power balance between the adult researcher and child participant [28]. A more supportive social context is created when participants can follow each other’s leads, respond and initiate discussion with their friend(s) [29]. Interviews lasted 25–55 minutes (average 40 minutes) and included visual stimulus methods to prompt discussion. Participants were shown a drawing of parents smoking in the home in the presence of children of various ages. They were also asked to draw home floor plans indicating where and when smoking was permitted in their homes. Participants were asked about their views and experiences of parents’ and other family members’ smoking, where and when they smoked in the home and car and their own role (if any) in negotiations around smoking and smoking restrictions. Interviews were recorded digitally and transcribed verbatim. Analysis The data were analysed thematically; each transcript was read several times and coded by N.R.-D. Codes were further broken down into categories and the relationships between the categories specified further in themes [30]. Themes were discussed between co-authors and analysis was then further informed by discursive approaches to examine what participants were trying to achieve with their accounts and which discourses they drew upon. By examining participants’ stake in what they disclosed and the scripts they used, the analysis focused on the motives and allegiances participants and their parents had in © 2013 Society for the Study of Addiction
their smoking practices and the ways in which participants described appropriate behaviour and assigned responsibility or blame [31,32]. Where quoteations are used in the Results, participants are identified by a pseudonym, community (D indicating disadvantaged, A indicating advantaged), whether or not they were a smoker (s for smoker) and their age.
RESULTS Reasons for resistance Most participants from both areas expressed a strong dislike of smoking using a language of disgust; it ‘stinks’ (Julia, D11) and is ‘horrible’ (Jack, A11; Jennifer, A14) and ‘minging’ (Danielle, D15). Rather than expressing concern about their own exposure to SHS, participants framed their concerns around the health of their parents and other family members who smoked. Practices of resistance were rationalized as acts of care and protection motivated by concerns for family members’ health, although the manner in which this was expressed was subject to debate. Anna, A12: I do understand why people do it [smoke]. But shouldn’t people around them, if people are trying to stop, shouldn’t your people around you try and tell you it’s bad for you? Catriona, A13: Yeah, to support them to stop but they don’t need to be like really mean. Anna, A12: But if you do that then it’ll give them more motivation to stop! Most participants described a repertoire of both overt and covert resistance to family members’ smoking. Overt practices refer to words and deeds that directly and openly challenged family members’ smoking; covert actions refer to deeds practised in secret. A trajectory of strategies over time was evident; many participants initially reported overtly opposing family members’ smoking, proceeding to more covert strategies when unsuccessful. The Addiction, 109, 645–652
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following sections explore this common trajectory, highlighting any differences in accounts from participants from different communities. Challenging and shaming smoking and smokers Most participants recounted asking family members to stop smoking, drawing attention to the unpleasant smell and taste of SHS by wrinkling their nose and/or turning away with the expressed intention of making the person who smokes feel ‘embarrassed’, ‘bad’ and/or ‘guilty’. Rebecca and Jack said they would walk away when parents smoked, with their dismissive tone of voice and facial expression indicating that this was an overt act of disapproval. Other strategies employed included rolling down windows in the car and coughing. Participants described that purposively coughing when someone smoked was intended to induce feelings of guilt.
tomorrow’, and then I’m like, ‘But you said that yesterday, shut up’, and then I’m like ‘Aaarghh’ [laughter] . . . so like, he bought these two massive packs and I was like [puts on angry voice] ‘I’ll kill you’, and then we put them in the bin and stuff [laughter]. In contrast to Danielle’s reported short-term success, Catriona’s father’s reported reluctance to stop smoking was reflected in most accounts. As also exemplified in this quote, while heated and an apparent source of family conflict, these interactions were nevertheless recounted, and met, with laughter. The comic effect may be due to such accounts reversing the traditional expected child/ adult roles by positioning the parent as a misbehaving child being told off. Humour also appeared to be a way to defuse any tension.
Mediating smoking risk messages N.R.-D.: And what does [your Dad] do when you were saying how you pretend to cough when he smokes, what does he do then? Jack, A11: He continues but . . . he looks guilty [laughter]. Referred to more frequently than covert practices, direct requests to stop smoking were often described as protests borne out of frustration with family members’ disregard of the health risks. Several participants from both communities described persistent attempts to persuade their parents to stop smoking. Such persistent ‘wearing down’ of the person who smoked was sometimes reputedly rewarded by short-term quit attempts. Danielle, D15: I asked my dad [to stop] and he stopped for six months and then he started again. [He stopped] ‘cause we kept on asking them for every week. He’d say, ‘What’, and I’d say ‘Stop smoking’ and he’d be like, ‘Fine then’ . . . like everyday [we used to say], ‘Stop smoking’. Some participants distinguished between forcefully resisting smoking and smokers. For instance, Catriona objected to the unambiguous attempts to induce guilt and embarrassment in those who smoke detailed by the other participants. Emma, A12: I just wrinkle my nose and turn away. Catriona, A13: But that’ll make them feel bad! Anna, A12: That’s the point! Emma, A12: I don’t want the smoke! While apparently reluctant to shame and induce guilt in people, Catriona later recounts her anger and frustration with her father’s empty promises to quit. Catriona, A13: [Dad] goes ‘I’ll quit tomorrow’, right? And then tomorrow comes and he says ‘I said I’ll quit © 2013 Society for the Study of Addiction
Other verbal practices of resistance underscored the way in which participants mediated smoking risk information received at school and in media campaigns. Drawing upon negative health messages, some participants said they selected the most repellent or memorable statements and passed these on to smoking family members in the hope of persuading them to stop smoking. N.R.-D.: Have you ever asked your sister not to smoke? Melissa, A12: Yeah I told her about how bad it is for you and she stopped for a while, and she like . . . started again. N.R.-D.: Yeah, and what did you tell her? Melissa, A12: After we got that talk in school [looking at the others in the group] I told her all the stuff that was in them and she stopped . . . but she started again. Catherine, A13: We got told that every cigarette that you smoke takes away 11 minutes of your life, apparently. Melissa, A12: And there’s sewage and stuff in them [pulling face]. Catherine, A13: Yeah, I told my uncle that one. Didn’t work! [laughter]. Attempts to stop parents and others from smoking were constructed as a responsible and knowledgeable response to smoking risk by most participants, but smoking risk messages received in school could also prompt anxiety. For example, Jennifer (A14), said she wanted her mother to quit smoking as ‘it just would have such a huge effect on us if she died’. Conversely, a lack of concern for someone who smoked was linked to a lack of resistant practices. For example, Anna (A12) stated that she did not resist her stepmother’s smoking as she hated her and ‘wouldn’t care if she got cancer’. While particularly strong, this Addiction, 109, 645–652
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view points to the same justification: resistance is linked to caring for someone.
about her mother’s smoking but suggested that some were getting less ‘acceptable’ as she got older:
Colluding with parents and siblings Several of the participants in the advantaged area described joint acts of resistance with their non-smoking parent to exert pressure on the smoking parent to stop smoking or stop smoking around family members. A nonsmoking parent appeared to lend weight to participants’ negotiation strategies by making them more radical and, perhaps, effective, as in Jack’s account:
Jennifer, A14: This is going to sound really bad but I shout at her. Quite a lot. And I snap her cigarettes, and I hide them. I’ve even poured water on them once. N.R.-D.: What happens then? Jennifer, A14: She goes, ‘STOP that’ and gets angry, too. I get into too much trouble now as I should know better at my age so I get my sister to do it, she’s 7 so she doesn’t get into as much trouble for snapping cigarettes. I tell her where she keeps them and tell her to hide them.
Jack, A11: My Dad [smokes in the house] but always in the utility room by the back door. We make him [laughter]! N.R.-D.: [laughter] you make him? How did you do that? Jack, A11: Yeah ’cause he used to smoke in the bathroom so we fitted a smoke alarm.
Several participants from the disadvantaged area also described involving younger siblings in covert acts in order to avoid an adverse family member reaction, either by blaming them when discovered or encouraging them to participate, suggesting overt acts appeared less acceptable in older children.
In contrast, most participants in the disadvantaged area had either single parents or two parents who smoked and often grandparents who smoked too. A few of these participants [and Jennifer (A14) in the following section], however, talked about colluding with siblings against smoking parents asking them to stop smoking or hiding their cigarettes. Subverting parental power in secret Secret deeds to subvert adult or parent power in small ways were described frequently in both communities. These covert acts included a commonly employed strategy of secretly hiding or destroying/disposing cigarettes. Abigail, A12: I have hidden them and she asked me where they were and I was like ‘dunno’ [shrugs shoulders and smiles]. I’ve broken them. She asked me to go and get a fag from auntie [name] ‘cause she smokes too and I snapped it and then I was like, ‘Oh, it broke in my pocket’ [laughter]. Covert deeds often appeared to follow on from overt ones and were often mentioned in the context of attempts to avoid the potentially adverse consequences associated with overt deeds such as anger or punishment. For example, Julia (D11) described hiding her stepfather’s cigarette packs underneath her sister’s cot-bed. She would replace them if she thought it might be discovered to avoid an angry reaction. It is impossible to know whether or not these expectations of anger were well founded. However, participants recounted instances where their resistance provoked parental angry responses. For example, Jennifer used a range of combined overt and covert strategies to protest © 2013 Society for the Study of Addiction
Accounts of acceptance or lack of resistance Several participants from both communities did not mention words or deeds of resistance, including six participants who smoked. Unlike others, smokers never spontaneously mentioned concern for the health of smokers or those exposed to SHS. When prompted, they said they did not engage in resistant practices or did so only on specific occasions. For example, Jenna (D15s) said she would roll down the car windows should anyone smoke because of the confined space and, if they protested about the cold, would say ‘dinnae smoke then!’. Some reported resisting family members’ smoking when younger, like Rachel, who described the futility of this: N.R.-D.: Do you ever ask your parents to stop? Rachel, D13s: Nah, I’ve only told my mum to stop [in the past] and she does and then she’s not and then she starts again. I don’t think to be honest she’ll ever stop. Other participants from the disadvantaged area described a more traditional asymmetrical parent/child power dynamic to explain why resistance was futile, as exemplified in the following discussion: N.R.-D.: Do you ever ask your parents not to smoke? Victoria, D12: Well I didnae ’cause they don’t! Laura, D12: It’s like, I’ve done it but . . . Victoria, D12: Me too, once. Laura, D12: . . . but you don’t ask really ’cause your mum and dad they’re like the boss of you, you’re not the boss of them! Victoria, D12: You can say but they won’t listen. N.R.-D.: Do they not? Victoria, D12: Nah. Addiction, 109, 645–652
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Amy, D12: In my family people listen to children. And in my church they really want to know what we think, they always ask us. All the time. N.R.-D.: And do you think children should be asked their opinions? Amy, D12: Yeah, ’cause children are the future. [Victoria, D12 and Laura, D12 exchange looks] Victoria, D12: But you’re the child, they’re not supposed to dae what you say, you dae what they say. Laura, D12: It’s your family; they’re the boss of you. In contrast to many other accounts of opposition to parents’ smoking, this discussion illustrates the subordinate, and at times disempowered, social position children can occupy. Unlike participants from the advantaged area, many participants in the disadvantaged area had grandparents who smoked and many spent prolonged periods of time with them on a daily or weekly basis. In these accounts, the child/parent power hierarchy appeared intensified, and challenging grandparents’ smoking appeared to be considered disrespectful and perhaps provoke a greater adverse reaction than asking parents would. Robbie (D10) emphasizes that ‘it’s their house’, suggesting this as a reason for a lack of resistance. Even in their own homes, participants did not challenge grandparents’ smoking. Indeed, the idea of imposing smoking restrictions on grandparents was seen as a joke or ineffective: Rebecca, D14: I hate going to my nana’s ’cause my nana’s a bad . . . a heavy smoker and she like starts off a fag, puts it doon, blah, blah, blah, starts off a new one again and I’m like, ‘Nan I can’t breathe’, and she’s like [puts on a high-pitched voice], ‘I finished one aboot 20 minutes ago’ [laughter]. Some participants in the advantaged area, where smoking only occurred outside or within very restricted areas such as the kitchen doorway, also described a reluctance to resist family members’ smoking. Such reluctance was explained differently, however, either as a lack of concern about SHS exposure (as they smoked outside or in a different room) or because protesting would infringe parents’ individual, and possibly adult, rights: N.R.-D.: So have you told him that you don’t like him smoking . . . ever? Lauren, A13: Nooo [laughter and looking at Jessica, A12]. N.R.-D.: [laughter] No? Why not? Lauren, A13: Ehm . . . ’cause it’s what he wants to do. He always does it ’cause he wants to so I don’t think I have the right to say. N.R.-D.: OK and is that because you want to be polite or . . . you know how you also said that when other © 2013 Society for the Study of Addiction
people smoke you would never tell them not to—is that because you don’t want to be rude or because it’s not such a big deal or . . . ? [silence]. Lauren, A13: People have a right to smoke . . . Jessica, A12: . . . if they want to. DISCUSSION The overarching concept of resistance which infused participants’ accounts of their engagement with issues around smoking in the home presented in this paper throws new light on the role of children in relation to their parents’ smoking and smoking in the home. Many participants described active attempts to stop their parents and others smoking, albeit with little reported success and diminishing enthusiasm over time. These resistant discourses contrast sharply with previous research with adults, which implicitly position children as passive victims of SHS and who lack agency. However, children’s accounts of resistance to parents and others’ smoking do not deny the significant constraints on child agency. Agency depends on its relationship to normative practices, social structures and the capacities of the agent in question. Child agency does not preclude child vulnerability, either physically to SHS or in relation to their subordinated position to adults. Indeed, the accounts demonstrate both children’s vulnerability and their competence [33]; that they are both passive and active, depending on the context. The nature and impact of agency, how and to what extent it is enacted, speak of different social norms and the relative power of children and adult family members in different homes and in different areas. While overt resistance was frequently mentioned by participants from both areas, it seldom persisted, perhaps because it had little perceived effect and could provoke tension and conflict in family relationships. Adverse parental reactions, or expectations of these, were reportedly a turning-point in changing to covert and/or less resistance. In a clear illustration of children’s power in relation to adults, some participants perceived resistance as unthinkable or futile. Many parents were also described as relatively unaffected by their children’s attempts at challenging their smoking. The impact children had on smoking practices in the home and car therefore appeared to be constrained by parents’ greater power in the home, with most parents reported as resisting attempts at negotiation from their children. Support from a non-smoking parent or sibling appeared to legitimize some participants’ acts of resistance. However, most homes and cars were described as subject to adultimposed smoking restrictions, not ones negotiated between adults and children. Addiction, 109, 645–652
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A non-smoking norm in the advantaged area (with more non-smoking parents and grandparents) may also have legitimized participants’ practices of resistance and encouraged more overt ones. In this context, the extent of child agency appeared to intersect with socio-economic status. While most participants from both areas described ways of subverting adult power around smoking in the home and car, participants’ agency in the disadvantaged area appeared more constrained, with less available options because more family members smoked and there were fewer home smoking restrictions. Indeed, six participants from the disadvantaged area smoked themselves. For these participants, expressing concern about and opposition to a practice in which they were engaging may have appeared illogical. Resistant acts were thus constrained by more permissive smoking social norms and whether the young person smoked, both reported only by the participants from the disadvantaged area. The paired and group interviews prompted discussion, with participants developing and challenging each other’s accounts. However, these also appeared to silence some participants, illustrating that children are not exempt from power differences among themselves [34]. Some participants’ silence may reflect unease at talking about their parents’ smoking in the presence of a researcher and their peers. Accounts of resistance may therefore also be constrained by methods and contexts. As with most qualitative research, this was a geographically limited study with findings which cannot be generalized more widely. However, some findings are consistent with adult accounts in previous studies, reflecting the different smoking norms in disadvantaged and advantaged areas and demonstrating that parental smoking is not a morally neutral topic. In describing resistant practices, participants may also wish to present themselves as moral agents, motivated by a concern for others’ health in the same way that mothers present their responsible smoking practices as protecting their children’s health [10,35]. Like these mothers, the child participants in this study appeared to assume some responsibility for family health, framing their resistant practices as motivated by concern for parental health. Some forms of smoking resistance were reported to cause friction between children and parents, and educating children further about the risk of SHS exposure might therefore cause further tension within families. Rather than not providing information, however, ways of opening up discussion in school health education about smoking in the home and car in a sensitive and nonstigmatizing way should be developed. Some local initiatives are already doing this [36], and include such discussions in school health promotion programmes. Using the empowerment model of health promotion, which strengthens individual capabilities to take positive © 2013 Society for the Study of Addiction
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health-related action [37], children could be supported to negotiate smoking restrictions in the home and car in ways which might help ease family tension and raise awareness of more effective strategies to protect children from SHS. This study also highlights the importance of wider social norms in facilitating or inhibiting resistant acts and their effectiveness. Thus, it is important that these are addressed through mass media and social marketing campaigns, particularly in areas of disadvantage. These should both increase awareness about the need to protect children from SHS and empower parents and others to challenge social norms around smoking and create smoke-free homes, an approach reflected in the ‘Take seven steps out’ campaign in the North of England, where parents are encouraged to take their smoking completely outside the home (http://www.take7stepsout.co .uk; Archived at WebCite® at http://www.webcitation .org/6Mb403x8n on 13 January 2014).
Declaration of interests None.
Acknowledgements We would like to thank the children who shared their views with us. We would also like to thank Catriona Rooke, Martyn Pickersgill, Nicholas Jenkins and Amy Chandler for their comments on a previous draft of this paper. This study was funded by the Chief Scientist Office of the Scottish Government, with additional support from the UK Centre for Tobacco and Alcohol Studies, a UKCRC Public Health Research Centre of Excellence. Funding to UKCTAS from the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, the Medical Research Council and the National Institute of Health Research, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. The views expressed in this paper are those of the authors and not necessarily the funders.
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20. Bottorff J., Kalaw C., Johnson J., Chambers N., Stewart M., Greaves L. et al. Unraveling smoking ties: how tobacco use is embedded in couple interactions. Res Nurs Health 2005; 28: 316–28. 21. Bottorff J., Kalaw C., Johnson J., Stewart M., Greaves L., Carey J. Couple dynamics during women’s tobacco reduction in pregnancy and postpartum. Nicotine Tob Res 2006; 8: 499–509. 22. Greaves L., Kalaw C., Bottorff J. Case studies of power and control related to tobacco use during pregnancy. Womens Health Issues 2007; 17: 325–32. 23. James A., Prout A. Constructing and Reconstructing Childhood: Contemporary Issues in the Sociological Study of Childhood. London: Falmer Press; 1990. 24. Tisdall K., Punch S. Not so ‘new’? Looking critically at childhood studies. Child Geogr 2012; 10: 249–64. 25. Bluebond-Langner M., Korbin J. Challenges and opportunities in the anthropology of childhoods: an introduction to ‘Children, Childhoods, and Childhood Studies’. Am Anthropol 2007; 109: 241–6. 26. Klocker N. An example of thin agency: child domestic workers in Tanzania. In: Panelli R., Punch S., Robson E., editors. Global Perspectives on Rural Childhood and Youth: Young Rural Lives. London: Routledge; 2007, pp. 81–148. 27. Morrow V., Richards M. The ethics of social research with children: an overview. Child Soc 1996; 10: 90–105. 28. Mayall B. Conversations with children: working with generational issues. In: Christensen P., James A., editors. Research with Children: Perspectives and Practices. London: Falmer Press; 2000, pp. 120–35. 29. Highet G. Cannabis and smoking research: interviewing young people in self-selected friendship pairs. Health Educ Res 2003; 18: 108–18. 30. Braun V., Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3: 77–101. 31. Potter J. Discourse analysis as a way of analyzing naturally occurring talk. In: Silverman D., editor. Qualitative Research: Theory, Method and Practice, 2nd edn. London: Sage; 2004, pp. 200–21. 32. Edwards D. Discourse and Cognition. London: Sage; 1997. 33. Komulainen S. The ambiguity of the child’s ‘voice’ in social research. Childhood 2007; 14: 11–28. 34. Christensen P., James A. Research with Children: Perspectives and Practices. London: Falmer Press; 2000. 35. Coxhead L., Rhodes T. Accounting for risk and responsibility associated with smoking among mothers of children with respiratory illness. Sociol Health Illn 2006; 28: 98–121. 36. Shaw A., Ritchie D., Semple S., Turner S., O’Donnell R., Amos A. et al. Reducing Children’s Exposure to Second Hand Smoke in the Home. A Literature Review. Edinburgh: ASH Scotland; 2012. 37. Green J., Tones K. Health Promotion: Planning and Strategies. London: Sage; 2010.
Addiction, 109, 645–652
This document is a scanned copy of a printed document. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material.
RESEARCH REPORT
doi:10.1111/add.12435
Children’s resistance to parents’ smoking in the home and car: a qualitative study Neneh Rowa-Dewar1, Amanda Amos1 & Sarah Cunningham-Burley2 UK Centre for Tobacco and Alcohol Studies, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK1 and Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK2
ABSTRACT Background and Aims Reducing second-hand smoke exposure in the home is a key tobacco control goal, yet few studies have explored children’s views and experiences of this. This study aimed to explore children’s accounts of family members’ smoking in the home and car and the impact of their socio-economic circumstances. Design Individual and friendship group interviews using topic guides and visual stimulus methods. Setting Two communities in Edinburgh, Scotland, one socio-economically advantaged, one socio-economically disadvantaged. Participants Thirty-eight children aged 10–15 years who had a close family member who smoked. Measurements Focus group and interview topic guides. Findings Participants in both communities expressed a strong dislike of family members’ smoking and concern about the potential impact on the smoker’s health. Participants described overt and covert acts of resistance, including challenging relatives about their smoking, expressing disgust and concern, hiding or destroying cigarettes. Some acts were carried out in collusion with a non-smoking parent and/or sibling. Resistant acts were constrained by expectations of negative responses, which appeared to increase with age, wider social norms around smoking and whether or not the young person smoked. Conclusions Some children and young people in the United Kingdom, irrespective of socio-economic status, may actively oppose parents’ smoking in the home and car, although their influence may be limited by their position in the family and social norms. Keywords
Car, children, home, parents, qualitative, second-hand smoke.
Correspondence to: Neneh Rowa-Dewar, UK Centre for Tobacco and Alcohol Studies, Centre for Population Health Sciences, University of Edinburgh, Edinburgh EH8 9AG, UK. E-mail: [email protected] Submitted 20 August 2013; initial review completed 26 September 2013; final version accepted 25 November 2013
INTRODUCTION Mounting evidence of the health risks of exposure to second-hand smoke (SHS) has led to the adoption of smoke-free legislation in enclosed public places in many countries, including the United Kingdom [1], with consequent improvements in public health [2]. Due to their smaller airways, fast breathing rates and immature immune systems, children are more susceptible to the adverse health effects of SHS exposure [3]. These include a range of illnesses, from middle ear disease and lower respiratory tract infection, to increasing the severity of asthma and bacterial meningitis [4]. In countries with comprehensive smoke-free legislation, such as the United Kingdom, children are now most likely to be exposed to SHS in homes and cars. While smoking prevalence has declined in the United Kingdom, the decline has been greatest in © 2013 Society for the Study of Addiction
socio-economically advantaged groups, leading to increased social inequalities in smoking. Children’s exposure to SHS has also declined [5], but children from socio-economically disadvantaged households remain most at risk, reflecting higher parental smoking prevalence and fewer home smoking restrictions [5–8]. Among the most disadvantaged children, only 26.3% reported a smoke-free home and 51.7% a smoke-free family car, compared to 72% of the most advantaged children who reported a smoke-free home and 83% a smoke-free car [9]. Described as ‘the next frontier in tobacco control’ ([10], p. 1098), health promotion campaigns have targeted parents and other family members to reduce children’s SHS exposure in the home and car. Children’s inability to protect themselves from SHS has been highlighted in the literature [11]. However, studies have rarely reported children’s own perspectives on SHS. While this Addiction, 109, 645–652
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may reflect a focus upon very young children in most SHS studies, this absence can reinforce assumptions of children being passive in response to parents’ smoking and their own SHS exposure. To our knowledge, only two studies have explored children’s experiences and views on their parents’ smoking and SHS [12–15]. While conducted more than 20 years ago, Michell reports the emotive and strong feelings that Scottish 10–14-year-old children expressed about other people’s smoking [12– 14]. These highlighted their sense of injustice about being near people who smoked and concerns about the health of their family members. More recently, Woods and colleagues examined the views of children in England aged 4–8 years in a study that included focus groups and draw-and-write techniques [15]. Children in this study also reported dislike of SHS exposure and some understanding of its health risks to themselves and smokers. Younger children responded particularly negatively and emotively to being among smokers; older participants expressed more concerns about the health of the smoker and their own health. Commenting on their findings, Woods et al. [15] expressed surprise about participants’ apparent reluctance to communicate their dislike of smoking to family members and to take direct action to ‘remove themselves from the situation. Instead, they rely upon the actions of their parents to protect them from environmental tobacco smoke’. Both studies demonstrate that children dislike SHS and this can cause considerable concern, but their responses to parental smoking were unexplored. Conducted several years before the smoke-free laws in the United Kingdom (2006–07), these studies also could not capture any normative changes in how smoking and SHS is now perceived [16]. While there is a dearth of research eliciting child accounts of responses to family smoking, studies that examine adult accounts of negotiating smoking and SHS suggest that such interactions may be underpinned by power relations [17–22]. Responses to partners’ smoking included attempts to induce guilt by highlighting child health problems, exemplifying the tensions that smoking around children can provoke and/or reflect [21,22]. Glimpses of children’s involvement in smoking negotiations exist in these studies, where parents report that children ‘nag’ them to quit [8], call them ‘smelly’ [10], or walk out of rooms when they smoke [17]. While, to some extent, adults appear to acknowledge these protests, children’s views remain indirect and peripheral in the literature. The study reported in this paper aimed to explore the accounts of children with family members who smoke to contribute children’s perspectives to existing understandings of family negotiations surrounding smoking. © 2013 Society for the Study of Addiction
The study was informed by a Childhood Studies perspective that conceptualizes children as actively shaping the world around them [23]. It also reflects recent debates on the need to develop more nuanced perspectives on child agency which challenge previous assumptions of children as vulnerable, passive and voiceless [24] through exploring the constraints placed upon children’s ability to act such as context and power [25,26]. This paper examines children’s responses to family members’ smoking and the ways in which these are constrained or facilitated in advantaged and disadvantaged communities with different smoking prevalence and norms.
METHODS Sample and recruitment The data were gathered between 2007 and 2009 by N.R.-D. from 38 participants aged 10–15 years. Participants lived in two Edinburgh communities at opposite ends of the socio-economic spectrum. The socioeconomically disadvantaged community is one of the most disadvantaged in Edinburgh, consists of mainly council housing and has high unemployment and smoking prevalence. The advantaged area is among the most advantaged in Edinburgh, and has low unemployment and smoking prevalence. Participants were recruited from local child and youth groups, 27 from the disadvantaged community and 11 from the advantaged community. Twenty-seven were girls and 11 were boys. Six were smokers. All participants were white, reflecting the predominant area ethnic composition (Table 1). Children with one or two parents who smoked were recruited initially. Recruitment from the advantaged area proved challenging, as few children said their parents smoked. Thus, in the final sample, four participants from the advantaged area and two from the disadvantaged area were recruited who had other close family members who smoked in their home.
Ethics Ethical approval was gained from the University of Edinburgh School of Health Social Science Research Ethics Committee. Potential participants were invited by N.R.-D. verbally and in writing to participate in a study about their views and experiences of ‘other people’s smoke’. Participants signed a consent form which clarified that they did not have to take part and could withdraw at any point. Parents and carers received written information about the study after their children had consented to participate and were given the option to withdraw their child, an option none took. Addiction, 109, 645–652
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Table 1 Participants’ characteristics. Age (years)
Smoking status
Participant characteristics
10–12
13–15
Smoker
Non-smoker
Girls
5 12 2 2 21
4 6 0 7 17
0 2 0 4 6
9 16 2 5 32
Boys
Advantaged Disadvantaged Advantaged Disadvantaged
Total
Data collection Participants took part in an individual interview, or a paired or group interview with their friends, depending on their choice. This resulted in three individual interviews, four paired interviews and eight groups with three or four participants. While individual interviews are often a preferred method in qualitative research [27], the experience of ‘being questioned’ can be intimidating. Providing a choice of how to participate in the study, and the presence of peers, can partially compensate the asymmetrical power balance between the adult researcher and child participant [28]. A more supportive social context is created when participants can follow each other’s leads, respond and initiate discussion with their friend(s) [29]. Interviews lasted 25–55 minutes (average 40 minutes) and included visual stimulus methods to prompt discussion. Participants were shown a drawing of parents smoking in the home in the presence of children of various ages. They were also asked to draw home floor plans indicating where and when smoking was permitted in their homes. Participants were asked about their views and experiences of parents’ and other family members’ smoking, where and when they smoked in the home and car and their own role (if any) in negotiations around smoking and smoking restrictions. Interviews were recorded digitally and transcribed verbatim. Analysis The data were analysed thematically; each transcript was read several times and coded by N.R.-D. Codes were further broken down into categories and the relationships between the categories specified further in themes [30]. Themes were discussed between co-authors and analysis was then further informed by discursive approaches to examine what participants were trying to achieve with their accounts and which discourses they drew upon. By examining participants’ stake in what they disclosed and the scripts they used, the analysis focused on the motives and allegiances participants and their parents had in © 2013 Society for the Study of Addiction
their smoking practices and the ways in which participants described appropriate behaviour and assigned responsibility or blame [31,32]. Where quoteations are used in the Results, participants are identified by a pseudonym, community (D indicating disadvantaged, A indicating advantaged), whether or not they were a smoker (s for smoker) and their age.
RESULTS Reasons for resistance Most participants from both areas expressed a strong dislike of smoking using a language of disgust; it ‘stinks’ (Julia, D11) and is ‘horrible’ (Jack, A11; Jennifer, A14) and ‘minging’ (Danielle, D15). Rather than expressing concern about their own exposure to SHS, participants framed their concerns around the health of their parents and other family members who smoked. Practices of resistance were rationalized as acts of care and protection motivated by concerns for family members’ health, although the manner in which this was expressed was subject to debate. Anna, A12: I do understand why people do it [smoke]. But shouldn’t people around them, if people are trying to stop, shouldn’t your people around you try and tell you it’s bad for you? Catriona, A13: Yeah, to support them to stop but they don’t need to be like really mean. Anna, A12: But if you do that then it’ll give them more motivation to stop! Most participants described a repertoire of both overt and covert resistance to family members’ smoking. Overt practices refer to words and deeds that directly and openly challenged family members’ smoking; covert actions refer to deeds practised in secret. A trajectory of strategies over time was evident; many participants initially reported overtly opposing family members’ smoking, proceeding to more covert strategies when unsuccessful. The Addiction, 109, 645–652
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following sections explore this common trajectory, highlighting any differences in accounts from participants from different communities. Challenging and shaming smoking and smokers Most participants recounted asking family members to stop smoking, drawing attention to the unpleasant smell and taste of SHS by wrinkling their nose and/or turning away with the expressed intention of making the person who smokes feel ‘embarrassed’, ‘bad’ and/or ‘guilty’. Rebecca and Jack said they would walk away when parents smoked, with their dismissive tone of voice and facial expression indicating that this was an overt act of disapproval. Other strategies employed included rolling down windows in the car and coughing. Participants described that purposively coughing when someone smoked was intended to induce feelings of guilt.
tomorrow’, and then I’m like, ‘But you said that yesterday, shut up’, and then I’m like ‘Aaarghh’ [laughter] . . . so like, he bought these two massive packs and I was like [puts on angry voice] ‘I’ll kill you’, and then we put them in the bin and stuff [laughter]. In contrast to Danielle’s reported short-term success, Catriona’s father’s reported reluctance to stop smoking was reflected in most accounts. As also exemplified in this quote, while heated and an apparent source of family conflict, these interactions were nevertheless recounted, and met, with laughter. The comic effect may be due to such accounts reversing the traditional expected child/ adult roles by positioning the parent as a misbehaving child being told off. Humour also appeared to be a way to defuse any tension.
Mediating smoking risk messages N.R.-D.: And what does [your Dad] do when you were saying how you pretend to cough when he smokes, what does he do then? Jack, A11: He continues but . . . he looks guilty [laughter]. Referred to more frequently than covert practices, direct requests to stop smoking were often described as protests borne out of frustration with family members’ disregard of the health risks. Several participants from both communities described persistent attempts to persuade their parents to stop smoking. Such persistent ‘wearing down’ of the person who smoked was sometimes reputedly rewarded by short-term quit attempts. Danielle, D15: I asked my dad [to stop] and he stopped for six months and then he started again. [He stopped] ‘cause we kept on asking them for every week. He’d say, ‘What’, and I’d say ‘Stop smoking’ and he’d be like, ‘Fine then’ . . . like everyday [we used to say], ‘Stop smoking’. Some participants distinguished between forcefully resisting smoking and smokers. For instance, Catriona objected to the unambiguous attempts to induce guilt and embarrassment in those who smoke detailed by the other participants. Emma, A12: I just wrinkle my nose and turn away. Catriona, A13: But that’ll make them feel bad! Anna, A12: That’s the point! Emma, A12: I don’t want the smoke! While apparently reluctant to shame and induce guilt in people, Catriona later recounts her anger and frustration with her father’s empty promises to quit. Catriona, A13: [Dad] goes ‘I’ll quit tomorrow’, right? And then tomorrow comes and he says ‘I said I’ll quit © 2013 Society for the Study of Addiction
Other verbal practices of resistance underscored the way in which participants mediated smoking risk information received at school and in media campaigns. Drawing upon negative health messages, some participants said they selected the most repellent or memorable statements and passed these on to smoking family members in the hope of persuading them to stop smoking. N.R.-D.: Have you ever asked your sister not to smoke? Melissa, A12: Yeah I told her about how bad it is for you and she stopped for a while, and she like . . . started again. N.R.-D.: Yeah, and what did you tell her? Melissa, A12: After we got that talk in school [looking at the others in the group] I told her all the stuff that was in them and she stopped . . . but she started again. Catherine, A13: We got told that every cigarette that you smoke takes away 11 minutes of your life, apparently. Melissa, A12: And there’s sewage and stuff in them [pulling face]. Catherine, A13: Yeah, I told my uncle that one. Didn’t work! [laughter]. Attempts to stop parents and others from smoking were constructed as a responsible and knowledgeable response to smoking risk by most participants, but smoking risk messages received in school could also prompt anxiety. For example, Jennifer (A14), said she wanted her mother to quit smoking as ‘it just would have such a huge effect on us if she died’. Conversely, a lack of concern for someone who smoked was linked to a lack of resistant practices. For example, Anna (A12) stated that she did not resist her stepmother’s smoking as she hated her and ‘wouldn’t care if she got cancer’. While particularly strong, this Addiction, 109, 645–652
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view points to the same justification: resistance is linked to caring for someone.
about her mother’s smoking but suggested that some were getting less ‘acceptable’ as she got older:
Colluding with parents and siblings Several of the participants in the advantaged area described joint acts of resistance with their non-smoking parent to exert pressure on the smoking parent to stop smoking or stop smoking around family members. A nonsmoking parent appeared to lend weight to participants’ negotiation strategies by making them more radical and, perhaps, effective, as in Jack’s account:
Jennifer, A14: This is going to sound really bad but I shout at her. Quite a lot. And I snap her cigarettes, and I hide them. I’ve even poured water on them once. N.R.-D.: What happens then? Jennifer, A14: She goes, ‘STOP that’ and gets angry, too. I get into too much trouble now as I should know better at my age so I get my sister to do it, she’s 7 so she doesn’t get into as much trouble for snapping cigarettes. I tell her where she keeps them and tell her to hide them.
Jack, A11: My Dad [smokes in the house] but always in the utility room by the back door. We make him [laughter]! N.R.-D.: [laughter] you make him? How did you do that? Jack, A11: Yeah ’cause he used to smoke in the bathroom so we fitted a smoke alarm.
Several participants from the disadvantaged area also described involving younger siblings in covert acts in order to avoid an adverse family member reaction, either by blaming them when discovered or encouraging them to participate, suggesting overt acts appeared less acceptable in older children.
In contrast, most participants in the disadvantaged area had either single parents or two parents who smoked and often grandparents who smoked too. A few of these participants [and Jennifer (A14) in the following section], however, talked about colluding with siblings against smoking parents asking them to stop smoking or hiding their cigarettes. Subverting parental power in secret Secret deeds to subvert adult or parent power in small ways were described frequently in both communities. These covert acts included a commonly employed strategy of secretly hiding or destroying/disposing cigarettes. Abigail, A12: I have hidden them and she asked me where they were and I was like ‘dunno’ [shrugs shoulders and smiles]. I’ve broken them. She asked me to go and get a fag from auntie [name] ‘cause she smokes too and I snapped it and then I was like, ‘Oh, it broke in my pocket’ [laughter]. Covert deeds often appeared to follow on from overt ones and were often mentioned in the context of attempts to avoid the potentially adverse consequences associated with overt deeds such as anger or punishment. For example, Julia (D11) described hiding her stepfather’s cigarette packs underneath her sister’s cot-bed. She would replace them if she thought it might be discovered to avoid an angry reaction. It is impossible to know whether or not these expectations of anger were well founded. However, participants recounted instances where their resistance provoked parental angry responses. For example, Jennifer used a range of combined overt and covert strategies to protest © 2013 Society for the Study of Addiction
Accounts of acceptance or lack of resistance Several participants from both communities did not mention words or deeds of resistance, including six participants who smoked. Unlike others, smokers never spontaneously mentioned concern for the health of smokers or those exposed to SHS. When prompted, they said they did not engage in resistant practices or did so only on specific occasions. For example, Jenna (D15s) said she would roll down the car windows should anyone smoke because of the confined space and, if they protested about the cold, would say ‘dinnae smoke then!’. Some reported resisting family members’ smoking when younger, like Rachel, who described the futility of this: N.R.-D.: Do you ever ask your parents to stop? Rachel, D13s: Nah, I’ve only told my mum to stop [in the past] and she does and then she’s not and then she starts again. I don’t think to be honest she’ll ever stop. Other participants from the disadvantaged area described a more traditional asymmetrical parent/child power dynamic to explain why resistance was futile, as exemplified in the following discussion: N.R.-D.: Do you ever ask your parents not to smoke? Victoria, D12: Well I didnae ’cause they don’t! Laura, D12: It’s like, I’ve done it but . . . Victoria, D12: Me too, once. Laura, D12: . . . but you don’t ask really ’cause your mum and dad they’re like the boss of you, you’re not the boss of them! Victoria, D12: You can say but they won’t listen. N.R.-D.: Do they not? Victoria, D12: Nah. Addiction, 109, 645–652
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Amy, D12: In my family people listen to children. And in my church they really want to know what we think, they always ask us. All the time. N.R.-D.: And do you think children should be asked their opinions? Amy, D12: Yeah, ’cause children are the future. [Victoria, D12 and Laura, D12 exchange looks] Victoria, D12: But you’re the child, they’re not supposed to dae what you say, you dae what they say. Laura, D12: It’s your family; they’re the boss of you. In contrast to many other accounts of opposition to parents’ smoking, this discussion illustrates the subordinate, and at times disempowered, social position children can occupy. Unlike participants from the advantaged area, many participants in the disadvantaged area had grandparents who smoked and many spent prolonged periods of time with them on a daily or weekly basis. In these accounts, the child/parent power hierarchy appeared intensified, and challenging grandparents’ smoking appeared to be considered disrespectful and perhaps provoke a greater adverse reaction than asking parents would. Robbie (D10) emphasizes that ‘it’s their house’, suggesting this as a reason for a lack of resistance. Even in their own homes, participants did not challenge grandparents’ smoking. Indeed, the idea of imposing smoking restrictions on grandparents was seen as a joke or ineffective: Rebecca, D14: I hate going to my nana’s ’cause my nana’s a bad . . . a heavy smoker and she like starts off a fag, puts it doon, blah, blah, blah, starts off a new one again and I’m like, ‘Nan I can’t breathe’, and she’s like [puts on a high-pitched voice], ‘I finished one aboot 20 minutes ago’ [laughter]. Some participants in the advantaged area, where smoking only occurred outside or within very restricted areas such as the kitchen doorway, also described a reluctance to resist family members’ smoking. Such reluctance was explained differently, however, either as a lack of concern about SHS exposure (as they smoked outside or in a different room) or because protesting would infringe parents’ individual, and possibly adult, rights: N.R.-D.: So have you told him that you don’t like him smoking . . . ever? Lauren, A13: Nooo [laughter and looking at Jessica, A12]. N.R.-D.: [laughter] No? Why not? Lauren, A13: Ehm . . . ’cause it’s what he wants to do. He always does it ’cause he wants to so I don’t think I have the right to say. N.R.-D.: OK and is that because you want to be polite or . . . you know how you also said that when other © 2013 Society for the Study of Addiction
people smoke you would never tell them not to—is that because you don’t want to be rude or because it’s not such a big deal or . . . ? [silence]. Lauren, A13: People have a right to smoke . . . Jessica, A12: . . . if they want to. DISCUSSION The overarching concept of resistance which infused participants’ accounts of their engagement with issues around smoking in the home presented in this paper throws new light on the role of children in relation to their parents’ smoking and smoking in the home. Many participants described active attempts to stop their parents and others smoking, albeit with little reported success and diminishing enthusiasm over time. These resistant discourses contrast sharply with previous research with adults, which implicitly position children as passive victims of SHS and who lack agency. However, children’s accounts of resistance to parents and others’ smoking do not deny the significant constraints on child agency. Agency depends on its relationship to normative practices, social structures and the capacities of the agent in question. Child agency does not preclude child vulnerability, either physically to SHS or in relation to their subordinated position to adults. Indeed, the accounts demonstrate both children’s vulnerability and their competence [33]; that they are both passive and active, depending on the context. The nature and impact of agency, how and to what extent it is enacted, speak of different social norms and the relative power of children and adult family members in different homes and in different areas. While overt resistance was frequently mentioned by participants from both areas, it seldom persisted, perhaps because it had little perceived effect and could provoke tension and conflict in family relationships. Adverse parental reactions, or expectations of these, were reportedly a turning-point in changing to covert and/or less resistance. In a clear illustration of children’s power in relation to adults, some participants perceived resistance as unthinkable or futile. Many parents were also described as relatively unaffected by their children’s attempts at challenging their smoking. The impact children had on smoking practices in the home and car therefore appeared to be constrained by parents’ greater power in the home, with most parents reported as resisting attempts at negotiation from their children. Support from a non-smoking parent or sibling appeared to legitimize some participants’ acts of resistance. However, most homes and cars were described as subject to adultimposed smoking restrictions, not ones negotiated between adults and children. Addiction, 109, 645–652
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A non-smoking norm in the advantaged area (with more non-smoking parents and grandparents) may also have legitimized participants’ practices of resistance and encouraged more overt ones. In this context, the extent of child agency appeared to intersect with socio-economic status. While most participants from both areas described ways of subverting adult power around smoking in the home and car, participants’ agency in the disadvantaged area appeared more constrained, with less available options because more family members smoked and there were fewer home smoking restrictions. Indeed, six participants from the disadvantaged area smoked themselves. For these participants, expressing concern about and opposition to a practice in which they were engaging may have appeared illogical. Resistant acts were thus constrained by more permissive smoking social norms and whether the young person smoked, both reported only by the participants from the disadvantaged area. The paired and group interviews prompted discussion, with participants developing and challenging each other’s accounts. However, these also appeared to silence some participants, illustrating that children are not exempt from power differences among themselves [34]. Some participants’ silence may reflect unease at talking about their parents’ smoking in the presence of a researcher and their peers. Accounts of resistance may therefore also be constrained by methods and contexts. As with most qualitative research, this was a geographically limited study with findings which cannot be generalized more widely. However, some findings are consistent with adult accounts in previous studies, reflecting the different smoking norms in disadvantaged and advantaged areas and demonstrating that parental smoking is not a morally neutral topic. In describing resistant practices, participants may also wish to present themselves as moral agents, motivated by a concern for others’ health in the same way that mothers present their responsible smoking practices as protecting their children’s health [10,35]. Like these mothers, the child participants in this study appeared to assume some responsibility for family health, framing their resistant practices as motivated by concern for parental health. Some forms of smoking resistance were reported to cause friction between children and parents, and educating children further about the risk of SHS exposure might therefore cause further tension within families. Rather than not providing information, however, ways of opening up discussion in school health education about smoking in the home and car in a sensitive and nonstigmatizing way should be developed. Some local initiatives are already doing this [36], and include such discussions in school health promotion programmes. Using the empowerment model of health promotion, which strengthens individual capabilities to take positive © 2013 Society for the Study of Addiction
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health-related action [37], children could be supported to negotiate smoking restrictions in the home and car in ways which might help ease family tension and raise awareness of more effective strategies to protect children from SHS. This study also highlights the importance of wider social norms in facilitating or inhibiting resistant acts and their effectiveness. Thus, it is important that these are addressed through mass media and social marketing campaigns, particularly in areas of disadvantage. These should both increase awareness about the need to protect children from SHS and empower parents and others to challenge social norms around smoking and create smoke-free homes, an approach reflected in the ‘Take seven steps out’ campaign in the North of England, where parents are encouraged to take their smoking completely outside the home (http://www.take7stepsout.co .uk; Archived at WebCite® at http://www.webcitation .org/6Mb403x8n on 13 January 2014).
Declaration of interests None.
Acknowledgements We would like to thank the children who shared their views with us. We would also like to thank Catriona Rooke, Martyn Pickersgill, Nicholas Jenkins and Amy Chandler for their comments on a previous draft of this paper. This study was funded by the Chief Scientist Office of the Scottish Government, with additional support from the UK Centre for Tobacco and Alcohol Studies, a UKCRC Public Health Research Centre of Excellence. Funding to UKCTAS from the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, the Medical Research Council and the National Institute of Health Research, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. The views expressed in this paper are those of the authors and not necessarily the funders.
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