THE “ SOCIAL ” IN THE SOCIAL CONTEXT OF SMOKING

1. THE “SOCIAL”IN THE SOCIAL CONTEXT OF SMOKING Katherine Frohlich, Ph.D. Presented to: Institute for Social and Preventive Medicine, University of Bern, SwitzerlandJuly 7, 2006

2. What is the problem? • A growing concentration of smoking among socially and economically marginalized groups. • Diverse sources of resistance to tobacco control. • This concentration of smoking among particular groups, as well as the sources of resistance, cannot stem just from individual-level behaviour alone.

3. Some examples of the problem

4. Smoking prevalence by sex and socio-economic group 1974-2003

6. What does the “social”refer to in thesocial context of smoking? • Beyond individual behaviours (addictions, or “lifestyle” model) • Beyond social influences (social norms, peer pressure) • Beyond social environment (tends to focus on units of analysis, often based on the ecological model)

7. Problems with understanding the social context of smoking • The social context is not easily defined or measured • The literature that we drew on can seem relatively inaccessible to practitioners and researchers • Do we want to come up with a metatheory or a bricolage of conceptual lenses and concepts?

8. The objectives of our project • to identify diverse theoretical analytic traditions that could be best drawn upon to illuminate theorization of the social context in general, and tobacco consumption in particular; • to determine key concepts from these traditions that would help explain the unequal distribution of smoking and; • to test these concepts through in-depth interviews with smokers.

9. Our key theoretical tenets • collective lifestyles • power relations • identity & consumption • place • the body • pleasure

10. Collective lifestyles • Cockerham et al, 1997 (The Sociological Quarterly); Frohlich et al, 2001 (Sociology of Health & Illness). • Drawing on Giddens & Bourdieu, ‘collective lifestyles’ are seen as ‘social practices’ of social groups embedded in ‘styles of life’ that are an expression of a (recursive) relationship between people’s social conditions and their social practices. • Lifestyle as expression of ‘habitus’ - practices and schemes of perception, preference and taste.

11. Power relations • Power is the capacity to act (power to). • Power is the capacity to prevail over others (power over). • Grabb (1997) identifies three fundamental bases of power: control of material resources (means of production, wealth), control of human resources (labour power), and control of ideas (ideology, hegemony, and cultural dominance). • Focusing on power relations draws attention to the ways in which the social and geographic patterning of smoking parallels the effects of other processes of marginalisation and disadvantage Grabb, E.G. (1997) Theories of social inequalitiy: Classical and Contemporary Perspectives (3rd ed). Toronto, ON: Harcourt Brace.

12. Identity/Consumption • Lifestyle / styles of life are embedded in consumption selected from among what is economically and socially feasible/practical in order to construct & maintain social identity that both establishes and expresses difference

13. Place • 3 elements of place (Agnew, 1993). • locale: settings in which social relations are constituted • location: effects upon locales of social & economic processes operating at wider scales • sense of place: local ‘structure of feeling’, attachment to place, experience of place Agnew, J. (1993). Representing space: Space, scale and culture in social science. In: Duncan J. Ley D. editors. Place/Culture/Representation. London: Routledge, 1993. p. 251-271

14. The body • Mauss; Bourdieu; socio-biology • embodiment of class / gender • examples: physique, gait

15. Pleasure • ‘promethean pleasure of ‘holding fire’’ • Klein (1993), Cigarettes Are Sublime • pleasure of bodily competence associated with ‘smoking well’ • health promotion’s ambivalent relationship to desire & pleasure

16. Preliminary results : Power #12/370 Q: You said that smokers are being treated as second class citizens. A: I’m just saying that a certain selection of the population (treats smokers as second class citizens). You know you could compare it to the religious right…..You know for some reason oh for the next twenty years we’re going to target smokers. #8/36 A: ….like I don’t smoke that much. That regularly. I don’t smoke throughout the day. I don’t smoke until I’m finished work. I never smoke at work. I guess my experience with smoking is maybe a little different from someone who, you know, smokes all the time.

17. Preliminary Results: Identity #2/p.6 A: My one brother he just says, what else am I going to do? …he’s like me, we’re going to die anyway, so I might as well enjoy life. It might not be what other people think is a better quality, but to us its our life. #3/298 A: …well nobody ever thinks that I smoke. Nobody would ever…When people find out that I smoke they’re completely shocked. Always. Like they’re just like, what? You smoke? Because it totally, like I said earlier, contradicts basically everything else about my lifestyle. Um, I am very concerned about what I eat. What I put in my body. I don’t eat processed foods. I don’t eat fast food…

18. Preliminary results : Place #12/434 A: …as I was saying before the war veterans, those are the people I feel for. You’re taking away a large part of their social life, getting together once a week or even once a month to go to a Legion or an army/navy club. You’re going to turn these people into shut-ins and they are just going to fade away and die because they’re going to lose that only social contact they have. #2/726 A: I can’t actually think of any friends really who smoke inside….Most people are all outside now. Somehow it makes people feel better.

19. Preliminary results: The body #4/518 A: You know my…my favourite answer is well if you can guarantee me that I won’t gain weight then I’ll quit smoking…Really it all comes back to that in the end. And, ah, yah find me a diet that I can lose weight and quit smoking all at the same time and I’ll be there. #3/178 A: I smoke certain types of cigarettes that don’t stain your fingers. So you can see my fingers don’t look like a smokers. I don’t have any nicotine residue or yellow nails or any of that.

20. Preliminary results: Pleasure #5/612 A: You know I don’t really know if I enjoy any of them anymore….It’s getting to the point where it’s not an enjoyment it’s more of a habit….I’ll eat an apple and I enjoy that a heck of a lot more than having a cigarette. #8/165 A: Like if I’ve had a hard day at work and like I walk from work and it’s like a twenty-five minute walk and I sort of walk home and clear my head and like have a cigarette I like that cigarette because it’s sort of….it’s very relaxed.

21. Concluding with reflexivity • attention to the tacit knowledge and perspectives that practitioners bring to their work • an openness to being transformed by the experience of engaging with smokers from very different social backgrounds who may question our (tobacco control) practices • a questioning of ‘‘received knowledge’’ (what we hold to be self evident and true) • a curiosity about—and openness towards—other perspectives and ways of seeing • an awareness of power relations and one’s own social location and positionality