Psychology and HealthVol. 24, No. 2, February 2009, 203–220

Why do young adult smokers continue to smoke despite the health risks?

A focus group study

Brendan Gougha*, Gary Fryb, Sarah Groganc and Mark Connera

aInstitute of Psychological Sciences, University of Leeds, Leeds, UK; bUniversity of Leeds,Leeds, UK; cStaffordshire University, Staffordshire, UK

(Received 3 April 2007; final version received 6 September 2007)

The focus of this article is on constructions of health and illness in relation tosmoking. Specifically, we were interested in how culturally embedded healthpromotion messages were discussed and understood by our young smokers – andhow continued smoking was rationalised in the context of a thoroughgoing anti-smoking climate. To investigate accounts of smoking maintenance, we conductedfocus group discussions (N¼ 22 groups) with young adults from both high schooland university settings. Techniques from discourse analysis were used to identifysignificant patterns of talk around health and smoking, and three mainrepertoires were elicited. First, the health risks of smoking were downplayed inseveral ways (e.g. by citing other risky activities). Second, the putative healthbenefits of smoking were emphasised (e.g. stress relief). Third, smoking wasconstrued as a temporary, youthful phenomenon, which would cease uponentering responsible adulthood. The implications of these three interlockingrepertoires are discussed in relation to smoking maintenance, and suggestions fortargeted health promotion are made.

Keywords: smoking; young adults; qualitative; discourse; rationality

Introduction

The deleterious health consequences of smoking are well established (ASH, 2006),prompting many Western countries to introduce restrictions on smoking in public places.Despite the efforts of health promotion agencies and legal initiatives, however, a sizeableminority continue to smoke. The prevalence of smoking in young people in particular is acause for concern – the last report from the Office for National Statistics on Smokingamong secondary school children in 2000 (Boreham & Shaw, 2001) found that 10% ofchildren age 11–15 were regular smokers. We know that early and prolonged smoking iscorrelated with severe illness and mortality (Centre for Disease Control and Prevention,2003), and that the earlier an individual starts smoking, the greater the risk of lung cancer(Doll & Peto, 1981). Young smokers also have more respiratory infections, more coughs,more stress on their hearts, are less fit, have a higher risk of strokes and the younger theyare when they start smoking the younger they are in developing heart disease (RoyalCollege of Physicians, 1992).

*Corresponding author. Email: b.gough@leeds.ac.uk

ISSN 0887–0446 print/ISSN 1476–8321 online

� 2009 Taylor & Francis

DOI: 10.1080/08870440701670570

http://www.informaworld.com

Questions concerning when, how and why many young people take up smoking havepre-occupied social scientists for years now. Within social and health psychology, researchon smoking and other health practices has been driven by models which incorporateindividual attitude variables such as beliefs, intentions and affect (notably the Theory ofPlanned Behaviour [TPB] e.g. Armitage & Conner, 2001; Conner & Sparks, 1996). TheTPB suggests that the proximal determinants of behaviour are intentions to engage in thebehaviour and perceived behavioural control over the behaviour. Intentions representconscious plans or a decision to exert effort to perform the behaviour. Perceivedbehavioural control (PBC) is the perception that performance of the behaviour is withinone’s control. The concept is similar to Bandura’s (1982) concept of self-efficacy.Intentions are determined by attitudes, subjective norms and PBC. Subjective norms arebeliefs about whether it is significant that others think the target individual should engagein the behaviour. In short, TPB suggests that individuals are likely to intend to initiatesmoking if they believe that the behaviour will lead to particular outcomes which theyvalue, if they believe that people whose views they value think they should carry out thebehaviour, and if they feel that they have the necessary resources and opportunities tosmoke (Conner, Sandberg, McMillan, & Higgins, 2006). Smokers are also significantlymore likely to perceive support from others for their smoking than non-smokers (Grogan,Conner, Fry, Gough, & Higgins, submitted).

However, models like the TPB have been criticised for assuming rational actorsconsciously making decisions independently, as if extricated from relevant social contexts(Gillies & Willig, 1997). The drive for measurement, prediction and control has produced anarrow focus on attitudinal variables as quantified via closed questions in questionnaireand experimental research. While such work can be useful in presenting aggregate patternsacross large datasets, the meaning/s that smoking holds for individuals and groups in situis neglected. Further, by locating the ‘cause’ of such behaviours within individuals,evidenced by the lexicon of attitudes, beliefs and intentions, psychological researcharguably promotes a culture of blaming individuals for problems, which may bealternatively understood as social, or indeed not as problems at all from the point of viewof those studied. Consequently, the mainstream health psychology literature on smokinghas paid little attention to the social construction and negotiation of meanings aroundsmoking, which are produced in different social locations such as school, home, university,sport and work – in this article we focus on educational settings (high school anduniversity). From a ‘critical health psychology’ perspective more qualitative, psychosocialresearch is required to develop and contextualise the ‘alternative lay rationalities’(Crossley, 2000) pertaining to smoking so that insights into the discourses and practicesperformed by individuals in specific social settings can be derived (Murray, 2004). Thepresent article then emerges from a qualitative study with young adult smokers (at schooland university) based on focus group discussions where a range of smoking-related topicswere covered.

Published qualitative research to date on young smokers highlights a construction ofsmoking and smokers as ‘cool’, while older smokers are considered to be ‘addicted’ and atrisk from health problems (Rugkasa et al., 2001). As well, Johnson, Boles, Vaughan andKleber (2000) show that smoking in young people is related to drinking alcohol, and thatheavy drinkers are more likely to smoke. Aveyard et al. (2003) claim that an institution’s‘ethos’ (for instance, a school in which smoking is prevalent) has an impact on smokingpatterns of young people. Bancroft, Wiltshire, Amos and Parry (2003) argue that smokingis related to daily routines, such as occupying restrictive areas and smoking at set times ofthe day. Collins, Maguire and O’Dell (2002) also claim that cigarettes are used as a ‘social

204 B. Gough et al.

tool’, the better to facilitate the interrelations enjoyed by young people on a daily basis. So,qualitative researchers have highlighted that smoking is perceived by young people to be acomplex phenomenon, involving many factors.

The particular focus of this article is on constructions of health and illness in relation tosmoking (elsewhere we have focused on social identity [Fry, Grogan, Gough & Conner,submitted] and appearance concerns [Grogan, Fry, Gough, & Conner, submitted]).Specifically, we were interested in how culturally embedded health promotion messageswere discussed and understood by our young smokers – and how continued smoking wasrationalised in the light of these wider health warnings. Within an anti-smoking climate, ithas been argued that smoker’s identities may be damaged or discredited (Parry & Platt,2000), or even deviant and immoral (Laurier, 1999; Lupton, 1994). It is important thento investigate how our young smokers account for and justify their smoking, and to whatextent health is incorporated as a concern. Clearly, this emphasise on health-relatedconsequences of smoking has implications for the design of campaigns aimed at deterringsmoking initiation and quitting smoking, which we discuss in the final section.

Method

Data interpretation was informed by concepts developed by discourse analysts anddiscursive psychologists (Potter, 1996; Wetherell, 1998), with special attention paid to talkaround health issues as discussed above. Discourse analysis has been used to good effect inthe context of health psychology (Willig, 2000), including analyses of smokers’ talk (Gillies& Willig, 1997). For the present analysis, we specifically attend to discursive practices i.e.the rhetorical strategies drawn upon to construct relevant ‘objects’, such as smoking andhealth, in the service of particular ends (Potter, 1996). For example, we may find thatsmoking is justified as a legitimate source of pleasure, or alternatively that smoking isconstructed as an addiction, beyond one’s control (Benford & Gough, 2005; Gillies &Willig, 1997). We are especially interested in how smoking is rationalised in the widercontext of a health-conscious culture.

Sample

Ethical approval for this study was obtained through the university committee and thoughnegotiation with relevant teachers and pupils at the high schools. The sample in this studyincluded 87 males and females, aged between 16 and 24 years, both smokers and non-smokers, from high schools and a university in Yorkshire. Table 1 shows the demographiccharacteristics of the sample.

Our aim was to maximise variation in our sample generally and in the composition offocus groups specifically to include young men and women, smokers and non-smokers,and different educational settings (university versus school; schools in affluent versusdeprived areas). This strategy was informed by some evidence from our questionnairestudies of variation in attitudes and smoking practices according to sex, smoking statusand social class (Grogan et al., submitted) – although in this article we are not focusing onor assuming such group differences. Our discourse analytic perspective here concentrateson talk between speakers and allows us to highlight how meanings around smoking andhealth are worked up, debated and disputed within different groups.

The high school pupils were recruited by contacting relevant members of staff, and theuniversity undergraduates by email and flyers on campus. All participants were paid £10for participation. Informed consent was obtained from each participant prior to the

Psychology and Health 205

interviews. Focus group interviews took place respectively in the high schools and in the

Psychology department of the University and were facilitated by the second author.

Procedure

In this study, we employed a focus group methodology, with between three and sevenparticipants in each group (22 groups in total). Focus groups mimic ‘natural’ peer groups

so that the data will likely be authentic, rich and informative. In contrast, one-to-one

interviews, although yielding valuable data about individual meanings (Stewart-Knoxet al., 2005), can nonetheless invite abstract, de-contextualised themes, which say little

about the actual construction and negotiation of smoking in social settings. Focus groups

have long been used in social science research, including health psychology (Crossley,2000; Wilkinson, 2003), and can be particularly useful in identifying both diverse

individual accounts and prevailing social factors which influence and constrain actions.

In the context of young people and smoking, focus group research allows us to gain accessto the multiplicity of perspectives presented and will also illuminate how accounts are

constructed and negotiated within peer groups. The influence of peers on decisions to

smoke has been documented (e.g. Ogden & Nicoll, 1997), but there is little qualitativeresearch looking at peer interaction from a discursive perspective.

The interview schedule was designed on the basis of a literature review on smoking in

young people. Many factors were included and grouped under the headings Routes toSmoking, Reasons for Smoking, Health Issues, Appearance Issues and Stopping Smoking.

However, the interview schedule was sufficiently flexible to allow participants to generate

their own understandings. This approach generated a great deal of material, allowingparticipants to explore in detail what smoking meant to them. As stated, we concentrate

here on data pertaining to health issues in an educational context – social identity aspects

and appearance concerns have been covered in other papers (Fry et al., submitted; Groganet al., submitted).

Participants were given a number of prompts about their views on smoking, such as

‘Please tell me why you believe you started smoking/resisted smoking . . .’ and ‘Please tellme what role you believe smoking/not smoking plays in your life . . .’. Participants were

encouraged to discuss these views among themselves, with minimal input from the

facilitator. The discussions, which lasted an hour each on average, were then transcribedverbatim.

Data analysis

To examine the data in detail, we started with an in-depth thematic analysis using some

strategies from Grounded Theory (Glaser & Strauss, 1967) before moving on to a more

Table 1. Participants.

Source High school pupils University undergraduates

Smoking status Smokers Non-smokers Smokers Non-smokers

Male 16 6 12 5Female 17 8 15 8

206 B. Gough et al.

discursive analysis (Willig, 2000). A concerted effort was made to remain open tounexpected themes and to constantly refine and validate emerging insights by consideringany counter examples (‘negative case analysis’). In practice, this translated as detailed,systematic, line-by-line coding to begin with, a ‘bottom-up’ mode of analysis grounded inthe data – akin to grounded theory analysis (Glaser & Strauss, 1967). This processgenerated myriad themes, which were periodically allocated to theme clusters, which inturn, were continually contrasted and refined (the ‘constant comparison’ process).

Once we were confident that the main themes generated captured all the variationconcerning health issues, we moved on to discourse analysis. In other words, weconsidered the ways in which each of the themes was talked about, and how these differentways of speaking functioned in context. For example, the theme labelled ‘smoking astemporary’ was considered to undermine health concerns and so legitimate currentsmoking. Indeed, we noted that participants performed much discursive work in order todefend their smoking, whether or not health issues were deemed relevant. In the analysiswhich follows, we highlight three broad sets of discursive practices clearly designed toprotect and enable current smoking.

Analysis

Health was generally not cited as a major concern for our youthful sample, and was notsomething that they introduced spontaneously during the discussions. Instead, partici-pants seemed much more concerned with the financial burden engendered by smoking –cost was deemed prohibitive in the student context of no/low income. When the topic ofhealth risks was mooted by the researcher, there was a general tendency to downplay ordiscount these – although, interestingly, our participants demonstrated a concern forothers (e.g. children) with respect to when and where they would (not) smoke. Moreover, itwas popularly claimed that smoking could function effectively as a form of stress relief –even when the stress is engendered by exposure to smoking-related health scares, either inthe media or within families. Finally, smoking was invariably presented as a temporaryphenomenon permitted, if not encouraged, by youthfulness, and as such granted a certainimmunity from any future health consequences. Taken together, these accounts help usappreciate why younger smokers persist with the habit inspite of the burgeoning anti-smoking climate in the UK. The three discursive patterns are formulated as follows:

(1) ‘Everything is bad for you now’: Contesting smoking-related health risks(2) ‘It does make you feel better’: Smoking as stress-relief(3) A ‘window of opportunity’: Smoking as youthful licence

(1) ‘Everything is bad for you now’: Contesting smoking-related health risksVarious strategies were deployed which rendered the health risks linked to smoking as

exaggerated, a ploy which clearly works to rationalise and uphold current smoking – a wayof immunising the self from the spectre of illness and mortality. For example, othermundane practices are cited which involve risk, and life itself is presented as saturated withrisk:

GF* What concerns you about the health consequences of smoking?Nancy** You like to think yourself that you’re not going to get cancer, but there is always

that more higher chance of you getting cancer than you would if you didn’t smoke.But it still doesn’t enter my head when I have a cigarette, I don’t think. I mean,they’re saying that cancer is caused by all these different things – I mean who’s tosay that smoking is definitely the worst one?

Psychology and Health 207

Alison There’s so many things that can give you cancer and make you poorly¼Nancy I go on sunbeds as well, and that gives you cancer, and it’s like ‘Yes, so what, I’m

going to be brown’, so like with a cigarette it’s like ‘Yes, so what, I’m not smokingin anybody’s face’.

Ellie All the things that they say are bad for you – if you didn’t do any of them youwouldn’t do anything. Everything is bad for you now. Everybody takes that risk,don’t they? Like there’s that advert where the woman says ‘I played the game andI lost’ – she was 38 and she had cancer didn’t she?1

(FG11¼Focus Group 11)

*GF¼ Interviewer**all names¼ pseudonyms

In this excerpt there is some recognition of risk (‘higher chance of you getting cancer’),

but then other carcinogens are alluded to and the dedicated link between smoking and

cancer is undermined (‘who’s to say?’). Thus, smoking is construed as nothing special, just

one of any number of possible causes of cancer (‘so many things’), and therefore not

worthy of disproportionate attention. Ellie then generalises the notion of risk – ‘everything

is bad for you now’ – so that living per se becomes inured with risk, something that affects

‘everyone’. Note the extreme case formulations which litter this extract: ‘all these different

things’; ‘so many things’; ‘all the things’; ‘everything’; ‘everybody’ – these work to

emphasise the pervasiveness of risk (Pomerantz, 1986). With risk being constructed as

ubiquitous, smoking is normalised and legitimised as just one of a multitude of potentially

risky practices. The example of sunbathing and cancer referenced by Nancy is, similarly,

presented as just one of a series of dangerous activities where health concerns are

jettisoned and other concerns privileged (in this case image-consciousness). A sense of

defiance is expressed (‘so what’), which again helps to dismiss riskiness as a valid pre-

occupation. Nested within Nancy’s contribution is consideration for others (‘I’m not

smoking in anybody’s face’), which further legitimises her smoking as an individual pursuit

which does not impinge on the health of others. So, smoking is part of life and is practiced

with care. Ellie’s concluding statement is also intriguing: again, life itself is presented as

risky, and while the example of a recent television advertisement depicting a 38-year cancer

victim is sobering and, arguably designed to deter smoking, as deployed here it works to

reinforce the consensus that all lifestyle choices carry risk – not just smoking.In a similar vein, smoking is presented as just one of number of unhealthy activities

which nonetheless provide enjoyment:

GF So, are health concerns an issue?Sara Well, yeah [laughs]. Not really, I suppose.

Gwen [unintelligible]Sara Well, they are, because sometimes you feel like (�) you do feel like crap on a

morning because your lungs are hurting, because you’ve been caning it all weekend,but you think, well (�) you might give up smoking, give up drinking, give upanything – and then get knocked down by a bus. I mean, to be honest, it’s all a bit,I know it’s a bit of a pessimistic view, but (�) if you’re going to stop, if you’re goingto stop everything that you enjoy, well what’s the point of living forever? You knowwhat I mean?

Tracy But don’t you, sometimes you just think ‘Well, what’s the point of it? You’re justbreathing in horrible smoke into your body’¼

Sara It’s like what’s the point of drinking? It’s fun!(FG4)

Again, the health risks of smoking are conceded, with reference to current, minor

symptoms. However, smoking is likened to other pleasurable activities (e.g. ‘drinking’) and

208 B. Gough et al.

‘anything’/‘everything you enjoy’ so that living is defined in terms of enjoyment over risk.A three part list (‘smoking, drinking, anything’) reinforces the ‘fact’ that any activity – notjust smoking – is open to risk, so that risk becomes so general as to defy conscious concern(see Jefferson, 1990 on listing). Instead, the emphasis is on ‘fun’ and not denying oneselfgratification – even if it means a shorter life-span or inhaling ‘horrible smoke’. The classiccommonplace reference to the indeterminacy of life is cited – ‘then get knocked down by abus’ – which is designed to undermine undue pre-occupation with health and illness and tojustify a focus on living for and enjoying the moment. In this way health concerns aresuspended, and arguably this is a privilege afforded callow youth – our young smokerswere often at pains to stress smoking as a temporary pastime, associated with being youngand having fun (see below).

The ‘fun’ theme is also cited as a legitimate response to health promotion overkill:

Bill The little stickers they put on the [cigarette] packet now, it’s just become a jokemore than anything¼

Calum ¼Yeah, it’s almost become like cliches really, you just expect to see it, it justpasses you by¼

Bill ¼Yeah, loads of people at uni and that have got them like on their folder, likejokes, ones, you know, ‘smoking’s cool’, stuff like that, funny ones that peoplemade up

(FG2)

Here, a sense of fatigue with anti-smoking messages is expressed (‘cliches’) and a desireto subvert and satirise evident. ‘Serious’ issues of health and illness are trivialised anddriven away from the context of youth. In addition, a consensus is generated over theclaim that smokers have become over-targeted, treated unfairly compared to other groups:

Mike it’s a real big thing for me because, I mean, they say on the packet ‘smokingincreases the risk of . . .’ but then you look at the other stuff, like new research into‘Diet coke increases the risk of . . .’ and ‘not eating five vegetables a day increasesthe risk¼

Jane Yes, and a lot of people I’ve spoken to always use the argument that alcohol isworse for you – they always say, you know, ‘I’ll try and stop smoking but alcohol’sworse and it’s socially acceptable’

Kath Yeah, that’s true actually(FG19)

Drawing attention to ‘the other stuff’ (cola, diet, alcohol) again places smoking on acontinuum where some things are more risky (‘alcohol’s worse’). Such claims arewarranted by science (‘new research into . . .’) and by citing consensus and corroboration(‘a lot of people’; ‘they always say’) – see Dickerson (1997) for research on this discursivestrategy. The hypocrisy of society is then conveyed by the implicit contrast between‘socially acceptable’ but ‘worse’ alcohol consumption and socially rejected smoking. Thetheme of double standards is elaborated in the following extract:

I think there are other things that annoy me like obesity. You would not go up to someonewho was obese and, like, I work in an pub and often I see people that are in the non-smokingsection, so healthy in that way, but kind of like hugely obese, having cheesy chips with extracheese and loads of mayonnaise, and I’m like ‘really’, and I don’t want to be nasty, but its kindof like they’re unhealthy – they’ll talk about draining resources and stuff like chocolate barsaren’t heavily taxed whereas cigarettes are, and so I get a bit annoyed because you cant tellsomeone they’re obese and like ‘oh, you shouldn’t be eating that’ – unless they’re your bestfriend or their mum I suppose. So I do think there’s a different standard and (.) smoking,like you say, is something you can pick up on and you can make someone feel uncomfortableor not happy.(Kiera, FG17)

Psychology and Health 209

In this instance, the unhealthy habits of obese others are emphasised using listing andextreme case formulations (‘hugely obese’; ‘cheesy chips, extra cheese and loads ofmayonnaise’) before a taboo on direct criticism is asserted (‘you can’t tell someone . . .’). Incontrast, smoking is something which attracts disproportionate censure, widely perceivedas a legitimate target for criticism, with the effect of making people miserable(‘uncomfortable or not happy’). This heightened contrast works to direct attention toother, perhaps worse, cases of risky behaviour, and to present smokers as victims ofunwarranted discrimination, at the mercy of an aggressive anti-smoking culture.

Another familiar trope used by participants was to cite known cases where smokinghad not impacted on health or performance, or where smoking cessation was linked todecline and illness:

Alan I used to work in a pub and you used to see, er people like X [former ManchesterUtd footballer] and Y [former Manchester City player], they always, they smokedjust as much as I did, so that didn’t put me off at all, seeing the people likeprofessionals smoking¼

GF Ah right, seeing people who you in some way you might aspire to¼Alan Yeah [unintelligible]¼GF Encouraged you to smoke?

Alan Yeah, well I was already smoking at the time, but it didn’t put me off at all, justthought if they can do it, then so can I¼

Dave Yeah, I found that playing football, like smoking cigars and stuff, it defeats thatpoint of staying healthy and keeping, you know, they are like one of the greatestfootballers in the world and they still smoke how many a day?

Bob (�) A guy, a guy I went to school with was cross country champion for our county,and he used to smoke like twenty a day [laughs] He used to smoke loads of draw,loads of weed and that, and he used to run for ages [laughs] (.) You see someonelike that, it’s just like, woah!

(FG 2)

So, citing cases, both famous and mundane, where smoking has not impeded sportingperformance, undermines claims about the deleterious health consequences of smokingand helps justify continued smoking. The sporting prowess of the footballers (‘greatest’)and the cross country runner (‘run for ages’) is emphasised, as is amount smoked (‘alwayssmoked just as much as I did’; ‘twenty a day’), thereby problematising the impact ofsmoking, and ultimately helping maintain current smoking (‘if they can do it, so can I’).Dave explicitly alludes to health-defeating implications of smoking and expresses surpriseat the smoking footballers (indeed, sport participation is otherwise cited as a deterrentfor male smoking – Fry et al., submitted), but his theme is not picked up in the nextturn by Bob, who reiterates the dominant argument which challenges the link betweensmoking and ill-health. The case of the cross-country champion cited by Bob is alsointeresting because marijuana smoking is also invoked, rendering the sportingperformance even more impressive, and further contesting the connection betweensmoking and not being healthy.

Other exceptional cases were cited by participants, such as highlighting the unhealthyconsequences of smoking cessation:

Roz You know, my granddad smoked up until he was about thirty or something andthen he stopped by himself and he has come out of it well bad through it. Now he’sgot inhalers non-stop. I don’t know, he can’t walk far or anything – it’s just madehim a lot worse for it by stopping.

Lou I knew somebody who used to smoke ten a day when they were about eighty-oddand have a glass of brandy every day (.) and when they got put in a nursing homethey took it all off her and within weeks she were dead.

210 B. Gough et al.

Lara It’s like alcoholics, int it? If alcoholics stopped drinking they do seem to die.(FG8)

In this extract, the dangers of stopping smoking are emphasised, thereby inverting the

‘normal’ warnings about taking up or continuing smoking. Dire health consequences are

cited (‘he can’t walk far or anything’) as well as death (‘within weeks she were dead’) – the

suddenness of death is clearly significant as it reinforces the link between smoking and life.

Also significant is the older status of the cases (‘granddad’; ‘about eighty-odd’), suggesting

that smoking does not impact on life expectancy, and is, by extension, good for you.

Mortality is the ultimate bottom-line argument (Edwards, Ashmore, & Potter, 1995) used

as a way of ending all discussion – in this case the debate about the health effects of

smoking. Again, there is reference to other practices (alcohol) and the power of the thesis –

that supposedly unhealthy things are health-protecting – amplified. Another type of case

cited within this range is that of the abstinent:

GF What are the health worries you might have about smoking?Noel Cancer

Gavin None, ‘cos I know a guy that lived until he was 23 and just dropped dead.He didn’t smoke and didn’t drink.

GF Yes, it does happenDani You could have a heart attack any day. Even if you didn’t smoke or owt. You’re

gonna die anyway.Gavin You know, the way I see it, you only live once – you might as well do it, haven’t

you.GF . . . but you might live less if you smoke.

Gavin Yes, but you might live and you’ll never know, so you might as well live a bitless and try more things and stuff.

(FG22)

Here Noel’s immediate response concerning health fears is not taken up as the others

proceed to reject this pre-occupation. Grant immediately invokes the case of a non-smoker

who died suddenly as a means of challenging the link between smoking and ill-health. The

randomness of life then becomes a key theme (‘you could have a heart attack any day’;

‘you’ll never know’), which again works to rationalise current smoking. The age of the

man is also significant – if death can visit someone apparently healthy at such a relatively

tender age, the claim seems to be: what’s the point of giving up unhealthy things if ‘you’re

gonna die anyway?’. In response to the retort from the interviewer, Gavin maintains his

stance by privileging a fuller (‘try more things’) if shorter life over a restricted, longer one.

The ‘only live once’ mentality is a recurring motif throughout the discussions, as smoking

is construed as life-affirming rather than health-defeating. As one participant put it: ‘it just

shows that you’re having a good time, you know, drinking and having a cigarette, and it

just kind of ties in together’ (Kate, FG1). Here, smoking (and drinking) is inextricably tied

to enjoyment, an automatic indicator of ‘good times’. Related to this, our young smokers

presented smoking as fostering health benefits, as the next section illustrates.

(2) ‘It does make you feel better’: Smoking as stress-reliefA theme endorsed across all discussions was the benefits of smoking in terms of

alleviating stress arising from various sources, for example, from work-related pressure:

It does make you feel better sometimes (.) when you’ve been sat there and you’ve just beenat work, and you just think ‘Oh, I’m going to go for a cig, and you go down and you havethe thing – obviously it does give you some kind of buzz, because you, you, it does definitelychill you out a bit, doesn’t it(Sara, FG4)

Psychology and Health 211

A smoke break at work clearly entails an attractive time-out quality – anotherparticipant states: ‘It gives me a couple of minutes and just chills me out again’ (Rachel,FG8) – and a relaxing property is attributed to smoking itself (‘chill you out’). Similarly,smoking can offer relief from domestic conflicts:

Ellie If I was talking to someone about an awkward situation then it would like chillme out and it would be alright then. Or, like if something that had upset me, likemy family life hasn’t been that good – I’ve been thrown out of my house and that’sthe reason why I started smoking a lot more than I would do just because of morestress and stuff. I do think that having a cigarette makes me relax a bit.

GF So, is that a chemical thing – is it a kind of chemical effect of the nicotine thatmakes you relax?

Ellie I would say so, yes.Nancy I don’t know, I think its just the thought of being able to, like, you know, when you

breathe things out and it feels like it makes you relax¼Ellie Yeah, there’s that as well.

(FG11)

According to Ellie then, smoking can facilitate delicate negotiations with another partyand can enable some relief from familial strife. Natalie then links smoking to exhalationand (again) to relaxation. Inhalation, and the attendant ingestion of harmful chemicals, isomitted from this relaxation account. This theme is elaborated later in the discussion, first

by Ellie, then Nancy:

At the moment I don’t want to [stop smoking] because I do see smoking as helping me chill outa bit – I mean, if I didn’t I’d be a tiger!(Ellie, FG11)

I’ve actually been told by my doctor not to stop smoking – he says its got anger management –it calms me down.(Nancy, FG11)

Both participants point to the grim consequences of not smoking i.e. uncontainedirritability. Nancy’s claim is warranted with reference to an authoritative source (a medic),a membership category (Widdicombe & Woofitt, 1995), which is culturally garnished withexpertise. This third party corroboration (Dickerson, 1997) is designed to be morepersuasive than accounts from smokers alone and gains further counter-intuitive powerbecause doctors generally have a stake in discouraging patients from smoking; so, the logicgoes, if doctors who routinely warn against the dangers of smoking actually advise thepatient to smoke for mental health reasons, then, it follows, smoking must be good foryou. The stress-protecting function accorded to smoking also extends, ironically, toexposure to smoking-related disease, for example, through the media:

GF What about the issues about the damage that smoking does to your health?Roz It is scary.Lara That’s the reason we don’t think about it to be honest.Lou Yeah, ‘cos when you watch those adverts on the TV you get upset and have to

go for a cigarette.GF So the adverts actually make you smoke more?Lou Yes (.) yes, ‘cos they start stressing you out and you think ‘Oh God!’Lara Especially those ones where it’s like their mums are dying of cancer and stuff (.)

that does make me want to cry that.(FG8)

Department of Health-sponsored advertisements in the UK warning of the dangers ofsmoking are clearly perceived as anxiety-provoking by these smokers; indeed this was acommon perception among our smoking sample. That such health promotion campaigns

212 B. Gough et al.

may actually instigate the very practice they seek to discourage provides food for

thought for the designers of such initiatives. A lack of choice is implied (‘you have to go

for a cigarette’), and a desire to avoid disease-related information (‘the reason we don’t

think about it’). So, a double coping strategy is required: avoidance of sources which

heighten awareness of the health costs of smoking, and then smoking itself as a way of

managing the stress experienced when exposure is inescapable. The category of mothers

as victims is give special status, implying that children (‘their mums’) will also be affected,

and children are culturally positioned as innocent (Burman, 1994). So, the impact of

smoking on families is foregrounded, and this pertains to participants themselves and their

families:

GF Let’s just talk about health concerns with smoking – what are they?Amy Cancer. I think like (.) my dad died of cancer a couple of years ago – it wasn’t lung

cancer or anything but his general health wasn’t very good, so, you know, smokingdidn’t contribute very well. My granddad died – he had lung cancer and had tohave a lung taken out – and then my grandma has just been in hospital and she’sgot emphysema and stuff (.) and she’s on a nebulae thing. And I really think like‘What are you doing – all these people around you are dying and really ill’, but thenlike when my dad was ill with cancer I just thought ‘Well, if there’s anything I needat the moment it’s to smoke because this is so stressful’. I think when you are ourage you kind of just think ‘Well, I’m only in my twenties like – I don’t have toworry about this’, and I kind of think that when I have kids I’ll give up, but not atthis moment.(FG18)

In this case, smoking is explicitly linked to the death and illnesses of significant family

members and Amy proceeds to initially question her own smoking practice (‘What are you

doing?’). However, the concern over her smoking is discounted (signalled by ‘but then . . .’)

as the notion of smoking as stress relief is promoted. Again, it is constructed as

compulsion rather than choice (‘I need to’), as if smoking is a natural or at least

understandable response to difficult circumstances – even those brought about by smoking

itself. Smoking is then further warranted by another popular account: relative youth (‘only

in my twenties’) as a space where health concerns are not appropriate. Following on from

this position, health is located in the province of adulthood, a future dimension when

responsibilities like children may pertain (this theme is elaborated below). As discussed

under the first theme, living in the present is prioritised, with all the connotations of

enjoyment and mindlessness that entails.Rachel (FG18) also cites her father’s smoking-related illness and then her own smoking

as a coping strategy, this time voiced as a distraction from challenging circumstances:

Yes, that’s the reason I first started smoking again, because I’d stopped smoking for so longand my dad gave up smoking, and my dad’s been smoking since he was twelve, and hestopped for six month and then he had a heart attack. You would expect that to make methink ‘Right, need to stop smoking’, or whatever, but straight away I went ‘Mum, give us afag’, because I honestly didn’t know what to do and I needed something to concentrate on – itgives you something to think about other than whats going on around you.

In sum, smoking is popularly constructed as a positive resource in times of stress,

whether provoked by work, arguments with friends and family, exams, and paradoxically

perhaps, exposure to smoking-related disease within families, whether in the media or

within participants’ biographies. However, other accounts across the sample emphasised

the irrelevance of health as a concern for individual smokers, and for young people

generally, as the next section demonstrates.

Psychology and Health 213

(3) A ‘window of opportunity’: Smoking as youthful licenceWhile the health costs of smoking were often minimised by participants

(theme 1 above), they were also recognised at other points in the discussions.However, a common means of managing health concerns was to defer them, to

project them on to imagined futures where adult themes of responsibility and disciplineapplied:

Lara I see it [disease] as not happening for years and years and years (FG8);Ciara I think people think they’re invincible anyway, and you know, that if you get ill

its going to be when you get older, so you just do the whole ‘Oh, it wont happento me, not until I’m old anyway’ (FG1)

In contrast to old age as the repository of health concerns, the present twin contexts ofyouthfulness and studenthood (whether at school or university), were universally

construed as a ‘window of opportunity’ (Nuala, FG 13), a time for excess and enjoymentwhere serious issues such as health could safely be dismissed:

Bob It’s hard to like really grasp the long term effects, because it is so, like, like you’retalking about, like fifty-odd years or whatever. I mean it’s quite hard to like sortof get it into your head. But it’s like say (.) you go now for a fag¼

Chas Especially like if this, like, at the age that like we are now, because like you’re sortof approaching your peak, so you feel like more, you know

Dave [unintelligible]Chas YeahGF What, indestructible is that?

Chas Well, not indestructible, but you know what I mean, not so like anything, you’renot going to get any sort of long-term illness snow, you know, someone’s not goingto turn round and say ‘Oh, you’ve got six months to live mate’. You’re not goingto get anything like that when you’re like eighteen really [laughs]

Dave I’m more worried about short-term causes, like going out tonight, doing this, doingthat¼

Chas Yeah¼Dave It’s more just like your family or your health when you’re older¼Chas Here and now(FG2)

In this extract, and many others, smoking-related illness is something regarded asintangible and distant, something inconceivable now and only relevant far into the future(‘fifty-odd years or whatever’). The bodily fitness of young people is then invoked

(‘approaching your peak’) as health-protecting, mitigating any potentially harmful effectsof smoking. An extreme scenario is concocted to emphasise the unlikeliness of death anddisease among younger groups (‘Oh, you’ve got six months to live mate’); indeed, anexplicit opposition is marked between youth (‘like, eighteen’) and life on one hand, anddisease and death on the other. The focus on the short-term is normalised (‘going out

tonight’) while thinking about health is allocated to an adult domain where familyresponsibilities pertain.

In some discussions, a degree of self-deception was proposed:

GF What about health concerns then? I mean as smokers, what are your healthconcerns?

Rachel It does dawn on you a bit when you are having a cig and you think ‘in ten yearstime I will be in a hospital bed’, and I’m just going to think ‘why am I laid here – Iwish I could go back in time’

Nicole But I think it gets out off as well – you’ll say you’ll stop but you just can’t and evenif you do stop, when you go out and drink then that’s when you start up again ¼

Lena Yeah, when everyone else is doing it.

214 B. Gough et al.

Fiona When I go out for a cigarette it doesn’t – you’re not constantly thinking ‘what’s thisdoing to me’ – it’s not something that you are constantly thinking about.Sometimes I might think, you know, like even when you get a cold and then geta cough and it’s worse because you smoke, then you think to yourself ‘Oh God,I should stop smoking’ – but you don’t do anything about it.

Nicole I started trying – I lie to myself about how much I smoke really – I do smoke morethan I probably say I do, but its hard to admit to it¼

Rachel ‘I’ve only had so and so’, ‘I only do it when I go out’– you make excuses foryourself. I mean, if I wrote down how many I had in a week I’d be quite shockedat how many I smoke.

Nicole The bad thing is – it’s like when you’re at work – when I’m at work I can just go outfor a cig when I want and its like ‘Oh I can’t be bothered doing any work, I’ll justslack off and go and have a cig outside. And that’s what its like when you’re outwith friends, because when you’re younger I think that window of opportunity isthere because when you’re younger, you’ve got nothing to do – you cant go to thepubs, you just want to smoke out with your mates, you just stand around andsmoke.(FG13)

Here, again, disease is something allocated to the future – ‘it doesn’t happen overnight’;‘in 10 years time..’ etc. A lapse of self-discipline is confessed ‘when everyone else is doingit’. Smoking is often construed as a social practice, especially tied to the consumption ofalcohol in pubs and clubs (see Fry et al., submitted). It is normalised (‘everyone’), and apre-occupation with health effects is presented as extreme and unrealistic (‘it’s notsomething you are constantly thinking about’). There is also a shared confession aboutself-deception in terms of amount smoked (‘you make excuses’), and a sense of avoiding‘reality’ and the awareness of disease entailed thereof (‘if I wrote down how many I had ina week, I’d be quite shocked’). Nicole then ties smoking concretely to youth – the boredomand lack of access to licensed premises – a natural and understandable activity under thecircumstances. Smoking is a social practice that you ‘just want to do’. The focus of oursmokers was very much on the present, including the current state of their bodies asapparently healthy:

GF Any issues about health as a smoker?Alex I’m not – to be honest I haven’t looked at it that greatly. It hasn’t quite dawned on

me yet, you know, because the way I look at it, smoking does not, in the scientificsense, does not equal lung cancer or throat cancer. That’s the way I’ve grown uplooking at it. Even when I find out more and more cases are being diagnosedbecause of smoking, somehow it hasn’t quite dawned on me. Yes I want to quit,but that’s more or less in theory. I probably am running away from the fact – youknow the naked truth that’s staring me in the eye. I haven’t faced it head on, youknow, to see serious health issues. I like to think ‘Is my body ok? Is it functioningfine? Is it getting by alright?’, you know

Jim Like a day by day basis.Alex Yes, like a day by day basis, and of course ignoring the fact that any damage that’s

been done I can’t quite see, and I won’t feel for probably a period of time and itwill be very gradual. So somehow I have subconsciously or consciously decided toignore these facts, those health issues.(FG5)

Again, the health effects of smoking is a topic which smokers like Alex do not activelyattend to or dwell upon. As with other smokers (see above) the direct link betweensmoking and cancer is questioned by Adrian, this time from within a scientific discoursepertaining to cause and effect – although growing evidence for the link is then concededand terms such as ‘fact’ and ‘naked truth’ are used. Active avoidance of this ‘reality’ isadmitted (‘I probably am running away from the fact . . .’); however, Alex then directs our

Psychology and Health 215

attention to his current healthy status (‘functioning fine’). This focus on the ‘day-to-day’ isclearly a choice (‘I have subconsciously or consciously decided’) designed to banishunwanted preoccupation with negative health costs, costs which are at any rate classed asnebulous and distant (‘can’t quite see, and I won’t feel for probably a period of time’). Theyouthful body in the present is construed as sound, while the imagined aged body is splitoff from self and projected into a possibly compromised future.

There is also some orientation to potential health costs, and how these might beameliorated:

Jill I tell myself that I’m going to quit soon so it doesn’t matter, and if I quit soon thenthe long-term effects (.) because everybody says if you stop smoking for like two years yourhealth and all that will go back to normal and so I kind of think ‘I’m still young, I’ve still gottime to, you know . . .’ (FG19)

Thus, if smoking is time-limited and practiced when one is young (and, by implication,healthy), then the universally approved consensus (‘everyone says’) is that health will notbe compromised. Present smoking is also mitigated by considerations of ‘safe’ amounts ofcigarettes consumed while young:

GF Would that [health] affect your thinking about smoking?Helen It’s not like (.) it doesn’t happen overnight, it takes a long time for you to see the

effects, so you’re hooked on twenty a day, then you don’t (.) well, you doappreciate the long-term risk, but you don’t really think about it that much.

GF Is it because you regard your smoking status as temporary that you don’t considerthe long term risks?

Helen I don’t know (.) I think it’s maybe like alcohol as well. It’s not – say for exampleit was a Class A drug, you kind of think ‘Well if I take this I could die’, or (.) youknow you’re not going to die from smoking, so if you want to smoke for a year,you’ve always got the option to be able to give up – you can turn . . .If I smoked ten a day I wouldn’t recognise it as being really detrimental, as opposedto other things. I just thing ‘everything in moderation’. If I smoked say 40 a week orsomething, I think I’d be fine for like, say – I’m not explaining this very well – erm,you know, if you smoked 40 a week for twenty years you appreciate that youcould get lung cancer, but because you can go ‘Well I can smoke 40 a week for twoyears and then give up, then I’ll be alright.’(FG6)

Again, health effects are consigned to the dim and distant future and not somethingthat can easily be grasped or verified in the present. A contrast is made with another,perhaps more addictive, substance – Class A drugs – which are deemed more obviouslyand immediately harmful (‘you kind of think ‘Well, if I take this I could die’’). Smoking,on the other hand, is constructed as something, which people can take up and then quit atwill after a while (‘you’ve always got the option’) – as if addiction is not a problem forsmokers. Risk inoculation is also reinforced with reference to amount smoked –‘moderate’ consumption (‘ten a day’; forty a week’) is not considered risky, as long as itdoes not continue for long (2 years is ok, whereas 20 is not). So, as with other extracts, ourparticipants people construct a ‘safe’ period for smoking while young so long as certainconditions such as ‘moderation’ are upheld.

By contrast, our smokers orient very closely to the potential harm inflicted on othersthrough smoking. Smoking in public places was generally rejected, and special concernwas registered when children and food were present:

Vicki The only thing is someone who doesn’t like smoking, find it offensive, that’s whenI tend not to do it

GF Ok

216 B. Gough et al.

Vicki If it’s around kids or¼Gwen ¼Yeah, I think it depends where you are, doesn’t it?Vicki And who the observer isTracy I think, I used to think nothing of it, but I think more recently, because there’s been

such a lot about erm, passive smoking and all this kind of stuff, I’ve thoughtmore that people would think ‘Oh, like why’s she doing that? It’s quite disgusting’

Gwen But I wouldn’t smoke on the street or in a shopping centre or in er, I don’t think I’dsmoke in a restaurant. I would only smoke in a pub

(FG4)

In attending closely to the potential health consequences imparted to vulnerable others,

our smokers position themselves as responsible citizens. Perhaps this moral positioning

helps rebut the pariah status assigned to smokers in the current anti-smoking culture; at

the very least, it demonstrates awareness of passive smoking risks even as risks to self are

downplayed and deferred.

Conclusions

Our analysis highlights the value of careful attention to discussions involving young

smokers since we have illustrated how smoking, for them, is understood as a rational,

situated choice (rather than, say, addiction) conferring benefits (stress relief, enjoyment).

This finding is in line with other research on ‘alternative rationalities’ (Crossley, 2000) with

adult smokers. For example, Graham’s (1993) study with young single mothers receiving

state benefits highlighted the role of cigarettes in attenuating the stress of life in a multiply

deprived social context – ‘cigarettes are one of the few constants, one of the few resources

that they can control and rely on’ (ibid: 33). It should be noted, however, that the

qualitative research literature on smoking deploys a range of methods and analytic

approaches, and in this article we clearly advocate a broadly discursive approach to

understanding how smokers legitimise and therefore maintain their smoking practices

within a social (focus group) context.So, the physical health consequences of smoking are not construed as significant for

various groups of smokers, including our young sample. While there is clear awareness of

health issues among our young smokers, a collective view is generated wherein such

concerns do not (currently) apply – they are issues for older people – and there is a widely

shared perception that the putative health risks associated with smoking are overstated.

Smoking is explicitly linked to pleasure and relaxation, a powerful symbol indicating ‘good

times’ (often tied to drinking contexts – see also Johnson et al., 2000). Our participants

also link other lifestyle practices to risk (e.g. alcohol, diet), highlight riskier activities (e.g.

overeating – obesity), and construe life itself as a ‘game’ of risk where preoccupation with

smoking-related or any other problems is deemed excessive and paralysing. To some

extent, it is fair to say that our sample construed risky smoking as exciting and rebellious, a

theme encountered in other research on risky activities such as high fat diets (Bordo, 1993)

and unprotected sex (Odets, 1995). Overall then, our analysis points to the various and

connected ways in which the young smokers skilfully deflect the concerns of a health-

conscious culture and furnish their smoking with legitimacy. It highlights how, in a period

of increasing pressure on smokers to quit (in the UK), a series of complex and creative

accounts can be marshalled to defend and preserve what is clearly perceived as an

important social practice.It could be argued that our young smokers are expressing ‘unrealistic optimism’

(Weinstein, 1984), that is ‘inaccurate’ perceptions of risk and susceptibility in relation to

Psychology and Health 217

smoking and illness. Certainly, some recognised components of unrealistic optimism havebeen presented by participants, such as claims that major health problems have not yetappeared (e.g. current health is emphasised) and that illness can be avoided by individualaction (i.e. quitting smoking in the near future). However, such cognitive explanationstreat participants’ accounts as aberrant and irrational and do not attend to the socialcontexts in which smokers are situated. By contrast, psychosocial research, whichcontextualises smokers’ talk, helps us to appreciate how smoking is rationalised andimbued with particular meanings within relevant social groups (in this case young adults ineducational settings), as well as highlighting the creativity and sophistication of layaccounts. In turn, attention to the grounded discourse of smokers may well help informmore effective health promotion interventions (Crossley, 2000).

Our analysis complements other qualitative work in this area, which highlights the socialmeanings of cigarettes within different contexts whereby smoking among young people islinked to social facilitation and identification with valued peer groups (Fry et al., submitted;Rugkasa et al., 2001). The emphasis on social dimensions by young smokers, and thecomplex and creative ways in which smoking is justified across time and place, questions thereductionism and generalisations provided by research driven bymainstream healthmodels.As well, our participants’ treatment of health issues clearly counters dominant bio-medicaldiscourses which construct smoking as addiction and which link even short-term, modestsmoking to disease and death. Clearly, health promotion initiatives, which demonisesmokers or which make dramatic claims about long term illness are likely to be rejected byyounger smokers. Instead, interventions might better focus on concerns which are relevantfor younger people, such as anxieties about appearance and shorter-term health effects(see Grogan et al., submitted). As well, campaigns might propose alternative means of stressrelief for young people, such as exercise, breathing techniques, cognitive strategies etc –although these might only be effective if framed within relevant social contexts (see Fryet al., submitted). Finally, health educators might devise counter-discourses with which tochallenge the typical ways in which health costs are minimised by young people. Forexample, evidence could be provided demonstrating the higher risks to health posed bysmoking compared to other activities (e.g. drinking alcohol, fatty diets etc.).

To build on the current analysis, future work could conduct ‘street’ interviews withyoung smokers in the public places where smoking is popularly practiced (e.g. designatedsmoking areas at university, in pubs). This ‘live’ context might prove especiallyilluminating in terms of the discourses reproduced with respect to health issues – howsmoking is defended while people are engaged in the act of smoking. As well, it would beinformative to examine patterns of discourse in vivo i.e. through recording naturallyoccurring conversations between young adult smokers where they gather. Such researchwould complement our focus group study by determining when and how health isintroduced as a concern by younger people themselves – and examining how such concernsare negotiated. The conversations could be transcribed in finer detail to enable a moresensitive discursive analysis (Potter & Hepburn, 2005). Qualitative research in this mouldhas much to offer in terms of insights into how smoking is maintained – and how healthpromotion efforts might be reframed to better effect.

Acknowledgements

This paper is based on research funded by an Economic and Social Research Council (ESRC) grantto the fourth, third and first authors: ‘Gender differences in smoking : A 6-year longitudinal study’(reference number RES-000-22-0077).

218 B. Gough et al.

Note

1. A simplified transcription system has been used derived from Potter and Wetherell (1987) asfollows: ¼ denotes overlapping speech; underlining denotes emphasis; (�) denotes short pause;[square brackets] signal contextual information.

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