Sociocultural change in communities: A longitudinal qualitative study

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Socio-cultural change in communitiesA
longitudinal qualitative study

• Deborah Ritchie
• Nursing Studies, University of Edinburgh
• Claudia Martin
• Scottish Centre for Social Research
• Amanda Amos
• Public Health Sciences, University of Edinburgh

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Behavioural and cultural change in communities

• Nested case studies in four contrasting
  localities (in two local authorities)
• Using a range of qualitative methods
• Exploring impacts on -
• individuals
• families
• communities
• public spaces

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Research design
Panel individual interviews Focus groups Key
informant/stakeholder interviews Observations
Time 1 Pre-ban
Panel interviews with selected sub-sample Focus
groups Observations
Time 2 0 3m Post-ban
Panel interviews Focus groups Observations Key
informant/stakeholder interviews
Time 3 6 9m Post-ban
Panel interviews Focus groups Observations
Time 4 10 12m Post-ban
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Locality characteristics
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Participants

• Purposively recruited panel of 40 participants
  (34 current and 6 ex-smokers)
• Community informants within each locality (14
  formal and informal enforcers)
• Group discussions with specific groups within
  communities (12 groups non-smokers smokers with
  children friendship panel young people)
• Discrete observation in 17 community venues

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Pre-smokefreeThe advantaged communities

• Positive about benefits of smokefree legislation
• Many venues already smoke free
• Social smoking already limited
• Knowledge and acceptance of SHS risks
• Concerns about increased trouble and mechanics of
  enforcement
• Concerns about loss to businesses
• Assumptions of compliance and speedy
  post-legislation adjustment

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Pre-smokefreeThe disadvantaged communities

• Often negative about legislation, lack of choice,
  enforced change
• Few smoke free venues
• Concerns about individual coping and trouble
  within the community
• Lack of knowledge and acceptance of SHS risks
  (but acceptance of harm to children)
• Expectations of non-compliance

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Locality characteristics
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Changes in consumption
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Changes in consumption by area
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Changes in behaviour and attitudes

• Smoking fewer cigarettes, smoking less of a
  cigarette
• Changes in consumption more notable in
  disadvantaged areas
• Shifts in awareness and acceptance of the effects
  of SHS
• Increased sense of felt stigma shame
• Continuing hostility to enforced changes, but
  awareness of benefits compliance

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Changes in the social environment Resistance

• Marginal accommodation for smokers
• Immediate post-legislation observed
  infringements and collusion between customers and
  bar staff, fall-off in attendees at community
  venues
• Longer term post-legislation minor
  transgressions accepted as local rules, more
  non-smokers in bars, calmer

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Changes in the social environment Transition

• Interior and external changes within venues to
  improve facilities
• Visible smoking in doorways
• Smoking in street while walking between bars
• Largely unchanged levels of social activity
• Businesses not unduly affected
• Low key enforcement and few infringements,
  managed informally

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Changes in the social environment Optimistic

• Re-created, comfortable outdoor space for smokers
  
• Dislike of groups of smokers outside the front of
  venues seen as intimidating
• Little outside smoking in public spaces during
  the day
• Outside noise in pub gardens at night a cause for
  complaints
• High compliance

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Losses

• Disruption to social routines and interactions
• Restriction of options for social contacts
• Loss of camaraderie/pub atmosphere
• Groups of smokers outside the front of venues
  seen as intimidating
• Outside noise in pub gardens
• Spoilt identity - shame of being a smoker

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Gains

• Shifts in attitudes and views about smoke free
  environments and understanding SHS risks
• Decreased consumption
• Aesthetic - perceived improved environment,
  cleaner, more enjoyable
• Perceived health benefits
• Supportive to quitting/reduction efforts
• Seen as better for families and children

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What this adds

• Reduction in tobacco consumption
• Understanding of the mechanisms that operate in
  communities in adopting and adjusting to
  smoke-free context
• Public disapproval is an important (unintended)
  consequence of smoke-free legislation and shapes
  smoking behaviour.
• Notable shifts in disadvantaged communities

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Conclusion

• Smoke-free legislation
• Has an impact on smoking consumption and
  behaviours
• Contributes to changes in attitudes towards
  smoking
• May be particularly influential in changing the
  smoking culture in areas of disadvantage

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Maybe happier than we expected!