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Smoking cessation in Sweden - gender, pathways, and identity
Stockholm University, Faculty of Social Sciences, Department of Sociology.
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Research on smoking has to a great deal been conducted within a public health or a medical context, or focused on policy making. Fewer studies have taken their point of departure in a social sciences context, and still fewer have analysed why individuals start and cease to smoke, and how and why smoking patterns on an aggregate level change over time and vary between different population groups.

The aim of this dissertation is to analyse changes in the Swedish tobacco consumption with special emphasis at elucidating the decrease in smoking during the past half-century from different angels. Thus, the first paper explore if and how changes in smoking patterns can be understood and explained with reference to Sweden’s development as a welfare state, and in relation to socio-demographic and socio-economic circumstances. The second paper focuses on the long-term pathways to smoking cessation, by discerning several distinct trajectories from smoker to non-smoker. The third paper analyses gender differences with regard to reasons to smoke, experiences of smoking, and central elements in the cessation process. Finally, in the fourth paper, the issue of to what extent smoking cessation can be described as a process of identity change is explored.  

Smoking initiation and cessation vary by socio-demographic and socio-economic factors, and the rapid decrease in smoking has resulted in a rather vulnerable group of smokers in these aspects. The results also indicate that the cessation process is complex, with personal and structural factors interacting in the long-term process, leading to multiple pathways to a smoke-free life. Moreover, they point to gender differences in reasons to smoke and to quit, and in strategies to quit smoking. In addition, identity change seems to be important in remaining smoke-free. The stated inequality in gender and class points in the direction that structural changes and social policies might be of need to decrease smoking even further.

Place, publisher, year, edition, pages
Stockholm: Department of Sociology, Stockholm University , 2014. , 85 p.
Series
Dissertations at the Centre for Social Research on Alcohol and Drugs (SoRAD), ISSN 1650-819X ; 13
Keyword [en]
Smoking, smoking cessation, Sweden, gender, pathways, identity, socio-demographic background, socio-economic factors, trajectories, factor analyses, interviews
National Category
Sociology
Research subject
Sociology
Identifiers
URN: urn:nbn:se:su:diva-108481ISBN: 978-91-7649-037-2 (print)OAI: oai:DiVA.org:su-108481DiVA: diva2:758945
Public defence
2014-12-10, De Geersalen, Geovetenskapens hus, Svante Arrhenius väg 14, Stockholm, 10:00 (English)
Opponent
Supervisors
Projects
Women, Health and Substance use
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 140 67 02
Note

At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 1: Submitted. Paper 3: Accepted. Paper 4: Manuscript.

Available from: 2014-11-18 Created: 2014-10-28 Last updated: 2014-11-21Bibliographically approved
List of papers
1. Changes in smoking in Sweden since the mid 20th century – the influence of age, gender, education, and socio-economic status
Open this publication in new window or tab >>Changes in smoking in Sweden since the mid 20th century – the influence of age, gender, education, and socio-economic status
(English)Article in journal (Other academic) Submitted
Abstract [en]

Introduction/Aim: Identification of factors that predicts smoking initiation and cessation is of importance both for effective prevention strategies and cessation aid. Therefore, the aim of this paper is to characterise individuals that has started to smoke and individuals that quit smoking, with respect to age, sex, education, socio-economic circumstances, and family situation and analyse to what extent these variables predicts smoking initiation and smoking cessation. The results are discussed in relation to the policy and societal development in Sweden.

Design/Method: The data consists of self-reported data on smoking experiences, obtained from the so-called Monitor-project during Oct 2009- May 2010. By the turn of each month 1 500 individuals, aged 16-84, from a representative sample in the Swedish population (n=12 008) were interviewed via telephone. The analyses consist of descriptive statistics as well as logistic regression models.

Results: Smoking initiation and cessation is found to vary between socio-demographic and socio-economic factors, and the rapid decrease in smoking during the past decades has resulted in a rather vulnerable group of smokers in these aspects. The changes in smoking patterns can be understood and explained in relation to social and tobacco policy developments in Sweden.

Discussion/Conclusions: The study concludes that the present situation, with a low smoking prevalence over all, however concentrated to rather vulnerable groups, such as young, low educated and single women, gives raise for the need of measures in the social-political framework. 

Keyword
Smoking epidemic, Smoking cessation, Socio-economic differences, Gender, Sweden
National Category
Sociology
Research subject
Sociology
Identifiers
urn:nbn:se:su:diva-108740 (URN)
External cooperation:
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 1406702
Available from: 2014-11-03 Created: 2014-11-03 Last updated: 2016-08-29Bibliographically approved
2. Developmental pathways to smoking cessation
Open this publication in new window or tab >>Developmental pathways to smoking cessation
2014 (English)In: Drugs and alcohol today, ISSN 1745-9265, E-ISSN 2042-8359, Vol. 14, no 2, 96-106 p.Article in journal (Refereed) Published
Abstract [en]

Purpose – To a great extent research about smoking cessation has focussed on effects from different support programs and means, in spite of that several studies have shown that over 90 percent quit smoking without such help. Factors that are important for the individual in the process from being a smoker to becoming smoke-free is less examined and also how these factors interact. The purpose of this paper is to describe typical careers or pathways that end up with a successful smoking cessation.

Design/methodology/approach – Respondents were recruited during Oct 2009-May 2010 via screening-questions in the so-called Monitor – project. By the turn of each month 1,500 individuals, aged 16-84, from a representative sample in the Swedish population, were interviewed via telephone. Respondents who stated being previous daily smokers, but smoke-free for at least 12 months, and agreed to participate were asked to answer a postal survey (n=¼1,683) concerning their process to a smoke-free life. The analyses of data included the linking of individuals between different states in the stages toward becoming smoke-free.

Findings – Several typical pathways were described and respondents with more severe smoking habits followed different pathways than individuals with milder problems. Nicotine replacement therapys or Swedish smoke-free tobacco was not found to be a component in any of the typical pathways.

Originality/value – Smoking cessation is a heterogeneous phenomenon and individuals can follow several pathways to become smoke-free, therefore this study adds to a more nuanced picture of smoking cessation and also expands the knowledge concerning smoking cessation in individual long-term processes.

Keyword
cluster analysis, process, pathways, smoke-free, smoking cessation
National Category
Social Work
Identifiers
urn:nbn:se:su:diva-108480 (URN)10.1108/DAT-11-2013-0046 (DOI)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 140 67 02
Available from: 2014-10-28 Created: 2014-10-28 Last updated: 2017-12-05Bibliographically approved
3. Smoking cessation and gender differences – results from a Swedish sample
Open this publication in new window or tab >>Smoking cessation and gender differences – results from a Swedish sample
2015 (English)In: Nordisk Alkohol- og narkotikatidsskrift (NAT), ISSN 1455-0725, E-ISSN 1458-6126, Vol. 32, no 3, 259-276 p.Article in journal (Refereed) Published
Abstract [en]

Aim: Previous research has concluded that the prevalence of smoking, as well as reasons to quit and strategies to become smoke-free, varies markedly by gender.  However, we lack a more comprehensive understanding of the process that leads to a quit attempt and a positive long-term outcome, and also the gender specific mechanism behind a successful cessation. The aim is therefore to investigate motives for, mechanism in, and factors behind smoking cessation, with special regard to gender differences.

Data/Method: During Oct 2009- May 2010 respondents were recruited via the so-called Monitor-project. By the turn of each month 1,500 individuals, aged 16-80, from a representative sample in the Swedish population (n=12 000) were interviewed via telephone. Via a screening process those who stated being previous daily smokers, but smoke-free for at last 12 months, were asked to answer a postal survey (n=1 683) concerning their process to a smoke-free life. The analyses consist of both descriptive statistics and factor analyses.

Results: The results indicate that women’s smoking filled several functions in life, that they often quit for the sake of others, and that the cessation process was quite complex. Men tended to experience smoking as quite unproblematic and often quit out of more self-oriented reasons. Moreover, even though a majority quit smoking without any professional help or other means the use among those who did was clearly gendered.

Conclusions: Gender differences were found in reasons to smoke, reasons to quit, and strategies to quit smoking why cessation strategies should be gender sensitive, taking special needs into account.

Keyword
Smoking cessation, Process, Gender differences, Sweden, Factor analyses
National Category
Sociology
Research subject
Sociology
Identifiers
urn:nbn:se:su:diva-108738 (URN)10.1515/nsad-2015-0025 (DOI)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 1406702
Available from: 2014-11-03 Created: 2014-11-03 Last updated: 2017-12-05Bibliographically approved
4. Identity changes in Smoking cessation- results from a Swedish sample of stable former smokers
Open this publication in new window or tab >>Identity changes in Smoking cessation- results from a Swedish sample of stable former smokers
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Previous research on recovering from different addictive behaviours has examined e.g. the need for change in lifestyle, the importance of social networks, and more medical aspects like how to overcome craving, and coping. However, as suggested by Koski-Jännes (2002), a recovery might require identity work to achieve a more permanent change. Thus, this is a study of the, eventual, long-term changes in identity among former smokers.

   Subjects were recruited from a representative sample of stable former smokers who previously had answered a postal survey (n=1683) concerning their process to a smoke-free life, and in relation to this been asked if they were willing to take part in a personal interview about their smoking cessation process. Out of convenience reasons, 150 interviewees were randomly selected among residents in Stockholm county (n=267), and out of these 75 had agreed to take part in a personal interview. After a second request 41 subjects were still willing to participate. Out of them, 10 women and 10 men were randomly chosen, and contacted at least three times via telephone during April and May 2012. The final sample consists of 19 former smokers (10 women, 9 men), who had been smoke-free for at least the latest 12 months before the interview.

       Finally, 19 personal, semi-structured, interviews were performed during May 2012. Respondents were asked to draw a life-line, and the interview circled around how they had experienced, understood, and interpreted the changes in their “smoking-career” – from initiation to cessation – with special emphasize on identity matters, and whether the changes in smoking also implied changes in respondents’ social and personal identity (Harré, 1983, Koski-Jännes, 2002).  The transcriptions of the semi-structured interviews were analyzed using basic Content Analysis (e.g. Morgan, 1993; White & Marsch, 2006).   The analyses showed that mainly women had benefited of an identity change in their smoking cessation process.  

Keyword
Smoking cessation, Personal identity, Social identity, Interviews, Sweden
National Category
Sociology
Research subject
Sociology
Identifiers
urn:nbn:se:su:diva-109071 (URN)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 1406702
Available from: 2014-11-11 Created: 2014-11-11 Last updated: 2014-11-13

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