Gender differences are marked in China in terms of smoking prevalence, with over half of Chinese adult men smoking while few women smoke. While studies have suggested that the women’s role be taken into account regarding anti-smoking initiatives, few in-depth studies have exclusively explored women’s constructions of their male family members’ smoking, particularly in rural contexts where smoking is rampant. Using a gender lens, the current study explores the role of mothers of young children to protect their children from exposure to SHS (Secondhand smoke). The study applies a micro-sociological approach using ethnography as the primary research methodology. Fieldwork for the study was conducted between November, 2008 and August, 2009 in a rural area of Central Jiangsu, China. Recruitment of the participants was guided by feminist theory about the values and limitations of the women’s experiences in constructing knowledge about their social life. While mothers of young children were the primary target participants, other family members were also recruited to complement the data from the mothers. In total 16 mothers of young children, four fathers, four grandfathers and five grandmothers were invited to participate in the study. In addition to field observations in home and public settings, interviews carried out with the 29 family members constituted a substantial part of the data. The study revealed that, while father’s smoking was a source of SHS exposure for children in their family, grandfathers’ smoking had become a more important source, posing challenges for mothers in their efforts to protect their children from SHS. Despite limited knowledge about the risks of tobacco smoke to their children’s health, mothers were highly motivated to reduce SHS for their children, who were generally the only child in the family as a result of the one-child policy. The initiation and selection of the strategies to reduce children’s SHS exposure were mediated by gender relationships between mothers and smokers. The lower status of women in the wider social structure, along with the broad acceptance of smoking in the social environment, further limited mothers’ agency in dealing with home smoking. This study calls for re-thinking of the development of home smoking control initiatives which rely solely on expectant/mothers’ roles because of their influence on men’s smoking. Interventions involving family members in a stronger position of power within the family, particularly the grandparents of children, can ease the moral pressure on young mothers to regulate men’s smoking and reduce the potential damage to family harmony caused by junior members’ confronting the smoking behaviours of patriarchal authorities in the family. Furthermore, policies are needed to tackle the pro-smoking culture in rural China.

Background: Since the implementation of Tobacco Advertising and Promotion Act (TAPA) in the UK, Point-of-Sale (PoS) tobacco displays have been an increasingly important medium of tobacco marketing in the country. However there is little UK evidence on how PoS displays promote tobacco products, brands and their prices, or the associations between PoS displays and adolescent smoking and susceptibility. The Health Act 2009 prohibited PoS displays in larger shops in April 2012, with an exemption for smaller retailers until 2015, but the health implications of this partial ban currently being implemented in England have not yet been addressed. Methods: An observational survey of PoS tobacco displays was conducted of a sample of small retailers selling tobacco in Nottingham, UK. Digital pictures of 117 tobacco displays were taken and analysed to assess the content of PoS tobacco displays and in particular the tobacco products and prices on display. A self-completion questionnaire survey was also carried out among students attending 11 secondary schools in and around Nottingham city, and logistic regression models used to investigate the relation between exposure to and awareness of PoS tobacco displays, and awareness of brands on displays, with adolescent ever-smoking and measures of smoking susceptibility. These associations were examined in more detail, for small and larger shops separately, to assess the impact of the first phase of the ban implemented in large shops under the terms of Health Act 2009. Results: The retailers' survey indicated that PoS tobacco displays were placed in close proximity and in the same field of vision with products attractive to children such as chocolates and sweets and often could be seen from outside the shops. Moreover, PoS displays communicate value in a jurisdiction where tobacco prices are particularly high. In the shops surveyed, 43% of all cigarette packs on display 2 were small packs containing 10 cigarettes, retailing on average at a mere £2.86; moreover, 60% of all RoII -Your-Own (RYO) tobacco packs on display were small packs of 12.5 g retailing on average at £3.06. Furthermore, 44% of all cigarettes packs and 40% of all RYO packs on display were price-marked, and price-marking was particular prevalent amongst the cheapest brands. According to the results of the school survey, the odds of ever-smoking were doubled in those visiting shops almost daily relative to less than once a week (OR 2.23 95% Cl 1.40 to 3.55), and the odds of susceptibility to smoking were increased by around 60% (OR 1.6295% Cl 1.25 to 2.10) with daily visits. In those who noticed tobacco on di splay every time during store visits, the odds of susceptibility were increased more than three times relative to those who never noticed tobacco (OR 3.15 95% Cl 1.52 to 6.54). For each additional tobacco brand recognised at the PoS, the adjusted odds of being an ever-smoker increased by 5% (OR 1.05 95% Cl 1.03 to 1.06) and of susceptibility by 4% (OR 1.0495% Cl 1.02 to 1.05). More frequent visits to shops displaying cigarettes were associated with higher awareness of tobacco brands. The association between frequency of visiting stores and susceptibility was due predominantly to exposure in small shops. Conclusions: PoS displays communicate value by displaying a high proportion of lower cost brands, and smaller and hence lower-cost packs, and by displaying price discounts on packs. Exposure to and awareness of PoS displays, and awareness of brands in displays, was associated with increased smoking susceptibility, predominantly through exposure in small shops. Removal of PoS displays will prevent price promotion at the PoS, but the findings of this research also suggests that minimum pricing of 20-pack cigarettes, prohibition of sale of cigarettes in packs less than 20, and plain packaging to prevent price-marking, are also necessary if price is to be used effectively as a tobacco control measure. This research adds to international evidence that PoS tobacco displays can promote smoking among young people and suggests that a one-off, 3 comprehensive tobacco display ban would be the recommended approach to prevent this effect. 4

No description available.

Background The harmful effects of smoking during pregnancy have been well documented within the literature (Eastham and Gosakan 2010, British Medical Association [BMA] 2004). Consideration of these facts encourages many women in giving up the habit during this period. However, following the birth the decision to remain abstinent from smoking is often a difficult one for women to make with quite a number relapsing in the first few months. The risk factors for smoking during pregnancy predominantly focus on the health of the baby whereas the longer term risks and benefits of not smoking, although identified by women are not reinforced in preparation for post natal abstinence. With knowledge of the high numbers of women relapsing to smoking postpartum the purpose of this study was to explore the experiences of women during transition to motherhood who stopped smoking during pregnancy. A mixed methods study was undertaken using both quantitative and qualitative approaches in the form of questionnaires and interviews. Participants Women were initially recruited to the study through questionnaires made available in the antenatal clinics in two large teaching hospitals in the East Midlands. In total 216 questionnaires were returned from a possible 400, however, nineteen had been incorrectly completed so were excluded. Of the remaining 197 questionnaires 75 had been completed by women who had not smoked at the beginning of pregnancy and as such were excluded from the final analysis. Women willing to participate in the interviews left contact details on the questionnaires. In total 27 women were interviewed on three occasions, once between 28 and 36 weeks of pregnancy and twice in the postpartum at six weeks and between three and six months. The women interviewed comprised women born in the UK and women born outside of the UK with ages ranging from 16-38 years of age. Analysis The questionnaires were analysed using SPSS which produced pertinent demographic details of the range of women within the catchment area for the study. Data collected during the interviews were finally analysed as a continuous narrative from each woman aided by the use of NVIVO software. Results/Findings Data arising from the results of the questionnaires showed that 53.2% of the women were primigravida and 57.6% were in close contact with a friend or relative who smoked. The data also indicated that the majority of women gave up smoking for the health of the baby and had little professional help in stopping. Some of the women considered that partners were supportive when stopping smoking, but overall, the women considered they stopped of their own accord. Findings from the interviews revealed three original concepts that had a further six themes and 15 subthemes. Social influence, barriers and facilitators, and most significantly, pregnancy seen as a new start in life or just an interval were the three key concepts arising from the study. These concepts were further broken down into themes and sub themes that impacted upon a woman’s relationship with smoking. The social influence of friends and family worked both positively and negatively for women with regard to remaining a non-smoker, professional support was generally seen as positive. The health of the baby, breast feeding, self-efficacy and self-belief, nausea, the smell and taste of cigarettes and policy change were also drivers for stopping and staying stopped. Where relapse was more likely, women struggled with issues of guilt, stress and difficulty in breaking long standing habits. However, the overriding factor in remaining a non-smoker was the notion of beginning a new chapter in their lives; a new life they discussed planning to stop and the emergence of a new identity. For some women returning to smoking was a reverse of these ideas, viewing pregnancy as an interval or suspension of their lives and a return to smoking signified a return to their previous, familiar identity and confidence in who they were. Conclusion It is anticipated the findings from this research will contribute to the development of more successful interventions to aid long term smoking cessation in the future by adding to the knowledge of the complexities of smoking cessation during pregnancy and the transition to motherhood. Further research is recommended to look at supporting women in achieving higher levels of self-belief and self-efficacy and to consider pregnancy as a time to start a new phase in their lives. For interventions to be successful greater collaboration between health professionals and women must take place to ensure that such interventions meet the needs of the women.

The overarching aim of this research was to investigate the role of affectivity in real-world smoking behaviour. The motivational relationship between affect and smoking was conceptualised within an interactive hierarchical framework: assessing associations with natural situational variability over time, and moderation by relevant individual differences (chiefly, BIS-BAS scores - as reflecting affective disposition/motivational sensitivity). An initial questionnaire study was undertaken towards the development of a diary design that would be useful in capturing experiences around everyday smoking behaviour (Chapter 4). This design was then applied in a series of diary studies that were set up to address questions pertaining to the central aim of the research. The main body of the thesis is structured around these areas of enquiry. Chapter 5 tested competing theoretical models of mood-smoking motivation in everyday contexts and Chapter 6 extended this Investigation hierarchically: to ascertain whether there are individual differences in identified motivational experiences. Chapter 7 compared smoking with natural appetitive behaviour (food consumption) to better demarcate parts of the motivational process that might be set awry in reinforcement of non-natural consumption. The influence of more general periodic shifts in motivational experiences and behaviour on consumption/desire to consume was examined in Chapter 8. The final investigative chapter (Chapter 9) compared processes identified for normal smoking behaviour with processes during deprivation/abstinence. Each chapter draws on data from the diary studies as appropriate. Findings were generally congruent with other naturalistic research in supporting positive mood enhancement (principally, anticipatory elevation of hedonic tone) as a motivation for normal smoking. BAS reward-sensitivity moderated hedonic incentive effects, but not in the expected direction. Comparisons with natural consumption behaviour suggested that motivations for natural appetitive rewards may differ from those for acquired substance use. Notably, smoking motivations changed somewhat during deprivation, when tense arousal and frustration emerged as operative factors. Chapter 10 considers the implications of the research for models of mood and personality. These include implications for conceptualising reinforcement sensitivity.

Αν και έχει περάσει τουλάχιστον μισός αιώνας από την πρώτη επιστημονική έρευνα που καταδείκνυε τις πιθανές επιπτώσεις του καπνίσματος στην υγεία και ενώ πλέον έχουν διερευνηθεί και διαπιστωθεί από την παγκόσμια επιστημονική κοινότητα, σε μεγάλο βαθμό, οι συνέπειες αυτών τόσο στον ενεργό όσο και στον παθητικό καπνιστή, ο αριθμός των καπνιστών παγκοσμίως αυξάνεται αντί να μειώνεται. Τα οικονομικά μεγέθη της καπνοβιομηχανίας, τα αίτια έναρξης του καπνίσματος και το οικονομικό κόστος που αυτό επιφέρει, οι μέθοδοι πρόληψης και διακοπής του καπνίσματος καθώς και η ανάλυση κόστους – αποτελέσματος αυτών των μεθόδων είναι μερικά από τα θέματα που θα μας απασχολήσουν στην παρούσα εργασία. / It has been at least half a century from the first scientific research that showed the likely repercussions of smoking in health and even it has been investigated and realised by the world scientific community, to a large extent, the consequences of smoking in the active and passive smoker, the number of smokers worldwide is increasing instead of decreasing. The economic sizes of tobacco industry, the reasons why people start smoking and the economic cost that this involves, the methods of prevention and interruption of smoking as well as the cost – effectiveness analysis of these methods are some of the topics that will occupy us in the present research.

Smoking is the leading avoidable cause of mortality and serious disability worldwide. The prevalence of smoking varies greatly between the 27 European Union (EU) Member States as does the implementation of tobacco control policies. The main aims of this thesis were to investigate the extent of the variation between and the reliability of measures of smoking prevalence, the relation between prevalence and tobacco control policy implementation, the country characteristics associated with policy implementation, and a detailed analysis of the association between cigarette prices and smoking prevalence.

Second-hand smoke exposure (SHSe) causes significant morbidity and mortality in children. A large proportion of children with smoking parents do not live in smoke-free homes, however, to date, little is known about the prevalence of partial smoking restrictions and their efficacy in reducing children’s SHSe. Given the lack of convincing evidence on how to achieve further reductions in children’s SHSe in the home, the identification of the modifiable factors associated with childhood SHSe is imperative to reduce the burden of disease resulting from childhood SHSe. Analysis of the Omnibus Survey (OS) revealed that the prevalence of smoke-free homes in England did not increase significantly between 2006 and 2008. Only 30% of smokers reported a smoke-free home in 2008. However, during the same time period, the proportion of smokers (who did not have a smoke-free home) reporting that they did not smoke when in the same room as a child increased significantly from 62.5% to 74.8%. Using the Health Survey for England, biologically validated self-reported measures of child SHSe revealed that in 2008 and 2009 approximately 50% of children living with a smoking parent were not exposed to SHSe in the home (0.30ng/ml, 95% confidence interval 0.27-0.32ng/ml). Of the 50% of children who remained exposed inside the home, 29% had a parent that smoked in one room only in the home. These children had significantly lower cotinine concentrations (1.13ng/ml, 95% CI 1.05-1.22) than the 21% of children with smoking parents who smoked in 2 or more rooms in the home (2.36ng/ml, 95% CI 2.08-2.68ng/ml). Although smoking in one room equates to lower risk it does not equate to no risk and so interventions are required to change indoor smoking to outdoor smoking. The OS data found that good knowledge of SHS-related illnesses was predictive of both full and partial smoking restrictions in the home. Increases in the proportion of respondents with good knowledge occurred during 2003-2006, a period when frequent anti-SHS mass media campaigns were aired. A case-study evaluation of a brief mass media campaign in the North West and North East of England, which aimed to move smoking parents to smoke outside, was found to have no statistically significant effect on home smoking behaviour in the short term, however knowledge that SHS caused both heart attack and Sudden Infant Death Syndrome increased in this region following the campaign whilst simultaneous decreases were found in the rest of England. Following the identification of those children most exposed to SHS, and the modifiable factors associated with this exposure, this thesis suggests that a comprehensive multi-level approach to tobacco control policy, which includes emotive media campaigns which include information on SHS-related illnesses, will contribute to the continued reduction of childhood SHSe.