And I actually have a savings account open as well now. In negotiating discourses of responsibility, a number of participants took up a position of resistance in relation to quitting smoking. She said,. I'm going to keep smoking just to be stubborn. By cutting down their smoking, but not quitting, young women can simultaneously take up positions as responsible and resistant. Accounting for the difficulty in quitting smoking, participants constructed their smoking as an addiction. This position of addiction was also assumed by Stephanie ex-smoker , when she was trying to quit smoking:.
However, this is not necessarily a comfortable or easy position for a smoker to find herself in. Several participants who had quit smoking continued to position themselves in relation to discourses of addiction. For example, Gemma ex-smoker said,. I do miss it. Constructing smoking as an addiction might prevent young women who have quit smoking from resuming smoking practices. Conversely, some participants resisted being positioned as an addict. For example, Shayma smoker said she took a photograph Fig. She explained,. What can I do? Sarah smoker spoke about the graphic health warnings on cigarette plain packaging, saying,.
Sarah draws on a neurological explanation of addiction which locates the source of addiction within the body, allowing her to position external stimuli, like the graphic health warnings on cigarette packaging, as ineffective in treating her smoking addiction.
Conversely, Emily ex-smoker , said,. In their accounts of quitting, participants challenged the idea that their addiction was only physiological by emphasising the habitual aspects of their smoking. For example, Courtney ex-smoker took a photograph of a cup of tea Fig. Like Courtney, many other participants spoke about how their smoking habits were paired with other habits and addictions, such as alcohol and coffee.
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I find that every night before I go to sleep, I look forward to a coffee and a cigarette in the morning. Participants gave accounts of how the habitual nature of their addictions rendered nicotine replacement products ineffective. I wanted a cigarette, even though I had the nicotine, I still got that kind of nice feeling of relaxation but it was the actual cigarette, like lighting it and stuff. I like the act of smoking. A lack of willpower was seen by participants as being a barrier to quitting smoking. This construction allows young women smokers, such as Caitlyn to take up a position of agency in relation quitting smoking.
I guess it is so much easier for me to let it go. In contrast to their accounts of addiction, participants constructed smoking as a choice, and emphasised the importance of making a decision to quit. The construction of smoking as a choice, and quitting as a decision had implications for subjectivity, allowing participants to develop a sense of agency and optimism around quitting. This optimism is also evident in the following comment from Rachel smoker :.
I want to do it on my terms. Another participant, Lisa smoker , said,. Like for a month, I do not have enough money…to justify smoking.
However, in another account given by Lisa, she describes a loss of optimism and agency:. This account from Lisa highlights how the sense of optimism that results from the construction of smoking as a choice, may diminish with multiple quit attempts. By constructing smoking as a choice, participants were able to dismiss tobacco control messages. The construction of smoking as a choice had implications for how participants approached quitting. For example, Courtney ex-smoker gave the following account of quitting cold turkey,.
She explained this photograph by saying,. I put the Band-Aids on the ground to kind of push the idea that, this is something I need to heal within myself. Public health initiatives, such as graphic health warnings on cigarette packets, often target individual smokers, reinforcing the notion that smokers are individually knowledgeable and responsible for the risks of their smoking [ 51 ]. Participants in our study took up positions of responsibility by reiterating the irresponsibility of smoking, and expressing their desire to quit, a finding consistent with previous research [ 52 , 53 ].
The cost of smoking and the impact of smoking on health were the two main reasons for wanting to quit or change their smoking behaviours, supporting previous research [ 16 , 54 ].
The responsibility participants took for both their own health, and the effect of their ill health on others, could relate to the unique material and discursive pressure put on women to be primarily responsible for health and to care for others [ 13 ]. Similar findings have been identified in other research, which show that women are twice as likely as men to report feeling pressure to quit smoking, saying this pressure mainly comes from children and other family members [ 55 ].
This study also provides further evidence that tobacco control policies, such as taxes and health warnings, are successful in prompting cessation, and discouraging regular smoking among young people who are experimenting with smoking [ 56 ]. However, despite being motivated to quit, some young women require additional support with the process of cessation [ 57 ], highlighting the need for comprehensive approaches to tobacco control which incorporate both population-level interventions and additional supports targeted specifically at young women.
Young women in this study also expressed resistance towards quitting, positioning quitting or cutting down smoking as a future event. Young people often perceive few short-term negative health effects as a result of smoking, which can produce a sense of invulnerability, allowing them to delay quitting until they are older [ 58 ]. This sense of invulnerability is also affirmed by the construction of smoking as a temporary, youthful phenomenon, which young people can take up and then quit when they chose to [ 59 ]. By positioning quitting as a future event, young women acknowledge the need to quit smoking, which allows them to maintain a position of responsibility.
Adopting an 'in between' identity [ 34 ], young women are able to retain the socially beneficial aspects of their smoking, while avoiding the stigma experienced by habitual smokers. This indifference towards quitting smoking represents a form of passive resistance to the imperative of health [ 61 ]. This study found that addiction discourses and a position as an addict have varying implications for young women smokers and ex-smokers.
Participants in this study both adopted and resisted positions as an addict — similar to a previous study of Australian smokers [ 62 ]. Addiction discourses alleviate some responsibility for smoking behaviours, allowing young women to defend their smoking and account for the difficulties they face in quitting [ 29 ]. Neurological explanations of nicotine addiction, which locate the problem of addiction within the individual as opposed to the cigarette, can also lead to feelings of fatalism, hopelessness and disempowerment [ 33 ].
Young women in this study differentiated between the physiological, and the psychological or habitual aspects of addiction, a finding consistent with previous research [ 29 , 65 ]. Positioning themselves as habit-addicted, rather than nicotine-addicted, allows smokers to contextualise their smoking as a social practice that forms part of their everyday lives [ 62 ]. This discursive positioning correlates with data that show that women are generally more sensitive than men to the non-nicotine factors that relate to smoking, such as smoking cues, and positive sensorimotor effects, leading them to have greater success with non-nicotine medications and behavioural interventions, compared to nicotine replacement therapies [ 67 ].
These findings suggest that it is important that smoking cessation programmes targeted at young women present a comprehensive view of addiction, and offer social and psychological interventions, such as counselling, alongside pharmacological treatments for nicotine addiction. Discourses around smoking being a choice are prevalent among health care workers [ 68 ], the tobacco industry [ 69 ], in tobacco control messages targeting young people [ 19 ], and has been reported in previous studies of young smokers [ 70 ].
The emphasis young women place on decision making in relation to quitting smoking may lead them to think they must put serious thought and planning into quitting. This focus may prevent young women from making spontaneous quit attempts, which may be more successful than planned attempts [ 72 ]. Smoking cessation research, policy and practice has concentrated on pharmaceutical and behavioural interventions, despite most smokers reporting that unassisted quitting is their preferred method, and unassisted quitting being the method with which they have the most success [ 73 ].
Tobacco control programmes and interventions targeted at young women need to acknowledge the value of unplanned, un-medicated cessation, but at the same time, allow space for those women who need further cessation support. As noted in previous research [ 75 ], participants in this study drew on notions of willpower to understand the control they have over smoking.
Young women who position themselves as lacking willpower may be reluctant to attempt quitting, highlighting the importance of cessation support that gives young women a sense of power over their smoking.
One participant constructed agency in relation to quitting as masculine, a finding which relates to research where men report greater agency over cessation [ 76 ]. The use of narrative therapy has been suggested as an intervention which may help smokers to make sense of these contradictory positions of addiction and agency [ 62 ].
Nicotine Replacement Therapy for Quitting Tobacco
This therapy could also incorporate dual process theories of smoking cessation, which integrate contradictory notions of spontaneity and preparation in their model of successful cessation [ 78 ]. Optimism also plays an important role in quitting, as self-efficacy and feeling able to quit are key to successful cessation [ 81 ]. However, as findings from this study, and others have shown [ 80 ], realising the difficulty in quitting may also be an important part of the quitting process.
Cessation supports and health campaigns need to foster optimism among young women smokers, by positioning quitting as an attainable goal [ 82 ]. However, they also need to be careful not to present the benefits of cessation as being immediate, or ignore the physical and psychological challenges of quitting [ 52 ].
Young Australian women’s accounts of smoking and quitting: a qualitative study using visual methods
The best approach for communicating this contradictory message of optimism and difficulty, should be the subject of further research. The use of qualitative interviews, a photography activity, and follow-up interviews allowed the researcher time to build trust with the women and actively involve them into the production and analysis of data, which helped to increase the credibility of our research [ 83 ]. The triangulation of different qualitative methods added variation to the data, which allowed for a more nuanced analysis to take place [ 84 ].
However, the triangulation of interview and photography data also presents several challenges. For instance, decisions relating to the privileging of one data set above another is a challenging aspect of the triangulation process [ 48 ].