1. Defending the Absurd? Interpretations of Smokers and Smoking Jude McCool, 1 Janet Hoek 2, Richard Edwards 2, Ninya Maubach 2, 1 University of Auckland; 2 University of Otago

2. Overview Smoking remains a serious preventable public health problem Use of denormalisation as a tobacco control strategy Industry exposure Re-adjustment of social norms regarding smoking Examination of smoking in an increasingly intolerant social environment Findings from qualitative study exploring smokers social identities

3. Tobacco Denormalisation De-normalising strategies expose the industrys behaviour Toxic product peddled by an unscrupulous industry (Lee et al., 2004) Suppression of research (Bero, 2005; Hammond et al., 2006a) Creation of doubt regarding medical evidence (Smith, 2006, Hurt and Robertson, 1998) Use of litigation to impede policy measures (Ibrahim and Glantz, 2006)

4. Tobacco Denormalisation Denormalisation also reframes smoking as socially unacceptable (Alesci et al., 2003, Alamar and Glantz, 2006) Spoiled identity of smokers depicts smokers as: Malodorous, selfish people Disproportionate users of public health services, and employer liabilities (Chapman and Freeman, 2008) Smoking becomes unattractive and unlikely to enhance social standing (Hoek et al., 2011)

5. Social Identity and Smoking Denormalisation Young adults use smoking imagery and tobacco brands to co-create identities (Pollay, 2000) important, if complex, relationships between the image of smoking and the images that young people hold of themselves and to which they aspire (Amos et al., 1997)(p. 848) Social identity theory recognises importance of group membership of specific groups (Taifel and Turner, 1979, Kobus, 2003, Moffat and Johnson, 2001) Smoking a defining behaviour that signifies group membership (Stewart-Knox et al., 2005, Fry et al., 2008)

6. Social Identity and Smoking Denormalisation De-normalisation decreases appeal of identifying with smoking Increases attractiveness and accessibility of smokefree groups. If you behave in this way, what will others think of you, and how will you feel about yourself? (Pechmann et al., 2003) (p. 195) Denormalisation campaigns challenge value offered by smoking offer and stimulate more negative perceptions 10% increases in smokings social unacceptability reduced consumption by 3.7% at the State level (Alamar and Glantz, 2006).

7. BUT... Denormalisation supports public health goals YET Raises questions about the transition from smoking acceptability to unacceptability How does this affect smokers and non-smokers (Trappitt, 2010) Could stigma result, and is this acceptable (Bayer, 2008a, Bayer, 2008b, Bayer and Stuber, 2006, Bell et al., 2010, Burris, 2008)

8. Research Questions RQ1: How are smokers and smoking perceived in an environment where smoking has become an increasingly unacceptable social behaviour? RQ2: To what extent could this environment stigmatise smokers?

9. Methodology 14 group discussions and 4 in-depth interviews 86 participants (18-24) Sample included smokers and non-smokers New Zealand European, Māori and Pasifika ethnicities Discussion explored: Views on smoking; Status as smokers or non-smokers Differentiation between smokers and non-smokers Transcripts analysed using thematic analysis Identified idea elements and relationships between these to develop themes (Braun and Clarke, 2006)

10. Findings Logic and reason Non-smokers found smokers a social enigma Hard to understand smoking, given strong smokefree messaging To be quite honest, it does make me kind of look down on people who smoke a bit more, like, because I do believe there is so much evidence out there that it is so bad for your health the fact that theyre making that decision is – I dont know, I think its just kind of like weird that someone would choose to do that to themselves. And so I dont respect them as much at all.

11. Findings: Logic and Reason Non-smokers saw smoking as a personal choice, and smokers as less than rational I just think that theyre kind of stupid if theyre still doing it, and its the warning – its blatantly right in front of their noses and then if theyre ignoring it, then theyre not thinking right, theyre not thinking straight.

12. Findings: Social Disapproval Smoking an act of flagrant disrespect for health A deficiency in common decency Expressed open disapproval if it does smell really bad you do the whole kind of wee bit of a cough as you walk past, just to y know, make sure that they know that you dont really approve of it. I know it probably sounds a bit mean, but its – I do feel strongly about it.

13. Findings: Social Disapproval Smokers focussed on immediacy and overlooked potential dangers: And I know that a lot of bad health things can come from it but you dont think about that, eh? At the time when youre young, you dont think oh its going to happen to me … you just dont – it doesnt cross your mind. Deeply resented non-smokers challenges: God they are a pain in the ass. They keep ranting and ranting about the bad things of smoking… The non- smoker hates the smell of it. If they dont like it they can go away.

14. Findings: Social Disapproval Smokers recognised (and reciprocated) non-smokers rejection of them: some people [non-smokers] can come across as a little stuck up… they sort of turn up their nose up at you.. if youre off having a smoke … or if youre smoking round them they sort of act – make a big show of like, yknow, having smoke being around them and stuff Its not caring. Yknow, and not – not having to care, cause were young at the moment maybe... smokings just another way to, just maybe symbolise that, or to show other people that yknow, Im cool eh, I smoke. Which is kind of sad when you say that out loud [laughs]....

15. Findings: Addiction and Compassion Some non-smokers saw smoking as complex and were more empathic: I dont really judge them for smoking, but you can tell they can – they get kind of pissed off about the fact that they have an addiction to it. Understood addiction compromised choices: I think that they often are so addicted, though, that they arent consciously making that choice every time that they do smoke Smokers spoke of addiction: When I am stressed or, I dont know, that addiction kicks in… smoking isnt good for you, but I cant help it

16. Discussion and Implications Most non-smokers made explicit and surreptitious judgements of smokers Differentiated between themselves and smokers by extending traditional stereotypes Saw their smokefree status as the logical response to a harmful behaviour Saw smokers as flawed and themselves as superior (Chapman and Freeman 2008; Stewart-Knox et al., 2005; Fry et al., 2008)

17. Discussion and Implications Smokers recognised their minority status and social risks they faced For some, this reinforced a desired outsider identity For others, diminished the experience of smoking Smokers not unaware of risks to social persona, but lived for the moment Avoided questions Pechmann et al. (2003) raised Yet, aware of derision and empathic concern they elicit

18. Conclusions Interventions that widen gulf between smokers and non- smokers may have unintended consequences: May foster smokers solidarity and increase resistance to change. Instead, need to consider how to enable movement from smoker to non-smoker identity Broader the perceived divide between the two groups, the greater the challenge Interventions could promote greater empathy, recognise the power of addiction, and avoid stigma