As previously described (Chapter 2) four focus groups were conducted with women in living in urban and rural locations in Ireland to explore their views on smoking cessation. The aim of the focus groups was to gain a range of views from different aged female smokers living in socially and economically disadvantaged rural and urban settings. The women were recruited through community based development organisations, community health workers, Youthreach, and training organisations. Within each group there was a mixture of smokers (light to moderate to heavily dependent). To commence each session, the researcher asked the individuals in the group to state what age they were when they started smoking and how many cigarettes they currently smoked. Smokers were also asked to describe previous quit attempts (see Appendix 6 for topic guide).
Most of the older women started to smoke at an early age (aged 11-14), and many of their friends and family are also described as smokers. A number of the participants in both the older and younger groups reported suffering from smoking related illnesses such as COPD and asthma. In the rural group many of the young women started smoking in their early teens (aged 11-14), but in the urban group the pattern was mixed with a number starting to smoke early in the teens but an equal number commencing later in the teens/early 20s. The group who started to use tobacco later did so after starting to use cannabis. Their continued cannabis use was also given by one young woman as a reason for relapse after previous quit attempts. All four focus groups identified common barriers. These included:
n level of addiction/dependency;
n the culture of smoking within the community/ peers;
n the social context of smoking (peers/family); and n coping with stress.
Women in the older smoker groups (aged 30-55) were more likely to report having received advice from health professionals to quit and/or to describe previous quit attempts. Only a small number of the younger women reported previous quit attempts, and any smoking cessation advice received was given in context of a pregnancy or a chronic health condition (asthma).
When asked what type of approaches might help smokers consider quitting, in all groups the women reported that local champions, accurate information on NRT, and other stop smoking medication would help. It is important to note that in all groups there were discussions about the benefits and disadvantages of NRT as a support to cessation. It was clear that the women were not fully informed about the different NRTs or the other pharmacotherapies available as a support to cessation. Notably, not all were aware of the availability of NRT on prescription for medical card holders. A small number of women held very negative perceptions of the different therapies and feared side effects.
Younger smokers felt that programmes that integrate smoking within wider issues such as health, beauty, fitness, money management might appeal more than a programme focused on smoking alone. Older smokers believed it was important to include a focus on stress management/ self-esteem, and to provide social support. The importance of integrating messages on the health effects of second hand smoke on children was raised by the older women. One woman described how smoking cessation messages delivered via her son’s primary school had already prompted her to consider quitting. Similarly, one of the young women with asthma described how her mother quit using NRT as an aid in order to support her cessation attempt. Her mother is still quit but the daughter relapsed. This highlights the importance of the wider family support for successful cessation, and how a quit attempt among one family member can prompt or facilitate quit attempts among other family members.
In one of the groups, the researcher raised the issue of financial incentives to promote and maintain cessation. This idea had mixed responses. Some felt that it might provide a motivation to quit but it would be difficult to implement and was open to abuse. One young woman felt that it would send the message to non-smokers that smokers were being rewarded, which she felt was wrong. Another young woman felt that despite the financial benefits of quitting, and even with an additional financial incentive to quit, no incentive would be great enough for her to quit, as she put it “I just love my cigarettes and couldn’t cope without them”. This highlights the level of physical and psychological dependency on tobacco even among the younger smokers.
Traveller women highlighted the need for tailored information and support, ideally delivered from community health workers who understood the pressures experienced by travellers (e.g.
unemployment, eviction, discrimination). Within the discussions there was a sense of powerlessness and hopelessness among some of the older smokers. This appeared to stem from the poor health status among the traveller community and feed into a lack of motivation to quit. One older woman stated when “it’s your time to go it’s your time to go”. The women described the culture of tobacco use among the traveller community and highlighted the need to explore ways of discussing quitting that is non-threatening or non-judgemental. They described a lack of trust in health professionals and the need for information and support from their own community to address the culture of smoking. Suggestions included working on other issues and embedding smoking cessation within these approaches rather than delivering a standalone smoking cessation programme.
4.2.1 Focus Groups with Women - Key
findings
Overall the barriers described by women smokers echoed those identified by the literature and by service providers. Across the four groups there were a number of common themes. For example, all women described a high level of addiction and dependency on tobacco. Many of the women, particularly the older women, were keen to quit but struggled to do so.
The culture of smoking within the family/peers and wider community emerged as a barrier for all groups. Older women with young children in the family home (children or grandchildren) felt that children were an important incentive to quit smoking or to cut down in the home.
The importance of support from community was felt to be important. Many felt that support from peers who understood their lives would be an asset. Within the traveller community the support of lay health workers was viewed to be particularly important.
Both young and older women had mixed views and understandings of the benefits of pharmacotherapies as a support to smoking cessation, and not all were aware that NRT is available free of charge on prescription for those on medical cards.
In terms of future support programmes, the younger women felt that smoking cessation could be
integrated within beauty and fitness programmes, whereas the older women were more likely to suggest personal development, debt management, parenting or self esteem programmes. Both groups referred to the need for stress management.
Irish Cancer Society 33