Explaining the social gradient in smoking and cessation: the peril and promise of social mobility.

Frances Thirlway

doi:10.1111/1467-9566.13039

Abstract

Smoking in high‐income countries is now concentrated in poor communities whose relatively high smoking prevalence is explained by greater uptake but above all by lower quit rates. Whilst a number of barriers to smoking cessation have been identified, this is the first paper to situate cessation itself as a classed and cultural practice. Drawing on ethnographic research carried out in a working‐class community in the North of England between 2012 and 2015, I theorise smoking cessation as a symbolic practice in relation to the affective experience of class and social mobility. I show that ambivalence about upward mobility as separation and loss translated into ambivalence about smoking cessation. The reason for this was that the social gradient in smoking operated dynamically at the level of the individual life course, i.e. smoking cessation followed upward mobility. A serious health problem was an appropriate reason to quit but older women continued to smoke despite serious health problems. This was linked to historical gender roles leading to women placing a low priority on their own health as well as the intergenerational reproduction of smoking through close affective links with smoking parents.

Highlights

Tobacco use in high-income countries is characterised by a social gradient whereby socioeconomic status is inversely associated with smoking (Barbeau et al 2004a, Blackwell et al 2014, Hiscock et al 2012)
The ‘injuries of class’ (Sennett and Cobb 1972) produce mixed emotions: resentment at the undeserved and valuable advantages conferred by an accident of birth, suspicion that some dominant values and behaviours have no intrinsic worth beyond signposting middle-class status, and temptation to refuse to acknowledge any value to the goods monopolised by the dominant class, leading to self-exclusion from potential advantages (Sayer 2002); this is described by Willis in relation to working-class boys resisting their schooling (Willis 1977)
My argument in this article is that working-class ambivalence about the benefits of upward mobility produces a similar ambivalence towards smoking cessation as a practice closely associated with it

Summary

Introduction

Tobacco use in high-income countries is characterised by a social gradient whereby socioeconomic status is inversely associated with smoking (Barbeau et al 2004a, Blackwell et al 2014, Hiscock et al 2012). There is a tendency in public health to equate ‘culture’ with risk factors, i.e. forms of ‘irrational’ behaviour by the cultural Other (Bradby and Nazroo 2010, DiGiacomo 1999), whereas In his famous account of contrasting classed dispositions, French theorist Bourdieu described a working-class ethic of sociable hedonism which he saw as going hand in hand with the rejection of middle-class practices seen as ‘pretentious’, one example of which was paying excessive attention to one’s health or appearance (Bourdieu 1984: 180–4). My argument in this article is that working-class ambivalence about the benefits of upward mobility produces a similar ambivalence towards smoking cessation as a practice closely associated with it

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Conclusion