Smoking to stay thin or giving up to save face? Young men and women talk about appearance concerns and smoking

UK women smokers' experiences of an age-progression smoking cessation intervention: Thematic analysis of accounts

Objectives

Appearance-related interventions to promote healthy behaviour have been found effective to communicate health risks. The current study aimed to explore women smokers' experiences of age-progression software showing the effects of smoking on the face.

Methods

A qualitative design was implemented, utilizing both individual interviews and focus groups within a critical realist framework. Fifteen, 19-52 year-old women smokers were administered an age-progression intervention. All participants responded to the intervention, engaged in semi-structured interviews, and were invited back to attend one of three focus groups. Data were analysed using inductive thematic analysis.

Results

Four main themes were identified: Health versus Appearance, Shock Reaction, Perceived Susceptibility, and Intention to Quit. Participants found the intervention useful, voicing need for a comprehensive approach that includes both appearance and health. Despite increases in appearance-based apps which could diminish impact, women's accounts of shock induced by the aged smoking-morphed images were similar to previous work conducted more than ten years previously.

Conclusions

The study provides novel insights in how women smokers currently perceive, and react to, an age-progression intervention for smoking cessation.

Innovation

Findings emphasise the implementation of this intervention type accompanied by health information in a range of patient settings.

Tobacco use, smoking identities and pathways into and out of smoking among young adults: a meta-ethnography

BACKGROUND

This meta-ethnography investigates how young adults describe their tobacco use, smoking identities and pathways into and out of regular smoking, to inform future smoking prevention and harm reduction interventions.

METHODS

Eight databases were systematically searched using keywords and indexed terms. Studies were included if they presented qualitative data from young adults aged 16-25 reporting smoking histories and/or smoking identities from countries culturally similar to the UK. A systematic and rigorous meta-ethnographic approach was employed, consistent with Noblit and Hare's methodology.

RESULTS

Thirty papers were included. Reasons stated for taking up smoking and becoming a smoker included alleviating stress, transforming one's identity, and coping with the transition to further education, employment or leaving home. Many used smoking to aid acceptance within new peer groups, particularly when alcohol was present. Smoking was also perceived as an act of resistance and a coping mechanism for those with marginalised identities. Barriers to quitting smoking included young adults' minimisation or denial of the health risks of smoking and not identifying with "being a smoker".

CONCLUSIONS

This meta-ethnography may provide a blueprint to inform the development of health and wellbeing interventions designed specifically for young adults. Smoking cessation interventions should be co-designed with young adults based on their perceived needs, resonant with their desire to quit in the future at key milestones. Harm reduction interventions should address the social aspect of addiction, without reinforcing stigma, particularly for those with marginalised identities.

Impact of tobacco and/or nicotine products on health and functioning: a scoping review and findings from the preparatory phase of the development of a new self-report measure

BACKGROUND

Measuring self-reported experience of health and functioning is important for understanding the changes in the health status of individuals switching from cigarettes to less harmful tobacco and/or nicotine products (TNP) or reduced-risk products (RRP) and for supporting tobacco harm reduction strategies.

METHODS

This paper presents insights from three research activities from the preparatory phase of the development of a new self-report health and functioning measure. A scoping literature review was conducted to identify the positive and negative impact of TNP use on health and functioning. Focus groups (n = 29) on risk perception and individual interviews (n = 40) on perceived dependence in people who use TNPs were reanalyzed in the context of health and functioning, and expert opinion was gathered from five key opinion leaders and five technical consultants.

RESULTS

Triangulating the findings of the review of 97 articles, qualitative input from people who use TNPs, and expert feedback helped generate a preliminary conceptual framework including health and functioning and conceptually-related domains impacted by TNP use. Domains related to the future health and functioning measurement model include physical health signs and symptoms, general physical appearance, functioning (physical, sexual, cognitive, emotional, and social), and general health perceptions.

CONCLUSIONS

This preliminary conceptual framework can inform future research on development and validation of new measures for assessment of overall health and functioning impact of TNPs from the consumers' perspective.

Systematic Review of Interventions to Increase Awareness of Ultraviolet Radiation-Induced Harm and Protective Behaviors in Post-Secondary School Adults

College and university students are a group known for excessive sun exposure and indoor tanning. Health education campaigns for avoidance of ultraviolet (UV) radiation have been relatively unsuccessful in this population. This systematic review examines interventions aimed at post-secondary school young adults on college and university campuses for skin cancer awareness, photoprotection, and change in UV-exposure-related behavior. Fifty-nine studies were identified for inclusion according to predetermined criteria. Study heterogeneity was high; methods of intervention were individual or group-based, and were mostly visually delivered and/or passive learning. Most interventions occurred at a single time point. Intervention success was assessed by evaluating subject behavior, intention, attitudes, knowledge, and emotion. Multicomponent interventions, generally consisting of UV photography and a passively delivered educational component, may be more effective than a single component alone. Overall, study quality was poor. Sample size of the majority of studies was <150 subjects. Most studies used self-report of behavior and had a short follow-up time. Generalizability of findings may be impacted as women, particularly white/Caucasian women, were overrepresented in the studies identified by this systematic review. For this specific target population, themes arising from the review include the importance of self-relevance and message framing. Self-affirmation was identified as a potential challenge in designing interventions for this target group, which can lead to defensiveness and a negative reaction to the health message. The findings of this systematic review may inform future research in this field, as well as guide planning of effective interventions in this target population.

A randomised trial of the effect of appearance versus health-framed messages on engagement with an online brief screening and alcohol reduction intervention

Objectives: To compare the impact of appearance versus health-framed messages on engagement in a brief web-based risk screening and alcohol reduction intervention. Design: Randomised trial delivered via Drinkaware's website. Visitors were exposed to appearance (n = 51,588) or health-framed messages (n = 52,639) directing them towards an AUDIT-C risk screening questionnaire. Users completing this questionnaire were given feedback on their risk level and extended frame-congruent information. Outcomes: The primary outcome is completion of the AUDIT-C questionnaire. The secondary outcome is whether the participant accessed any of four further resources. Results: The appearance-framed message led to a small but significant increase in the number of users completing the AUDIT-C compared to the health-framed message (n = 3,537, 6.86% versus n = 3,355, 6.37%, p < 0.01). Conversely, following subsequent risk feedback, users exposed to extended health-framed information were more likely to access further resources (n = 1,146, 2.17% versus n = 942, 1.83%, p < 0.01). Conclusions: Physical appearance-framed messages increased the likelihood of engagement with an online alcohol screening and brief intervention tool, whereas health-framed messages increased the likelihood of accessing further resources. This highlights the potential for the use of multi-level approaches in alcohol reduction interventions.

Incorporating environmental variables as precursor background variables of the theory of planned behavior to predict quitting-related intentions: a comparative study between adult and young adult smokers

BACKGROUND

As previous studies suggest that the theory of planned behavior (TPB) is open to the inclusion of further predictors, identifying a number of additional background variables within the context of the TPB may help improve the predictive power of the theory. The purpose of this study is to incorporate environmental variables as precursor background variables of the TPB to predict quitting-related intentions.

METHODS

This study consists of two sub-studies. Sub-study 1 and 2 analyzed different data sets and were conducted using the similar methodology for the comparison. A total of 395 Texas adult smokers (sub-study 1) and 379 university student smokers (sub-study 2) were analyzed using multiple structural equation modeling.

RESULTS

The extent of agreement with regulating smoking in public places had positive indirect effects on intention to quit through subjective norm among both Texas adult smokers (β = 0.03, p < .01) and university students (β = 0.01, p < .05), and through attitude among Texas adult smokers only (β = 0.02, p < .01). The number of smokers among 5 closest friends had negative indirect effect on intention to take measures to quit through subjective norm among Texas adult smokers (β = - 0.02, p < .05).

CONCLUSIONS

The results of this study indicate that environmental variables need to be considered as precursor background variables of the TPB to predict quitting-related intentions.

Intentions to Prevent Weight Gain in Older and Younger Adults; The Importance of Perceived Health and Appearance Consequences

OBJECTIVES

This study investigates whether health and appearance consequences predict intentions to prevent weight gain and whether these relationships differ in younger versus older adults and in men versus women.

METHODS

UK adults aged 18-26 years (younger adults; n = 584) or >45 years (older adults; n = 107) participated in an online survey. Logistic regression assessed associations between intentions to avoid gaining weight and age, gender as well as perceived negative consequences of weight gain for health and appearance. Co-variates were ethnicity, education, weight perception and perceived weight gain vulnerability. Interactions between age, gender and perceived health and appearance consequences of weight gain were also tested.

RESULTS

Perceived negative appearance consequences of weight gain predicted weight gain prevention intentions (OR = 9.3, p < 0.001). Health concerns were not a significant predictor of intentions overall but were a strong predictor for older adults (age × health concern interaction: OR = 13.6, p > 0.01).

CONCLUSION

Concerns about feeling unattractive predict intentions to prevent weight gain. However, health consequences of weight gain are only important motivators for older adults. Future research should identify ways to shift the focus of young people from appearance concerns towards the health benefits of maintaining a healthy weight.

Aerobic and concentration training and allele 7 in the dopamine receptor D4 (D4DR) gene increase chances of smoking cessation in young Polish women

INTRODUCTION

One reason for the limited effectiveness of the available smoking cessation methods is the fact that the causes of tobacco addiction have not been adequately explained yet. Numerous anti-smoking programs aimed at women involve intense physical activity. The goal of the study was to evaluate the effectiveness of health training for smoking cessation by young women in connection with the dopamine receptor gene (D4DR) in their genetic profile.

MATERIAL AND METHODS

Forty-eight adult female smokers were randomly assigned to: 1) a concentration training group, or 2) an aerobic and concentration training group. Genetic and phenotypic data were obtained from 48 participants. Genotyping was performed for allele 7 in the D4DR gene.

RESULTS

Individuals with allele 7 in the dopamine receptor D4 gene have two times greater chances (OR = 2.13: 95% CI: 0.91-4.96) of quitting smoking than individuals without allele 7. No statistical significance was revealed (p = 0.0805). Individuals undertaking aerobic training in combination with concentration training are three times more likely (OR = 3.06: 95% CI: 1.03-9.05) to quit smoking than individuals who do not perform aerobic training (p = 0.0439).

CONCLUSIONS

The results of the study show that an intensive, 6-week health training program had a significant influence on smoking cessation. Smoking quitters, who are genetically predisposed and decide to take up aerobic training in combination with concentration training, have much greater chances of quitting smoking.

Smoking status and attractiveness among exemplar and prototypical identical twins discordant for smoking

Smoking is associated with negative health of skin and increased signs of facial ageing. We aimed to address two questions about smoking and appearance: (1) does facial appearance alone provide an indication of smoking status, and (2) how does smoking affect the attractiveness of faces? We used faces of identical twins discordant for smoking, and prototypes made by averaging the faces of the twins. In Task 1, we presented exemplar twin sets and same sex prototypes side-by-side and participants (n = 590) indicated which face was the smoker. Participants were blind to smoking status. In Task 2 a separate sample (n = 580) indicated which face was more attractive. For the exemplar twin sets, there was inconclusive evidence participants selected the smoking twin as the smoker more often, or selected the non-smoking twin as the more attractive more often. For the prototypes, however, participants clearly selected the smoking prototypes as the smoker more often, and the non-smoking prototypes as the more attractive. Prototypical faces of non-smokers are judged more attractive, and prototypical faces of smokers are correctly identified as smokers more often than prototypical faces of matched smokers/non-smokers [corrected]. We discuss the possible use of these findings in smoking behaviour change interventions.

Doing and undoing femininities: An intersectional analysis of young women’s smoking

Previous research has found that young women’s smoking relates to their performance of feminine gender identities. Using an intersectional approach, we explore in this study how young women’s smoking is implicated in the doing and undoing of femininities, as well as other intersecting identities. Discourse analysis was used to examine interviews and a photography activity conducted with young women, both current and ex-smokers. This analysis revealed four culturally dominant repertoires: “cigarettes and smoking styles as gendered”, “smoking as controlling weight”, “smoking as a sexual tool”, and “smoking as compromising appearance”. Young women’s experiences and negotiations of discourse surrounding smoking and femininity were shaped by intersecting social class and sexual identities. These findings can be used to inform the development of smoking cessation interventions which recognise the diversity in how young women perform femininity.

Information and Communication Technology, Well-Being, and Ethnicity

The relationship between use of information and communication technologies (ICTs) and well-being is an increasingly debated public health issue. Currently, there is limited understanding of how the ethnic digital divide influences this association. Thus, this study assessed how ethnicity has historically moderated relations between ICT (mobile phone, computer, and TV) uptake, and several well-being indicators: (a) long-term health (chronic illness), (b) cigarette smoking, and (c) self-perceptions of personal health. Archived data from a U.K. Office for National Statistics household survey 2007-2011 (97,697 participant records) were analyzed, controlling for multiple sociodemographic confounders. Mobile phone dependence was associated with poorer health perceptions in Caucasian women, but more favorable appraisals in ethnic minority females (OR = 0.51). Furthermore, mobile phone uptake was more strongly related to increased behavioral risk (cigarette smoking) in Caucasian men compared with ethnic minority males (OR = 1.68). Ethnicity did not influence relations between ICT uptake and long-term health. Overall, ethnicity was implicated in relations between mobile phone use and well-being indicators: unfavorable associations occurred primarily in Caucasians.

The relationship between disordered eating and cigarette smoking among adult female twins

OBJECTIVE

While previous studies have shown a link between cigarette smoking and disordered eating (DE), it is less clear whether this association can be explained by attempts to control weight and/or temperament. This study had two aims: to examine weight/shape and DE symptomatology associated with weight control-related smoking and disordered eating; second, to investigate whether temperament-based factors explain the association between compensatory smoking and weight and shape-related characteristics, and disordered eating symptoms.

METHOD

Female twins (N = 1,002) from the Australian Twin Registry, aged 28-39 years, were assessed by interview yielding lifetime diagnostic information of disordered eating and use of cigarette smoking for weight control. Self-report measures of temperament were available.

RESULTS

Women who had never smoked (50.6%, n = 495) or had smoked for reasons other than weight and shape control (42.5%, n = 415) were generally not differentiated with respect to indicators of disordered eating. Women who smoked for reasons primarily associated with weight and shape control (6.9%, n = 67) had significantly higher levels of disordered eating than non-smokers identified as being higher levels of purging (OR = 4.55, 95% CI = 2.41-8.59) and fasting (OR = 9.32, 94% CI = 4.43-19.90) but not objective binge episodes (OR = 1.69, 95% CI = 0.71-3.99). Of those women diagnosed with lifetime eating disorders, weight-control smokers had higher levels of purging (OR = 4.22, 95% CI = 1.13-15.80) than those who did not. There were no differences in temperament.

DISCUSSION

Results support co-occurrence of smoking for weight control and purging in both community and clinical groups, and indicate this association is related to weight control and not temperament.

Gender-transformative health promotion for women: a framework for action

Gender inequity is a pervasive global challenge to health equity. Health promotion, as a field, has paid only limited attention to gender inequity to date, but could be an active agent of change if gender equity became an explicit goal of health promotion research, policy and programmes. As an aspect of gendered health systems, health promotion interventions may maintain, exacerbate or reduce gender-related health inequities, depending upon the degree and quality of gender-responsiveness within the programme or policy. This article introduces a framework for gender-transformative health promotion that builds on understanding gender as a determinant of health and outlines a continuum of actions to address gender and health. Gender-transformative health promotion interventions could play a significant role in improving the lives of millions of girls and women worldwide. Gender-related principles of action are identified that extend the core principles of health promotion but reflect the significance of attending to gender in the development and use of evidence, engagement of stakeholders and selection of interventions. We illustrate the framework with examples from a range of women's health promotion activities, including cardiovascular disease prevention, tobacco control, and alcohol use. The literature suggests that gender-responsiveness will enhance the acceptance, relevance and effectiveness of health promotion interventions. By moving beyond responsiveness to transformation, gender-transformative health promotion could enhance both health and social outcomes for large numbers of women and men, girls and boys.

'It's on your conscience all the time': a systematic review of qualitative studies examining views on obesity among young people aged 12-18 years in the UK

OBJECTIVE

To explore the perspectives of young people in the UK on obesity, body size, shape and weight.

DESIGN

Systematic review of qualitative studies using thematic synthesis.

DATA SOURCES

Sensitive searches of 18 electronic databases from 1997 to February 2010 supplemented by grey literature searches.

STUDY SELECTION

Studies produced since 1997 using qualitative methods to collect perspectives of people aged 12-18 years in the UK, reporting methods for data collection or analysis. Studies of people with eating disorders and those rated low in reliability and usefulness were excluded.

RESULTS

Searches identified 30 studies involving over 1400 young people from a range of contexts. Young people of all sizes placed considerable emphasis on personal responsibility, and on the social, rather than health implications of being overweight. Young people with experience of obesity described severe, unrelenting, size-related abuse and isolation. Regardless of their own size, young people were judgemental of individuals who were overweight, but those with experience of obesity described an environment that contained multiple barriers to weight loss. Only one study asked young people directly what might support them to have a healthy body size. Study findings were configured under three main themes, labelled with quotes from included studies: general perceptions of size and society's responses ('It's on your conscience all the time'); the experiences of young people who were overweight ('If I had the choice I wouldn't be this size') and these larger young people's experiences of trying to loose weight and suggestions for action ('Make sure, even when it's hard, you've got people there').

CONCLUSIONS

The perspectives of young people in the UK, when synthesised across the spectrum of body sizes, paint a picture of a stigmatising and abusive social world. Research and policy need to engage young people actively so as to address the social implications of obesity.

Strength Training Improves Body Image and Physical Activity Behaviors Among Midlife and Older Rural Women

The effect of strength training on body image is understudied. The Strong Women Program, a 10-week, twice weekly strength-training program, was provided by Extension agents to 341 older rural women (62±12 years); changes in body image and other psychosocial variables were evaluated. Paired-sample t-test analyses were conducted to assess mean differences pre- to post-program. Strength training was associated with significant improvements in several dimensions of body image, health-related quality of life, and physical activity behaviors, satisfaction, and comfort among rural aging women-an often underserved population that stands to benefit considerably from similar programs.

Gender influences in tobacco use and cessation interventions

Smoking rates among and between men and women are in large part a reflection of the influence of gender and its intersections with other social factors including ethnicity, age, and social class that influence tobacco use and, ultimately, tobacco reduction and cessation. In this article, opportunities for developing and delivering gender-sensitive (programs addressing gender) and gender-specific (programs designed for men or women) interventions in the context of tobacco dependence treatment are discussed.

Women smokers' experiences of an age-appearance anti-smoking intervention: a qualitative study

OBJECTIVES

This study was designed to investigate women's experiences of engaging in an age-appearance anti-smoking intervention.

METHODS

Ten 18- to 34-year-old women gave accounts of their experiences after engaging in an age-appearance facial morphing anti-smoking intervention in interviews (n= 7) and a focus group (n= 3), and 37 women gave their accounts while they were engaged in the intervention. Transcripts were analysed using a thematic analysis broadly informed by the procedures of Grounded Theory.

RESULTS

Women were very concerned about the impact of ageing on their faces in general, and in particular the additional impact of smoking on their skin. Women were concerned about other people's reactions to them as older smokers with wrinkled skin, and many experienced a physical shock reaction (including reports of nausea) to seeing how they would age if they continued to smoke. They reported that seeing their own face aged on the computer screen increased their perceived risk of skin wrinkling. Women reported being highly motivated to quit smoking as a result of the intervention, and many reported that they would take active steps to quit having seen how they would look if they continued to smoke. This was linked with increased perceived personal responsibility for quitting.

CONCLUSIONS

Results are discussed in relation to suggestions for anti-smoking interventions aimed at women in the 18- to 34-year-old age group. It is concluded that interventions incorporating age-appearance morphing techniques are likely to be effective in helping women to take active steps to quit smoking.

Aging images as a motivational trigger for smoking cessation in young women

Recruiting adolescents into smoking cessation programs has been challenging, and there is a lack of effective smoking cessation interventions for this age group. We aimed to assess whether the approach of using aging images can be used to recruit young, female smokers for a smoking cessation course. In this study, 853 14- to 18-year-old subjects were photographed (2006–2007). After software-aided aging, the images evoked strong emotions, especially in subjects with an advanced motivational stage to quit. Twenty-four percent of current smokers reported that the aging images increased their motivation to quit smoking (pre-contemplation: 8%; contemplation: 32%; and preparation: 71%). In multivariate analyses, the aged images had a high motivational impact to quit smoking that was associated with an increased readiness to stop smoking and the individual’s assessment of the aging images as shocking, but not with the number of previous attempts to quit and the assessment of the pictures as realistic. However, it was not possible to recruit the study population for a smoking cessation course. We concluded that aging images are a promising intervention for reaching young women and increasing their motivation to stop smoking. However, smoking cessation courses may not be appropriate for this age group: none of the recruits agreed to take a cessation course.

Vascular and morphogenetic abnormalities associated with exposure of cigarette smoke condensate during chicken and murine embryogenesis

OBJECTIVE

Embryonic movements (EM) and angiogenesis pathways are evolutionarily conserved mechanisms which are essential for proper embryonic development. Deviations in these processes by exposure to cigarette smoke condensate (CSC) may cause vascular and morphogenetic disorders.

METHODS

Using chicken and mouse embryos, we have demonstrated the in vivo effects of CSC on EM, vascular development, and organogenesis.

RESULTS

Examination of the CSC exposed chicken embryos revealed a significant reduction in EM, stunted growth, deviated pattern of blood vessels, hemorrhages, and localized necrosis. Likewise, mouse embryos that were exposed to CSC at E8.5 and E9.5 died between E11.5 and E12.5, respectively. These mouse embryos showed defects in morphogenesis and remodeling of the embryonic vasculature, while littermate controls showed normal development.

CONCLUSIONS

Cigarette smoking during pregnancy is fatal for growing embryos. CSC may induce the remodeling of embryonic vasculature, leading to various pathologies.