Results
Phase 1: The illusion of choice and control
Responses to the photo sort task revealed two dominant metaphors: choice and control. Participants resisted acknowledging they were addicted by asserting smoking as a choice over which they maintained control. Yet despite constructing this position, none described smoking as a conscious choice and nearly all began smoking to avoid deviating from the peer group and family social norms: “We were raised in a smoking house...there was just smoke… It wasn't really peer pressure or ’cause it was just to be cool, ’cause everybody else was doing it at the time.” These comments highlight the pervasiveness and normality of smoking, where ‘everybody else’ and ‘everyone’ smoked: “When I was going out [to pubs] all the time and everyone was just smoking outside, so that's mainly why I started.” Smoking defined group membership; rather than reflecting deeply on their actions, participants adopted behaviours others modelled: “Yeah. It means a lot. It means like- ah, um, I can actually smoke. I can actually afford a smoke, and I can, um, actually, um, be my boss.” Despite the apparent passivity of their smoking initiation, smoking provided participants with a tool they used to assert their social identity.
While they had not made active choices to smoke, participants nevertheless regarded smoking and quitting as a choice that only they (or other smokers) could make. They saw choice as a personal entitlement: “…it's my choice. Freedom of choice”; a general right: “… these guys [smokers] have made the choice …”, and a national freedom: “It's New Zealanders’ choice… if they wanna quit they'll quit.” By framing smoking and quitting as “choices”, participants maintained control and distanced themselves from stereotypes of addicted smokers who had lost control. This metaphor maintained the belief their situation could change and created a protective barrier they used to deflect health advice that impinged on their perceived autonomy: “I pretty much just tell them [health professionals] what I tell everybody else. I'm gonna do what I wanna do when I wanna do it and no one can tell me otherwise.”
Despite asserting their ‘choice’, many participants struggled to maintain this privileged position of control because nearly all had tried but failed to quit while pregnant. While some women had made a quit attempt because they were advised to do so by their midwife, others had tried to stop smoking because they recognised the harms continued smoking presented to their unborn child. Women in this latter group had to contend with ongoing complications and the guilt these caused: “ I always blame myself because I know it was my smoking… I don't want to have another sick baby” and all felt the stigma of smoking while pregnant: “you know …it just looks wrong. You know, you feel bad. You feel really bad and you feel guilty.” The resulting dissonance weighed heavily as women wanted the best outcomes for their children, even though their continued smoking conflicted with this goal.
While a minority acknowledged their smoking was controlled by an addiction, the general dominance of control and choice metaphors in participants’ discourse suggested three potential cessation message themes that we developed and tested in phase 2. The first two used affect-laden approaches to challenge the reasoned positions smokers had constructed. Specific messages illustrated the effects of smoking on babies who had no choice in being exposed to toxins, and the consequences children face when their parents are harmed by smoking. The final theme used a rational approach to support smoke-free behaviours; messages recognised smokers’ autonomy and promoted children's right to a smoke-free life.
Results (
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ผลลัพธ์ขั้นตอนที่ 1: ภาพลวงตาของการเลือกและการควบคุมคำอุปมาอุปมัยหลักสองเปิดเผยคำตอบงานการเรียงลำดับภาพ: ทางเลือกและควบคุม ผู้เข้าร่วม resisted จิตเขาได้ติดตามกรรมสิทธิ์บุหรี่เป็นทางเลือกที่จะเก็บรักษาควบคุม แต่แม้ มีการสร้างตำแหน่งนี้ ไม่อธิบายนี่เป็นตัวเลือกที่ใส่ใจ และเกือบทั้งหมดเริ่มสูบบุหรี่หลีกเลี่ยงการ deviating จากกลุ่มเพื่อนและบรรทัดฐานทางสังคมครอบครัว: "เราขึ้นในบ้านสูบบุหรี่...มีเพียงควัน... มันไม่ได้จริง ๆ เพื่อนดัน หรือ 'cause ก็ เพิ่งจะเย็น 'cause ทุกคนอื่นนั้นทำเวลา" ความคิดเห็นเหล่านี้เน้น pervasiveness และ normality ของการสูบบุหรี่ 'ทุกคนอื่น' และ 'ทุกคน' ควัน: "เมื่อผมไปออก [กลาง] ตลอดเวลา และทุกคนมีเพียงสูบบุหรี่นอก เพื่อให้เป็นส่วนใหญ่ทำไมผมเริ่ม" สมาชิกกลุ่มสูบบุหรี่ที่กำหนด แทนที่จะสะท้อนอย่างลึกซึ้งในการกระทำของพวกเขา ผู้เรียนนำพฤติกรรมอื่น ๆ คือ แบบจำลอง: "ใช่ หมายถึง มาก หมายความว่า เหมือน - ah อุ่ม ฉันสามารถจะสูบบุหรี่ สามารถจริงข้าพเจ้าสูบ และ อุ่ม จริง อุ่ม ได้เจ้านายของฉัน" แม้ มีปล่อยที่ชัดเจนของการเริ่มต้นสูบบุหรี่ สูบบุหรี่จัดร่วมกับเครื่องมือจะใช้ยืนยันรูปลักษณ์สังคมWhile they had not made active choices to smoke, participants nevertheless regarded smoking and quitting as a choice that only they (or other smokers) could make. They saw choice as a personal entitlement: “…it's my choice. Freedom of choice”; a general right: “… these guys [smokers] have made the choice …”, and a national freedom: “It's New Zealanders’ choice… if they wanna quit they'll quit.” By framing smoking and quitting as “choices”, participants maintained control and distanced themselves from stereotypes of addicted smokers who had lost control. This metaphor maintained the belief their situation could change and created a protective barrier they used to deflect health advice that impinged on their perceived autonomy: “I pretty much just tell them [health professionals] what I tell everybody else. I'm gonna do what I wanna do when I wanna do it and no one can tell me otherwise.”Despite asserting their ‘choice’, many participants struggled to maintain this privileged position of control because nearly all had tried but failed to quit while pregnant. While some women had made a quit attempt because they were advised to do so by their midwife, others had tried to stop smoking because they recognised the harms continued smoking presented to their unborn child. Women in this latter group had to contend with ongoing complications and the guilt these caused: “ I always blame myself because I know it was my smoking… I don't want to have another sick baby” and all felt the stigma of smoking while pregnant: “you know …it just looks wrong. You know, you feel bad. You feel really bad and you feel guilty.” The resulting dissonance weighed heavily as women wanted the best outcomes for their children, even though their continued smoking conflicted with this goal.While a minority acknowledged their smoking was controlled by an addiction, the general dominance of control and choice metaphors in participants’ discourse suggested three potential cessation message themes that we developed and tested in phase 2. The first two used affect-laden approaches to challenge the reasoned positions smokers had constructed. Specific messages illustrated the effects of smoking on babies who had no choice in being exposed to toxins, and the consequences children face when their parents are harmed by smoking. The final theme used a rational approach to support smoke-free behaviours; messages recognised smokers’ autonomy and promoted children's right to a smoke-free life.
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