Pieces of the Puzzle

2010

To further understand men's continued smoking during their partner's pregnancy and the postpartum period, a study was undertaken to explore women's perspectives of men's smoking. Using a gender lens, a thematic analysis of transcribed interviews with 27 women was completed. Women's constructions of men's smoking and linkages to masculine and feminine ideals are described. The findings highlight the ways women position themselves both as defenders and regulators of men's smoking. Femininities that aligned women with hegemonic masculine principles underpinned their roles in relation to men's smoking and presented challenges in influencing their partner's tobacco reduction. By positioning the decision to quit smoking as a man's solitary pursuit, women reduced potential relationship conflict and managed to maintain their identity as a supportive partner. Insights from this study provide direction for developing gender-specific tobacco reduction initiatives targeting expectant and new fathers. Indeed, a lack of intervention aimed at encouraging men's tobacco reduction has the potential to increase relationship tensions, and inadvertently maintain pressure on women to regulate fathers' smoking. This study illustrates how gender-based analyses can provide new directions for men's health promotion programmes and policies.

Twenty new fathers participated in photo elicitation or ‘photovoice’; their photographs and the interviews in which they discussed them were analyzed using the methods described in Oliffe et al. 2008. We identified three kinds of places that the fathers smoked and that reflected efforts to sustain a masculine self. (1) Smoking on the job: the men described smoking in work settings that were aligned to traditional masculine roles such as trades and manual labour. Smoking was presented as benign compared to workplace dangers, and rationalized both as a form of stress release and a way to connect socially with other men in the workplace. Men separated their work from direct fathering, but alignment to breadwinner and provider roles were embedded in their accounts. (2) Bifurcated domestic sphere: photographs depicted acceptable smoking places as located outdoors (balconies, porches, parking lots, alleys, streets and yards); inside the home was off-limits because of the baby. Boundaries between inside and outside (as represented by the elevator panel in one photograph) were places of tension for the men, because in crossing these thresholds they were choosing between smoking or direct fathering, sometimes incurring feelings of guilt. They expressed nostalgia for single and pre-fathering days that afforded them the freedom to smoke anywhere, including inside their own home. (3) Solitary confinement: the private environments to which many men retreated to smoke were linked to traditional masculine ideals such as self-reliance, autonomy, and solitude. Smoking in solitary spaces allowed men to escape critical judgment and limit possible effects of their smoking on others. The isolation was offset by feelings of peace and calm; a smoke break was a way to transition from the work day to domestic life. A great deal of smoking took place when travelling between work and home, or when driving on the job (transit smoking). The men’s vehicles provided a space that was neither inside nor outside, nor explicitly tied to home or work. Transit smoking provided one of the few opportunities for unregulated and surveillance-free smoking and was sometimes specifically tied to male breadwinner roles. Each of the places these new fathers smoked provided opportunities and affirmation for the display of traditional masculinities; strategies that support men’s engagement in fathering may be effective in reducing tobacco use.

2009

During individual interviews, men were invited to respond to men’s images from 5 recent, mass media anti-smoking campaigns. The 5 images included: a close-up of a fetus with a warning about “daddy’s cigarette smoke”; a Health Canada image of a cyclist with text stating “Go 100%”; an illustrated cartoon-like depiction of two fingers representing men’s legs with a burning cigarette between them and textual information about impotence and smoking; the image of a grave site with a marker saying “Dad” , and text about quitting to protect your family; and a ‘real’ photograph of a 34 year-old smoker in his hospital bed dying from lung cancer while his wife and child looked on with much distress. In each instance, the men refuted the prevailing social message communicated by the campaign image with a different reading that supported their traditional ideas about masculinity. Overall, with little effort, they rationalized their own continued smoking and discounted the health effects of smoking represented in the ads. The images that presented participants with current social beliefs about fathering, such as the graveyard and the hospital image, elicited feelings of fear at leaving their families without a provider and a protector. The images that communicated factual information about the incompatibility of exercise and smoking, or dangers of impotence from smoking, were most readily refuted with assertions of strength and virility or with misinformation. These results underscore the importance of gender and how social beliefs about masculinity influence how men read mass media messages. Health promotion professionals will need to account for multiple social messages in the public domain, and be aware of the fact that communication about health dangers is insufficient to counter the impact that beliefs about masculinity exert on men’s smoking decisions.

The narrative or story-telling devices men used in their interviews when talking about reducing and quitting smoking during their partners’ pregnancy and postpartum are described in this article. Four storylines were identified in new fathers’ narratives of modifying tobacco use as part of their new parental role: (1) the cold turkey storyline (acting on an impulsive decision to quit, re-enforcing masculine ideals of independence and strength); (2) the planned reduction storyline (relying on a carefully constructed plan to reduce smoking which remained in the vague future); (3) the baby as the patch storyline (the need to smoke is displaced by the baby, who increased motivation and enhanced success); and 4) a story of forced reduction. The challenge associated with nicotine addiction was a subtext running throughout all the narratives; experiences of failed quit attempts, and the inability to explain both successful and unsuccessful quits attempts, made them see their current quits as unstable. These findings suggest that smoking has become incongruent with the current ideal of a “good father”, who is represented as actively involved in the care and nurturing of his children, and who takes seriously the responsibility to promote the wellbeing of his family. This is helpful in identifying ways interventions might be tailored to more specifically address the tobacco reduction needs of fathers. Men’s narratives suggested that rather than using NRTs, they found it preferable to draw on familiar ways to increase strength and endurance, such as setting up smoking cessation as a competition, or to maintain male socializing patterns and routines by making smoking cessation a team effort among friends. These narratives also revealed that without a clear understanding of addiction, the men tended to rely on their own resources, an approach consistent with dominant masculine ideals.

2008

Oliffe, J., Bottorff, J.L., Kelly, M., & Halpin, M.  (2008).  Analysing participant produced photographs from an ethnographic study of fatherhood and smoking. Research in Nursing and Health Research, 31, 529-539.

Twenty new fathers participated in photo elicitation or ‘photovoice’, in which they were given a 24-exposure camera and asked to capture ‘smoking through the eyes of the fathers’. These photographs were then discussed in a subsequent interview. Analysis of the photographs and narratives was conducted to ascertain how the fathers created social, psychological, and relational space for continued smoking. The four-part analysis of the photographs consisted of preview (privileging fathers’ perspectives on the photographs), review (adding other readings from the researchers’ perspectives), cross-photo comparison (viewing the entire photographic collection to develop categories of meaning), and theorizing (analyzing photographs from each category using Connell’s masculinities^1,2 and Bourdieu’s theory of practice³ frameworks). Preview and review revealed important contextual information about fathers’ smoking, as well as divergent and sometimes contradictory representations in photographs and narratives needing explanation. Cross-photo comparison found that men view their vehicles (often work vehicles that the children do not ride in) as acceptable places to smoke (‘transit smoking’). Theorizing highlighted the interplay of dominant masculine ideals and smoking behaviours, as with transit smoking. By conducting formal layered analyses, researchers can expand and extend both what is said about, and interpreted through, photographs; this type of visual data can be used to develop valuable insights into men’s health behaviours and beliefs.

2007

This analysis identified and described elements of power and control evident in couple tobacco-related interaction patterns during pregnancy. The Duluth Abuse Intervention Project Power and Control Wheel was used to examine women’s experiences of tobacco reduction during pregnancy and post partum. Although no direct evidence of partner abuse or violence accompanying partner efforts to influence women’s smoking was described, most of the elements of power and control (economic abuse, coercion, intimidation, emotional abuse, isolation, blaming, using children, and male privilege to exert control) were present in the case studies examined, and appeared to have an emotional toll and a negative impact on women’s ability to freely express their views about their own tobacco use. These factors often contributed to women’s continued and in some cases increased smoking. The findings suggest that additional care and attention should be taken in designing tobacco reduction interventions and policies directed at pregnant and post partum women and their partners to reduce the possibility that these interventions may contribute to the use of power and control.

2006

Women who quit or reduced smoking for pregnancy, and their partners, were interviewed to explore the influence of couple interactions on women’s tobacco reduction in pregnancy and the postpartum period. Analysis revealed that unexamined expectations for pregnant women’s cessation created a social context of compelled tobacco reduction, altering couples’ previously established tobacco-related routines. Changes varied depending on the couples’ established tobacco-related interaction patterns. For those couples with an accommodating tobacco-related interaction patterns (TRIP), pregnancy was a time to reaffirm shared understandings about tobacco reduction and the role each might play; however, the focus for reduction tended to remain on the pregnant woman. Couples had to find other activities to replace smoking. Women in relationships with previously disengaged TRIPs began to experience pressures for reduction. This sometimes contributed to conflict, especially if the woman was reducing and the partner was not. Women in relationships with conflictual TRIPs felt the effect of compelled reduction the most acutely, as partners became more persistent and confrontational in their demands for cessation; however, if the woman was successful with cessation, conflict decreased beyond pre-pregnancy levels. These findings regarding compelled reduction, and the attendant focus on protecting fetal health (rather than women’s health) could help to explain why cessation during pregnancy is often not sustained past the post-partum. Further, it cannot be assumed that all women are able to discuss tobacco reduction with or receive support from their partners without increasing their risk for interpersonal conflict, suggesting that a de-linked approach to supporting tobacco reduction may be needed.

How new fathers who smoked justified their smoking within the contexts of fatherhood and their partners’ tobacco reduction or cessation during pregnancy and postpartum was of primary interest in this study. Four themes emerged in men’s accounts of their continued tobacco use: (1) expressing masculinity through smoking, (2) reconciling smoking as a family man, (3) losing the freedom to smoke, and (4) resisting a smoke-less life. Men’s reliance on and commitment to dominant ideals of masculinity seemed to allow them to avoid viewing their partner’s tobacco reduction or cessation for pregnancy as an opportunity for cessation. The men presented their smoking as a deeply ingrained part of their lives, a source of enjoyment and an addiction they could not imagine giving up. Men used three strategies to support their continued smoking: a) making and breaking promises to quit smoking, b) modifying their smoking patterns, and c) minimizing the consequences of smoking. However, men acknowledged that becoming a father challenged their previously uncontested freedom to smoke in several ways. Partners’ requests or demands to stop, social ideals about fathering, and a new responsibility as a caregiver and role model for their child unsettled their resolve to smoke. Expectant and new fathers may, therefore, be optimally targeted for cessation interventions. They experience and express discomfort with their smoking, and discontinuities in everyday life associated with the transition to fatherhood. The presence of a new baby also provides opportunities for establishing new routines. It is possible that the experience of fatherhood and the notion of ‘doing’ health for someone else, an established masculine tradition, may provide a way to join together masculine identities with health-promoting change for men.

2005

Interviews were conducted with 28 postpartum women who quit or reduced smoking for pregnancy and with their partners, to explore couple interactions related to tobacco use prior to pregnancy. Analysis of their accounts resulted in the identification of tobacco-related routines that became established over the course of the relationship. These routines related to: (a) the regulation of smoking, such as where and when it was permitted; (b) practices related to the acquisition, use and handling of tobacco; (c) communication about tobacco use; and (d) responding to slips and lapses. These routines, as they were enacted and experienced by couples, could be captured in three tobacco-related interaction patterns (TRIPs): (a) disengaged, in which smoking is viewed as an individual activity or personal choice necessitating little communication; (b) conflictual, in which smoking was a source of tension in the relationship; and (c) accommodating, in which partners had similar views and expectations about smoking, communicated about it, and smoked together, or in which a non-smoking partner accommodated their partner’s smoking. These findings point to the critical role tobacco plays in couple relationships, providing empirical support for a systemic/ interactional model of the social dynamics of cigarette smoking which may influence cessation.

This article describes methodological and ethical issues that arose in an ongoing qualitative study focused on tobacco reduction in the context of couple relationships, and the strategies undertaken to deal with these challenges. Experiences with recruitment in the context of social stigma related to smoking and the potential for intra-couple coercion are discussed, as well as data collection and the implications of uncovering intimate dimensions of couples’ lives, the impact of the research process on mothers’ vulnerability, and the challenges of capturing shared, “dyad” experiences through separate interviews with men and women. These issues point to unique challenges in conducting qualitative research with couples and families and provide a useful base for similar studies.