1 Introduction
UK based literature on smoking in relation to black and minority ethnic (BME) communities although substantial, tends to concentrate mainly on the medical and disease prevention arena (Ahmad 1988) showing cause and effect relationships rather than prevalence, needs and development of anti-tobacco dissemination programmes. Studies pertaining to the latter are few and far between and although a recent study conducted in England (HEA1999) provides a useful insight into the prevalence of tobacco usage south of the border, no similar study has been conducted in Scotland. The present study is the first of its kind in Scotland and more specifically in Glasgow.
2 Background to the Study
ASH Scotland is one of the leading providers of information and resources pertaining to the use of tobacco and its devastating effects. The organisation is acutely aware that existing resources and information may not necessarily be reaching all the intended sectors of the Scottish community and that they may not be appropriately developed to suit different audiences.
In response to this, ASH Scotland initiated a programme of community initiatives (1996) which offered funding and support to community based agencies to develop, implement and evaluate initiatives within the Women Low Income and Smoking Project (WLISP). Although one project within this programme was directed at black and minority ethnic communities in Scotland, the findings were not completely disseminated to ASH Scotland.
In the absence of such information, ASH Scotland remains unaware of the nature and extent of smoking amongst these communities. In an effort to gain a better understanding of key issues in this area, ASH Scotland commissioned the Scottish Ethnic Minority Research Unit (SEMRU) to conduct an exploratory study on smoking patterns (prevalence) within BME communities in Glasgow. The focus of the study was mainly on their usage of tobacco and awareness of tobacco related issues.
3 Aims and Objectives of the Study
The main aim of the research was to examine the perceptions and experiences of BME adults in terms of smoking so that appropriate strategies might be developed to support both smokers and non-smokers within these communities.
In order to achieve the above aim, the study examined the views of a sample of BME adults and health workers in Glasgow on smoking patterns and prevalence within BME communities. In addition to this, an assessment was made of the existing tobacco resources, information and support for smokers aimed at BME communities. In particular, participants were invited to share their views on the nature and development of appropriate anti-tobacco strategies and the promotion of the work of ASH Scotland within these communities.
4 Research Methodology
While a mainly qualitative research approach was adopted, a small amount of quantitative information was collected given the limited information available in this area of work in Scotland. The majority of the data were collected through one to one in-depth interviews with members of the BME community, using a structured questionnaire (Fieldwork One). To supplement this process, a semi-structured topic guide was designed to direct the discussions with service providers (Fieldwork Two).
Quantitative data were analysed using a statistical analysis package (SPSS) and quantitative data are presented in the form of tabulations and graphic representations to highlight key findings, where relevant. A content analysis technique was used to sort qualitative information and this is mostly represented in the respondent’s own words throughout the report.
5 Profile of Respondents (Fieldwork One and Two)
85 members of the BME communities across Glasgow were interviewed during Fieldwork One. The respondents represent the four main minority ethnic communities in Glasgow: Black1 (9.4%), Chinese (17.6%), Indian (15.3%) and Pakistani (59.9%). The majority of the respondents in Fieldwork One were fairly youthful being under 35 years of age. A fairly even distribution of male (47.1%) and female (52.9%) respondents was achieved in the sample.
20 organisations were interviewed during Fieldwork Two, the majority (80%) of whom worked within the health service field. Approximately, two thirds (n=12 60%) of the organisations were voluntary and the rest (n=8 40%), were statutory.
6 Key Findings
6.1 Profile of Smokers
The personal experiences of smoking recorded in this study are based on a sub-sample of 57 respondents (this includes those who may not be currently smoking but had smoked previously).
Interestingly, respondents appeared to place emphasis on the frequency of smoking, and many, especially those who used tobacco less regularly, believed that there ought to be distinctions between those who smoked regularly and those who smoked sporadically. As a result, those who used tobacco described themselves in three different ways.
More than half (59.6%) the respondents described themselves as regular "smokers" while the rest felt that although they smoked, they did so less frequently. The latter tended to see themselves as either "social smokers" (24.6%) or "occasional smokers" (15.8%). (For the purpose of this analysis the terms "smoker" refers to respondents who smoked daily; a "social smoker" refers to respondents who smoked during certain periods when socialising, for example weekends and an "occasional smoker" refers to those who smoked less than once a week).
In terms of ethnicity, the majority of those who smoked in the sample were of Pakistani background (n=29 64.4%) and there is ample evidence to show that the incidences of smoking were higher amongst Pakistani females than amongst the Pakistani males. This pattern of high prevalence was also noted by the service providers in the study who believed that smoking was escalating amongst South Asian girls in general, but more so within the Pakistani community.
An overwhelming majority of those who smoked (n=49 86%) began smoking either during their teenage years (13-19 years): (64.9%) or before the age of 25 (21%). This pattern is consistent across all ethnic groups in the sample.
Data collected on income did not reveal any notable pattern in earnings between those who smoked and those who did not.
6.2 Initiation into Smoking
Although previous research has shown that children of smoking parents are more likely to experiment with and take tobacco than children whose parents do not smoke (Gritz et al1998), only one respondent in this study felt that their initiation into smoking was as a result of family influence.
However, family influence cannot be completely ruled out as closer analysis of the data revealed that those who smoked were more likely to have a smoker in the family (51.8%) compared to those who did not smoke (30.6%). The data also revealed that smokers were more likely to be influenced by a brother or sister who smoked rather than by a parent who smoked.
More importantly, the vast majority of those who smoked (n=34 60.7%) cited "peer pressure" (n=16) or "friends smoking" (n=16) as the key factor which encouraged them to start smoking.
6.3 Methods of Tobacco Consumption
The main method of tobacco consumption was through cigarettes and nearly three-quarters (74.2%) of those who described themselves as smokers consumed between 5-20 cigarettes per day. On the other hand, social smokers indicated that they smoked no more than 10 cigarettes while socialising (not daily), which is arguably lower in volume when compared to the amount consumed by smokers during a 24-hour period.
Overall, smokers within all minority ethnic groups in this study smoked substantially less than the UK average of 17 cigarettes per day but the Pakistani smokers tended to smoke more on average than other minority groups in England (HEA 1999). These and other similar patterns noted earlier in terms of ethnicity, suggest that the Pakistani respondents were the heaviest smokers in the study, a pattern that might warrant closer monitoring in terms of anti-tobacco intervention.
Whilst 93% of the smokers used tobacco in the form of cigarettes, a small number of South East Asian smokers used the hooka2 or paan3, usually in addition to cigarettes. Despite the low level of usage of the hooka and paan, service providers noted concern regarding the easy availability of paan in Asian shops and, in particular the lack of warning labels on paan packages.
The hooka was used mainly by male respondents in this study and again, while the level of usage was relatively low, service providers were equally concerned about the general belief amongst users that tobacco filtered through water is less harmful than cigarette smoking.
6.4 Smokers’ Attitude towards Tobacco Use
Although, the majority of the smokers in the study had been smoking for less than 10 years, more than two thirds (n=38 67.8%) perceived themselves to be addicted4 to tobacco. The rest (32.2%) believed that they were not dependent on tobacco and could stop smoking at any time.
The majority of those who smoked felt that they would not be able to "cope" without cigarettes. Nearly all respondents (96.4%) recognised that smoking had negative effects, particularly on their health (50.6%), however, many felt that the "beneficial" factors outweighed the negative ones. Positive ’benefits" were expressed mainly in terms of aiding users to relax, socialise and manage stress.
6.5 Respondent’s Views on how Tobacco is Perceived within BME Communities
While over two-thirds (69.4%) of all respondents (smokers and non-smokers) felt that tobacco taking was widespread within BME communities, many believed that the act of smoking was nevertheless treated with a degree of disdain in certain circles.
Respondents felt that smoking is either "frowned upon" (35.8%) or seen as, ’disrespectful"(9.4%), especially in relation to women. Moreover the majority of respondents admitted (71.8%) that smoking was not acceptable by their families even although many of them smoked. "They don’t allow it" (27.9%), "not respectful" (19.7%) and "health of others" (21.3%) were typical comments made in this regard.
Inequalities in terms of gender were frequently highlighted with both male and female respondents amongst all ethnic groups (84.7%) and many respondents (34.7%) believed that women who smoked were portrayed in a tainted manner. Words such as "easy, "bad", or "cheap" were frequently mentioned as terms used to describe women who smoked. Service providers also mentioned the stigma attached to BME women who smoked.
In certain cases, inequalities were also noted in terms of age, with respondents believing that cigarette smoking is more tolerated amongst the older rather than younger people.
Such attitudes are relevant in that they might have an impact on covert smoking practices, particularly within the young female sector.
6.6 Smoking Cessation
Nearly two thirds of the smokers (n=36 63.2%) admitted that they had attempted to stop smoking previously, mainly because of concerns relating to personal health but admitted having little success in this regard.
Approximately half (n=16 45.7%) of those who attempted to refrain from smoking, reverted back to smoking within a month of doing so. Indeed, only two respondents were able to refrain from smoking for more than a year.
Interestingly, in terms of the types of smoking cessation methods used, the most frequently cited was "willpower" (83.3%) i.e., giving up unaided. Despite its reported limited success (Parrott S et al 1998), a majority of those who tried this method, still believed it to be effective.
Respondents were notably unaware of the available range of smoking cessation methods and smoking cessation services and only a small number mentioned nicotine patches and gum (14.3%)5. Although only a very small number of respondents had used nicotine patches and gum respondents were able to cite the experiences of others who had tried them.
6.7 Respondents’ Awareness and Views on Anti-tobacco Material and Support
Smokers were more likely to seek assistance and advice on smoking cessation within their own social circles rather than through professional agencies. Even so, an overwhelming majority (90%) of the service providers felt that if approached they would, in any case, not be able to provide the necessary information and support, in an appropriate manner.
When asked to comment on existing anti-tobacco materials, the majority of the respondents (64.7%), ironically, appeared more aware of promotional material from the tobacco industry than of prevention material from anti-tobacco agencies.
Indeed, more than two thirds of the respondents (67.1%) had not heard of any anti-tobacco agencies and only a small number mentioned organisations such as HEBS and help lines such as Smokeline were also mentioned by respondents.
Of particular significance is that over three-quarters (77.6%) of the respondents and around a third of the service providers (30%) had not heard of ASH Scotland. Those who had, (especially the services providers) were not aware of any material produced by ASH Scotland. Indeed, only one agency had actually seen ASH Scotland promotional material.
Those who were aware of certain anti-tobacco material (63.4%) felt that the material was not suited to older members of the BME communities. In addition, the lack of visual representation of BME members in prevention advertisements, posters and leaflets was also highlighted by many who felt that some BME youth might not easily identify with the images portrayed.
6.8 Respondents’ Views on the Development of Relevant Anti-smoking Strategies
Respondents generally agreed that there was a need for specifically designed material to take into account certain cultural aspects.
The government (15.7%), medical profession (21.7%), black and minority ethnic community organisations (14.5%) and the media (21.7%) were all seen as having pivotal roles in providing relevant anti-tobacco information which reflects more appropriately the diverse nature of the present Scottish population.
Respondents generally, felt that inclusive strategies within mainstream services and proactive approaches by agencies in this field would be the most effective way to address smoking within BME communities. The latter was strongly supported by the services providers in the sample.
Ahmad, W.IU. (1988) Alcohol and cigarette consumption among white and Asian general practice patients, Health Education Journal, Vol. 47/4, pp128-129.
Health Education Authority (1999) Black and Minority Ethnic Groups and Tobacco Use in England, Health Education Authority, London.
1 Black is collectively used for those describing themselves as Black-Caribbean, Black African and Black-other.
2 A hooka is a pipe used to smoke tobacco filtered through water.
3 paan is a green leaf filled with a paste made of areca nuts, lime condiment and sweeteners and sometimes tobacco. It is chewed. It is a smokeless form of tobacco.
4 Addiction is characterised by compulsive drug-seeking and use, even in the face of negative health consequences.
5 This research took place prior to the availability of Bupropion (Glaxo Wellcome’s Zyban product) on reimbursed prescription.
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Last updated: 15 July 2009