'I've never ever let anyone hold the kids while they've got ciggies': moral tales of maternal smoking practices

Subculture wars: The struggle for the vape industry

Drawing on a 2-year study, I argue that the UK vape industry is engaged in a classificatory struggle between a subcultural industry and its "other", the mainstream industry. I build on Thornton's analysis of club culture to characterize the subcultural vape industry as a community of taste built round a masculine aesthetic and a commitment to authenticity and DIY practice. Its attachment to complex systems and masculine spaces risked excluding customers without specialist knowledge or interest. The mainstream industry included tobacco companies which promoted vaping as a complementary category to smoking, linking their own vaping products to historic meanings of the cigarette as a lifestyle product. This task was hampered by the toxic legacy of combusted tobacco and its increasing reversion to a generic category rather than a branded product. Finally, the success of the price-focused vaping industry has been largely overlooked, but suggests that for most consumers, electronic cigarettes are still a contrasting category to combusted tobacco and are purchased largely on price. I conclude that the exclusion of a feminized, classed "other" is a defining element of subcultural formation, itself an overwhelmingly male mechanism of group identity construction.

Adherence and the Moral Construction of the Self: A Narrative Analysis of Anticoagulant Medication

In this article, we examine illness narratives to illuminate the discursive work that patients undertake to construct themselves as "good" and adherent. Biographical narrative interviews were undertaken with 17 patients receiving anticoagulation for stroke prevention in atrial fibrillation, from five English hospitals (May 2016-June 2017). Through pluralistic narrative analysis, we highlight the discursive tensions narrators face when sharing accounts of their medicine-taking. They undertake challenging linguistic and performative work to reconcile apparently paradoxical positions. We show how the adherent patient is co-constructed through dialogue at the intersection of discourses including authority of doctors, personal responsibility for health, scarcity of resources, and deservingness. We conclude that the notion of medication adherence places a hidden moral and discursive burden of treatment on patients which they must negotiate when invited into conversations about their medications. This discursive work reveals, constitutes, and upholds medicine-taking as a profoundly moral practice.

Stigma and Smoking in the Home: Parents' Accounts of Using Nicotine Replacement Therapy to Protect Their Children from Second-Hand Smoke

Evidence and campaigns highlighting smoking and second-hand smoke risks have significantly reduced smoking prevalence and denormalised smoking in the home in Scotland. However, smoking prevalence remains disproportionally high in socioeconomically disadvantaged groups. Using stigma as a theoretical lens, this article presents a thematic analysis of parents' accounts of attempting to abstain from smoking at home, using nicotine replacement therapy (NRT), in disadvantaged areas of Edinburgh and the Lothians. Smoking stigma, particularly self-stigma, underpinned accounts, with two overarching themes: interplaying barriers and enablers for creation of a smoke-free home and reconceptualisation of the study as an opportunity to quit smoking. Personal motivation to abstain or stop smoking empowered participants to reduce or quit smoking to resist stigma. For those struggling to believe in their ability to stop smoking, stigma led to negative self-labelling. Previously hidden smoking in the home gradually emerged in accounts, suggesting that parents may fear disclosure of smoking in the home in societies where smoking stigma exists. This study suggests that stigma may act both as an enabler and barrier in this group. Reductions in smoking in the home were dependent on self-efficacy and motivations to abstain, and stigma was entwined in these beliefs.

Patterns of parents' perspectives on protecting young children from secondhand smoke exposure: A Q-methodology study

AIMS

To identify and describe the various patterns of parents' perspectives on avoiding secondhand smoke exposure.

DESIGN

Q methodology was applied to investigate the parental perspectives of 50 parents.

METHODS

The study was implemented from September-December 2016. Forty-two Q-statements were constructed based on the literature related to parental attitudes and prevention practices regarding preventing young children from experiencing secondhand smoke exposure. A series of Q-sorts was performed by the participants to rank the statements into a Q-sort grid. PQMethod 2.35 software was used to perform principal component analysis to identify different patterns of parents' perspectives.

RESULTS

Five patterns of shared perspectives, which accounted for 62% of the total variance, were derived from the analysis: (a) lack of confidence to confront smokers in non-smoking areas; (b) awareness of health hazards but not ready to take preventive actions; (c) emphasis on parental responsibility and behavioural guidance; (d) awareness of health rights protected by legislation; and (e) strong willingness to take protective actions.

CONCLUSION

Our findings revealed the shared perspectives of five groups of parents. The exploration of clusters of parents could assist healthcare professionals in acknowledging parents' tendencies related to attitudes and responses towards secondhand smoke exposure.

IMPACT

Using a forced distribution through the Q-sorting technique, the particular perspective patterns of parents' experiences would be captured. These findings can serve as a useful guide for researchers and practitioners to develop tailored intervention programs for parents with the purpose of reducing secondhand smoke exposure in young children.

Smoking during pregnancy, stigma and secrets: Visual methods exploration in the UK

BACKGROUND

Moral judgements are commonly directed towards mothers through reference to health behaviour in pregnancy, and working-class mothers are particularly subject to this moral gaze.

AIM

To gain an in-depth understanding of the health issues affecting 10 low income pregnant women from deprived areas of south Wales, UK.

METHODS

Participants completed visual activities (timelines, collaging or thought bubbles and dyad sandboxing) prior to each interview. Participants' visual representations were used in place of a topic guide, to direct the interview. Guided by feminist principles, 28 interviews were completed with 10 women. Data were analysed thematically.

FINDINGS

Smoking was discussed at length during interviews, and this paper focuses on this issue alone. Five of the participants had smoked during pregnancy. Negative reactions were directed towards pregnant women who smoked in public, resulting in maternal smoking being undertaken in private. Participants also reported awkward relationships with midwives and other health professionals, including receipt of public health advice in a judgemental tone.

DISCUSSION

Smoking during pregnancy is a particularly demonised and stigmatised activity. This stigma is not always related to the level of risk to the foetus, and instead can be seen as a moral judgement about women. We urgently need to move from individualised neo-liberal discourses about the failure of individual smokers, to a more socio-ecological view which avoids victim blaming.

CONCLUSION

Stigma from friends, family, strangers and health professionals may lead to hidden smoking. This is a barrier to women obtaining evidence based stop smoking support.

Negotiating Closed Doors and Constraining Deadlines: The Potential of Visual Ethnography to Effectually Explore Private and Public Spaces of Motherhood and Parenting

Pregnancy and motherhood are increasingly subjected to surveillance by medical professionals, the media, and the general public, and discourses of ideal parenting are propagated alongside an admonishment of the perceived "failing" maternal subject. However, despite this scrutiny, the mundane activities of parenting are often impervious to ethnographic forms of inquiry. Challenges for ethnographic researchers include the restrictions of becoming immersed in the private space of the home where parenting occurs and an institutional structure that discourages exploratory and long-term fieldwork. This paper draws on four studies, involving thirty-four participants, that explored their journeys into the space of parenthood and their everyday experiences. The studies all employed forms of visual ethnography, including artifacts, photo elicitation, timelines, collage, and sandboxing. The paper argues that visual methodologies can enable access to unseen aspects of parenting and engender forms of temporal extension, which can help researchers to disrupt the restrictions of tightly time bounded projects.

Antimicrobial stigmatization: Public health concerns about conventional pig farming and pig farmers' experiences with stigmatization

According to the World Health Organization, antimicrobial resistance is one of the most severe threats to public health. Since the 1950's contemporary farming of pigs has been heavily dependent on the use of antibiotics. Recently, concerned experts of public health have become more outspoken, often, criticizing pig farmers for social irresponsibility and gambling with public health. Danish pig farmers are internationally renewed for their relatively low use of antibiotics. Nevertheless, the public criticism aimed at farmers is relatively strong in Denmark. Based on qualitative interviews with 30 pig farmers and 21 public health experts, this article sets out how pig farmers, according to public health experts, threaten public health and how pig farmers, according to the farmers, experience and internalize stigmatization related to their lives as farmers. By focusing on Danish pig farmers' experiencing public condemnation from scientific experts as well as in their local communities, this article proceeds along the line of existing research on health-related stigmatization.

"I Was a Full Time Proper Smoker": A Qualitative Exploration of Smoking in the Home after Childbirth among Women Who Relapse Postpartum

Background

Many women stop smoking during pregnancy but relapse shortly afterwards, potentially putting their infants at risk of secondhand smoke (SHS) exposure. Women who were able to stop during pregnancy may be a motivated group, receptive to making behaviour changes postpartum to protect their infant from SHS exposure. Understanding more about their experiences of relapse, and if this influences home smoking behaviours and children’s exposure to SHS in the home may help to inform intervention development to prevent infant SHS exposure.

Methods

Guided by interpretative phenomenological methodology we conducted and analysed nine semi-structured interviews with women who quit smoking during pregnancy, but relapsed ≤3 months postpartum.

Findings

Central to mothers’ accounts of their smoking behaviours during pregnancy and postpartum was their desire to be a ‘responsible mother’. Mothers described using strategies to protect their infant from SHS exposure, and held strong negative attitudes towards other smoking parents. After relapsing, mothers appeared to reposition themselves as ‘social’ or ‘occasional’ smokers rather than ‘regular’ smokers.

Conclusions

Findings suggest that interventions to prevent/reduce infants' home SHS exposure should build on mothers' intentions to be responsible parents. As mothers who relapse principally view themselves as ‘social’ or ‘occasional’ smokers, interventions that are highlighted as relevant for women with these types of smoking patterns may be more likely to be responded to, and, ultimately, be effective.

Smoke-free homes: what are the barriers, motivators and enablers? A qualitative systematic review and thematic synthesis

OBJECTIVE

To thematically synthesise primary qualitative studies of the barriers, motivators and enablers of smoke-free homes (SFHs).

DESIGN

Systematic review and thematic synthesis.

DATA SOURCES

Searches of MEDLINE, EBM Reviews (Cochrane Database of Systematic Reviews), PsycINFO, Global Health, CINAHL, Web of Science, Informit and EMBASE, combining terms for families, households and vulnerable populations; SFH and secondhand smoke; and qualitative research, were supplemented by searches of PhD theses, key authors, specialist journals and reference lists.

STUDY SELECTION

We included 22 articles, reporting on 18 studies, involving 646 participants.

INCLUSION CRITERIA

peer-reviewed; English language; published from 1990 onwards (to week 3 of April 2014); used qualitative data collection methods; explored participants' perspectives of home smoking behaviours; and the barriers, motivators and enablers to initiating and/or maintaining a SFH.

DATA EXTRACTION

1 of 3 authors extracted data with checking by a second.

DATA SYNTHESIS

A thematic synthesis was performed to develop 7 core analytic themes: (1) knowledge, awareness and risk perception; (2) agency and personal skills/attributes; (3) wider community norms and personal moral responsibilities; (4) social relationships and influence of others; (5) perceived benefits, preferences and priorities; (6) addiction and habit; (7) practicalities.

CONCLUSIONS

This synthesis highlights the complexity faced by many households in having a SFH, the practical, social, cultural and personal issues that need to be addressed and balanced by households, and that while some of these are common across study settings, specific social and cultural factors play a critical role in shaping household smoking behaviours. The findings can inform policy and practice and the development of interventions aimed at increasing SFHs.

TRIAL REGISTRATION NUMBER

CRD42014014115.

The downside of tobacco control? Smoking and self-stigma: A systematic review

OBJECTIVE

Little is known about the consequences of tobacco smoking stigma on smokers and how smokers may internalize smoking-related stigma. This review summarizes existing literature on tobacco smoking self-stigma, investigating to what extent smokers are aware of negative stereotypes, agree with them and apply them to themselves.

METHODS

We carried out a systematic search of Pubmed/Web of Science/PsycInfo databases for articles related to smoking self-stigma through June 2013. Reference lists and citations of included studies were also checked and experts were contacted. After screening articles for inclusion/exclusion criteria we performed a quality assessment and summarized findings according to the stages of self-stigma as conceptualized in Corrigan's progressive model of self-stigma (aware, agree, apply and harm). Initial searches yielded 570 articles.

RESULTS

Thirty of these articles (18 qualitative and 12 quantitative studies) met criteria for our review. Awareness of smoking stigma was virtually universal across studies. Coping strategies for smoking stigma and the degree to which individuals who smoke internalized this stigma varied both within and across studies. There was considerable variation in positive, negative, and non-significant consequences associated with smoking self-stigma. Limited evidence was found for subgroup differences in smoking-related stigma.

CONCLUSION

While there is some evidence that smoking self-stigma leads to reductions in smoking, this review also identified significant negative consequences of smoking self-stigma. Future research should assess the factors related to differences in how individuals respond to smoking stigma. Public health strategies which limit the stigmatization of smokers may be warranted.

How do women manage the spoiled identity of a ‘pregnant smoker’? An analysis of discursive silencing in women's accounts

Drawing on public and private accounts of smoking during pregnancy (interviews, survey responses, and a public media article), we examine how women discursively manage the ‘spoiled’ identity associated with inhabiting the body of a ‘pregnant smoker’. We focus on two salient identities ‘the silenced smoker’ and ‘the bad mother’ and explore the discursive and material consequences of these identities. We found that references to smoker and maternal identities were largely absent in women's accounts, and discuss how these absences enabled women to evade stigma and the rhetorical harm of these identities. Further, we discuss the material consequences of stigma including women's need to conceal their ‘pregnant smoker’ body in the face of heightened surveillance. We propose ‘discursive silencing’ to explain how dominant motherhood and anti-smoking discourses serve to render women's experiences as ‘untellable’ and therefore reduce women's capacity to seek help or support to quit smoking.

Exploring the experiences of pregnant women using an NHS stop smoking service: a qualitative study

AIM

The purpose of this article was to explore women's experiences of attempting to stop smoking while pregnant using National Health Service (NHS) support.

METHOD

A qualitative methodological approach was adopted to enable the researcher to develop an understanding of the women's experiences. Six individual semi-structured interviews were conducted with women who accessed an NHS stop smoking service while pregnant. The data were analysed using comparative analysis.

RESULTS

Five themes were identified: health risks, motivations to stop smoking, influences on smoking behaviour, feelings about smoking and experiences of using NHS stop smoking support. Motivation to stop smoking was predominantly due to concerns about their unborn baby's health, and knowledge of health risks was generally good. Limited information relating to the associated health risks of continued smoking in pregnancy from healthcare professionals appeared to be a common experience. External pressures both positively and negatively influenced the smoking status of the women. Stress was cited by all the women as a significant challenge to smoking cessation and something which they all struggled with. The women's experiences of using NHS support while pregnant was varied; some felt it adequately met their needs, while others felt that their expectations were not met.

CONCLUSION

Continued smoking in pregnancy is complex, and it appears that successful smoking cessation is related to a number of internal and external factors which present significant challenges for expectant mothers who smoke. Stress was found to be a major contributor in continued smoking; therefore, NHS stop smoking services should incorporate stress management techniques into stop smoking interventions. In addition, services should be flexible, adapting service provision to meet women's needs.

Foucault, surveillance, and carbon monoxide testing within stop-smoking services

Health professionals have adopted proactive testing for early evidence of disease. Researchers have identified that this leads to enumerated understandings and shapes behavior in productive ways. Smoking-cessation advisors regularly test clients for carbon monoxide (CO), but client views of this had not previously been explored. We interviewed 23 clients of a United Kingdom-based stop-smoking service regarding their experiences of CO testing. The majority of participants were successful quitters. We used ATLAS.ti 7 as a data-management tool during structured qualitative analysis. Our findings reveal that clients believed the results of their CO tests. Many became enumerated in their understanding, and thus placed themselves in a hierarchy with other members of their group. Almost all clients found that knowing their CO test score was motivating. We conclude that additional research is needed to understand the experiences of CO testing among clients who do not quit.

Children's resistance to parents' smoking in the home and car: a qualitative study

BACKGROUND AND AIMS

Reducing second-hand smoke exposure in the home is a key tobacco control goal, yet few studies have explored children's views and experiences of this. This study aimed to explore children's accounts of family members' smoking in the home and car and the impact of their socio-economic circumstances.

DESIGN

Individual and friendship group interviews using topic guides and visual stimulus methods.

SETTING

Two communities in Edinburgh, Scotland, one socio-economically advantaged, one socio-economically disadvantaged.

PARTICIPANTS

Thirty-eight children aged 10-15 years who had a close family member who smoked.

MEASUREMENTS

Focus group and interview topic guides.

FINDINGS

Participants in both communities expressed a strong dislike of family members' smoking and concern about the potential impact on the smoker's health. Participants described overt and covert acts of resistance, including challenging relatives about their smoking, expressing disgust and concern, hiding or destroying cigarettes. Some acts were carried out in collusion with a non-smoking parent and/or sibling. Resistant acts were constrained by expectations of negative responses, which appeared to increase with age, wider social norms around smoking and whether or not the young person smoked.

CONCLUSIONS

Some children and young people in the United Kingdom, irrespective of socio-economic status, may actively oppose parents' smoking in the home and car, although their influence may be limited by their position in the family and social norms.

Smoking spaces as enabling spaces of wellbeing

A persistent emphasis on the negative biomedical effects of cigarette smoking effectively glosses over the affectual-sensual and social wellbeing that smoking can enable. In addition, while tobacco research has recently been more attuned to the stigmatizing affects brought about by smoking de-normalization efforts, a lot less attention has been placed on how smokers negotiate these feelings of stigmatization so as to restore their personal spaces of wellbeing. In this paper, I situate my investigation of smoking geographies in the burgeoning literature on enabling spaces which focuses on how places co-constitute our ability to act/affect in empowering ways. By deploying qualitative research methods such as in-depth interviews, I argue that an acknowledgment of how smoking spaces in Singapore can be enabling along affectual, sensorial and social registers is long overdue. While it is not my purpose to systematically downplay the damaging health effects that smoking can engender, a focus on enabling smoking spaces emphasizes the role of smokers as creative agents capable of (re)fashioning their own holistic and subjective versions of wellbeing. In so doing, I hope to contribute to the existing research on smoking spaces and a recent profusion of work on relational geographies of affect.

Smoking, self-regulation and moral positioning: a focus group study with British smokers from a disadvantaged community

Smoking in many Western societies has become a both moral aand health issue in recent years, but little is known about how smokers position themselves and regulate their behaviour in this context. In this article, we report the findings from a study investigating how smokers from an economically disadvantaged community in the East Midlands (UK) respond to concerns about the health impact of smoking on others. We conducted ten focus group (FG) discussions with mixed groups (by smoking status and gender; N = 58 participants) covering a range of topics, including smoking norms, self-regulation, and smoking in diverse contexts. We transcribed all FG discussions before analysing the data using techniques from discourse analysis. Smokers in general positioned themselves as socially responsible smokers and morally upstanding citizens. This position was bolstered in two main ways: 'everyday accommodation', whereby everyday efforts to accommodate the needs of non-smokers were referenced, and 'taking a stand', whereby proactive interventions to prevent smoking in (young) others were cited. We suggest that smoking cessation campaigns could usefully be informed by this ethic of care for others.

The role of nicotine replacement therapy for temporary abstinence in the home to protect children from environmental tobacco smoke exposure: a qualitative study with disadvantaged smokers

BACKGROUND

Nicotine replacement therapy (NRT) has recently been licensed to help smokers to abstain from smoking for short time periods and recent studies have shown that 8-14% of smokers are regularly using NRT to cope when they cannot or are not allowed to smoke. These data suggest that, potentially, NRT for temporary abstinence might be an acceptable method to help smoking caregivers, who are not able to stop smoking completely, to avoid smoking whilst inside their home in order to protect their children from the harms of environmental tobacco smoke (ETS). The aim of this study was therefore to explore the concept of using NRT for temporary abstinence in the home, to protect children from exposure to ETS.

METHODS

Qualitative in-depth interviews were conducted with thirty six disadvantaged smoking parents who were currently, or had recently stopped smoking in the home with at least one child under the age of five. Parents were recruited from Children's Centres and Health Visitor Clinics in Nottingham, UK. Interviews were audio recorded and transcribed verbatim. Data were coded and analysed thematically to identify emergent main and subthemes.

RESULTS

Overall, participants responded negatively to the concept of attempting temporary abstinence in the home in general and more specifically to the use of NRT whilst at home to reduce children's exposure to ETS. Many parents would prefer to either attempt cutting down or quitting completely to make a substantial effort to change their smoking behaviour. There was limited interest in the use of NRT for temporary abstinence in the home as a first step to quitting, although some parents did express a willingness to use NRT to cut down as a first step to quitting.

CONCLUSION

Disadvantaged smoking parents were reluctant to initiate and maintain temporary abstinence with or without NRT as a way of making their homes smoke free to protect their children's health. More education about the specific risks of ETS to their children and the utility of NRT for use in the home might be needed to have a public health impact on children's health.

'They don't live in my house every day': How understanding lives can aid understandings of smoking

While the prevalence of smoking in western countries has substantially reduced following the introduction of comprehensive tobacco control programs, reduction strategies such as the introduction of smokefree legislation, media campaigns and individual and group support for people trying to quit have been less successful with people living on low income, suggesting the need for new ways to engage with people who smoke. We argue that, rather than focusing solely on researching smoking behaviors to generate new understandings of why people smoke, people working in the broad area of public health should look more widely at peoples' lives in order to understand their smoking. Using a biographical, narrative perspective as part of a wider ethnographic study of 12 families living in one community within Liverpool in 2006, we argue that understandings that position smoking purely as a harmful, deviant behavior, fail to capture the cultural complexity of the lives of smokers and the changing place and meaning of cigarettes over a person's lifetime, and may explain why smokers fail to engage with smoking cessation services and continue to smoke.

Parental smoking and children's anxieties: An appropriate strategy for health education?

While the prevalence of smoking has declined in the UK in recent years, class differentials in smoking behaviour have become more marked and smoking is increasingly recognised as a causal factor in inequalities in health. Health education initiatives to support both smoking cessation and to teach children about the health risks of smoking remain key initiatives in reducing health inequalities. However, teaching children about the risks of smoking and the impact of parental smoking in their health is not straightforward for children from backgrounds who are more likely to encounter smoking at home and in their local communities. These children have to reconcile the key messages taught at school and reinforced in smoking cessation campaigns with the knowledge that their parents and other family members smoke. In this paper we consider how children from smoking homes make sense of these education and health campaigns as observed by their parents, and the impact that this has on both parental smoking and relationships within the home. The paper thus seeks to challenge assumptions about the delivery of health education and the need to acknowledge family diversity.

Evaluation of a programme to increase referrals to stop-smoking services using Children's Centres and smoke-free families schemes

AIMS

To assess the feasibility and effectiveness of a new service using referral liaison advisers to increase the number of referrals of parents/carers at selected Children's Centres to National Health Service (NHS) Stop Smoking Services (SSS) and/or smoke-free families schemes (SFS).

DESIGN

This mixed-methods pilot study collected numerical data on indicators of smoking behaviours and carried out face-to-face and telephone interviews.

SETTINGS

Thirteen Children's Centres in Liverpool and Nottingham using local providers of smoking cessation services, from September 2010 to April 2011.

PARTICIPANTS

Parents and carers registered with, and staff working for, Children's Centres.

MEASURES

Number of smokers referred to smoking cessation services and/or smoke-free family schemes and the views of service providers and users on the new service.

FINDINGS

In Liverpool, 181 referrals to NHS SSS were made from 331 identified smokers (54.7%); extrapolated to 12 months, this represents a 182% increase in referrals from baseline and a similar extrapolation indicates a 643% increase from baseline of referrals to smoke-free families schemes. There were no reliable baseline data for Nottingham; 31 referrals were made (30.7% of smokers) to SSS and 44 referrals to SFS from 52 contacts (84.6%). The interviews highlighted the need for sustained personal contact with parents/carers to discuss smoking behaviours and concerns and their willingness to be referred to SFS as part of caring for their child.

CONCLUSIONS

Routine recording of smoking status and appropriate follow-up by trained staff in Children's Centres can lead to significant numbers of clients attending stop-smoking services, although relatively few stop smoking.

The motivators and barriers to a smoke-free home among disadvantaged caregivers: identifying the positive levers for change

INTRODUCTION

The aims of this study were to explore home smoking behaviors and the motivators and barriers to smoke-free homes among a group of disadvantaged caregivers for young children and to identify the positive levers that health care professionals can utilize when supporting smoking behavior change.

METHODS

In-depth qualitative interviews were conducted between July and September 2009, with 22 disadvantaged smoking caregivers, accessing Children's Centre Services in Nottingham, UK. Interviews were audiorecorded and transcribed verbatim. Data were coded and analyzed thematically to identify emergent main and subthemes.

RESULTS

Caregivers had some general understanding of the dangers of secondhand smoke (SHS), but their knowledge appeared incomplete and confused. All interviewees described rules around smoking in the home; however, these tended to be transient and fluid and unlikely to be effective. Caregivers were often living in difficult and complex circumstances and experienced significant barriers to creating a smoke-free home. The motivators for change were more strongly linked to house decor and smell than children's health, suggesting that visible evidence of the harm done by SHS to children might help promote smoke-free homes.

CONCLUSIONS

Findings suggest that further tailored information on the effect of SHS is required, but to instigate caregiver behavior change, providing demonstrable evidence of the impact that their smoking is having on their children's health is more likely to be effective.

Volunteered, negotiated, enforced: family politics and the regulation of home smoking

The protection of children from secondhand smoke in their homes remains a key objective for health agencies worldwide. While research has explored how parents can influence the introduction of home smoking restrictions, less attention has been paid to the role of wider familial and social networks as conduits for positive behaviour changes. In this article we explore how people living in Scotland have introduced various home smoking restrictions to reduce or eliminate children's exposure to tobacco smoke, and how some have gone on to influence people in their wider familial and social networks. The results suggest that many parents are willing to act on messages on the need to protect children from smoke, leading to the creation of patterns of smoking behaviour that are passed on to their parents and siblings and, more widely, to friends and visitors. However, while some parents and grandparents apparently voluntarily changed their smoking behaviour, other parents found that they had to make direct requests to family members and some needed to negotiate more forcefully to protect children, albeit often with positive results.

'I take a small amount of the real product': Elevated cholesterol and everyday medical reasoning in liminal space

The medical consequences of elevated cholesterol are widely known, as are the medical regimens to control and manage it. At the same time, elevated cholesterol is bereft of bodily signs. Being symptomless places the condition in a no man's land: people with elevated cholesterol are assessed as medically sick but their bodies signal wellness. In this article I refer to this ambiguous grey area, betwixt and between being healthy and being sick, as liminal space . The aim of this article is to show how people manage the symptomless condition of elevated cholesterol in liminal space. Particular attention is paid to everyday medical reasoning in that space. Based on interviews with people with elevated cholesterol, I show that medical regimens are 'up against' - challenged by - a variety of competing conditions in everyday life, illustrating ambiguity. Facing this dilemma between medicine and everyday life, they ongoingly need to navigate - edit, modify, adjust - medical regimens against everyday conditions. This navigating work can be seen as ritualized strategies to sort ambiguity. People with elevated cholesterol do not so much act 'against medical regimens' as they simultaneously need to take account of other matters they are up against in trying to stay healthy. Medical regimens are sometimes central, sometimes peripheral. Adapting medical regimens to the situation at hand, people continuously comply with medical regimens, producing and reproducing medical regimens in moral contexts of everyday life.