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Laney Graduate School

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A Qualitative Inquiry into Smoking Cessation: Lessons Learned from Smokers

Kluge, Aukje (2009)
Dissertation (279 pages)
Committee Chair / Thesis Adviser: Kushner, Howard I
Committee Members: Sterk, Claire E ; Neill, Darryl B ;
Research Fields: Health Sciences, Public Health
Keywords: smoking cessation; history of cigarettes; qualitative research
Program: Laney Graduate School, Graduate Institute of the Liberal Arts
Permanent url: http://pid.emory.edu/ark:/25593/1cjw1

Abstract

A Qualitative Inquiry into Smoking Cessation: Lessons Learned from Smokers

By Aukje Kluge

This project explores why persistent smokers have failed to quit smoking despite the behavioral and pharmacological interventions that are available. Beginning with an historical overview of how cigarettes became popular in the United States, this dissertation further
investigates the shift from behaviorally based therapies to pharmacological treatments.

Initially smoking was understood as a morally reprehensible behavior in need of modification. With the ever increasing knowledge of nicotine's effects on the smoker's brain, researchers began to understand and treat smoking as a nicotine dependence disorder. However, long-term successful treatment rates remain modest. The question of why cessation tools have overwhelmingly failed smokers stands at the forefront of the inquiry.

This dissertation adds an important component to smoking cessation research. Drawing on qualitative data collected for the Persistent Smokers Project, the analysis of the interviews reveals that there are three recurring themes associated with quitting smoking. First, interviewees provide important information on cessation motivators. Second, participants in the study focus on smoking cessation barriers that keep them from initiating a quit attempt. Third, smokers identify relapse triggers that end a period of smoking abstinence. Overall, these interviewees confirm much of what is already known in the research literature. However, the analysis also adds important knowledge in all three cessation areas and is able to offer an in-depth perspective of smokers' experiences with cessation. The qualitative findings are used to make recommendations for public health practices and research.

Table of Contents

Introduction .............................................................................................. 1

Chapter I: A History of Cigarette Smoking ...................................................... 10

Humble Beginnings - The Era of Hand-Rolled Cigarettes ............................ 11
Buck and the Bonsack Machine - The Industrialization and Popularization of

Cigarettes ....................................................................................... 22

World War I (1914-1918) and the Birth of Advertisement ......................... 33
The Depression, World War II (1939-1945), and Some Puzzling Medical

Observations ................................................................................... 43
The Plot Thickens -- The Causal Challenge and the Response from the

Industry ......................................................................................... 51

Chapter II: A Historical Analysis of Smoking Cessation Strategies ...................... 56

Gentian Roots and Silver Nitrate - Before the Establishment of the Lung

Cancer- Smoking Link ......................................................................... 57
How Knowing the Etiology of Lung Cancer Affected Smoking Research ........ 66
Electroshock and Lobeline - Early Attempts at Breaking the Smoking Habit .. 73
Smoking Cessation Research Is Coming of Age -- The 1970s ..................... 83
Pharmacological Treatment Therapies - - A Breakthrough in Cessation? ...... 92

Chapter III: Research Methodologies ............................................................ 113

Research Questions .......................................................................... 118
Establishing the Cessation Groups ....................................................... 119
Sample and Data Collection ................................................................ 119

Recruitment strategies .............................................................. 119
Eligibility and screening process ................................................... 121
Interview ................................................................................ 122
Interview guide ........................................................................ 124
Themes of interest ................................................................... 124
Data management .................................................................... 124

Data Analysis.................................................................................... 125
Coding Tree ..................................................................................... 126
Potential Validity Concerns .................................................................. 130

Credibility and reflexivity ............................................................ 132

Potential Limitations .......................................................................... 133

Chapter IV: Qualitative Inquiry ..................................................................... 134

Participants ...................................................................................... 134
Themes ........................................................................................... 135
Quitting Experiences .......................................................................... 135
Barriers to Quitting ............................................................................ 160
Relapse ............................................................................................ 171

Chapter V: Discussion of Qualitative Findings and Recommendations .................... 191

The Past and the Future of Smoking Cessation Research ........................... 215
Recommendations for Public Health Practice ........................................... 218

Motivators and self-exempting beliefs ............................................ 218
Barriers to quitting ..................................................................... 220
Triggers to relapse ..................................................................... 220

References ................................................................................................ 222

Footnotes ................................................................................................. 265

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