Coxhead Lauren, Rhodes Tim
The Centre for Research on Drugs and Health Behaviour, Department of Primary Care and Social Medicine, Imperial College London, UK.
Sociol Health Illn. 2006 Jan;28(1):98-121. doi: 10.1111/j.1467-9566.2006.00484.x.
Contemporary public health discourses construct individuals as rational, responsible and knowledgeable, and thus promote a self-controlled prudent response to risk. In the context of evidence emphasising risks to children's health associated with passive smoking, mothers of children with respiratory illness may knowingly place their children at increased risk should they continue to smoke in their presence. Drawing on an analysis of depth qualitative interview accounts with mothers who smoke and whose young child was recently admitted to hospital with respiratory illness, this study describes mothers' constructions of risk and responsibility associated with their smoking. Three forms of accounting style were identified: 'stories of acceptability'; 'denial of agency'; and 'reflections of guilt'. 'Stories of acceptability' either positioned the risk of passive smoking as contained and controlled to an acceptable level, or disputed the level of risk that passive smoke posed. 'Denial of agency' drew on discourses of addiction and shared responsibility to exonerate the mother of responsibility or blame. 'Reflections of guilt' were presented when contradictions arose within accounts, particularly in relation to discussions of agency and rationality in decision-making. The study illustrates how constructions of moral responsibility, especially in relation to being a 'good mother', framed mothers' accounts of smoking in the face of risk. The study concludes that far greater consideration be given to the way in which mothers rationalise their smoking to others if paediatric doctors are to foster risk reduction practices associated with passive smoking more effectively.
当代公共卫生话语将个体建构为理性、有责任感且知识渊博的，从而促进对风险采取自我控制的审慎应对。在有证据强调被动吸烟对儿童健康构成风险的背景下，患有呼吸道疾病儿童的母亲若继续当着孩子的面吸烟，可能会在明知的情况下使孩子面临更高风险。基于对吸烟且其幼儿近期因呼吸道疾病住院的母亲的深度定性访谈记录的分析，本研究描述了母亲们对与吸烟相关的风险和责任的建构。确定了三种解释风格：“可接受性故事”；“否认能动性”；以及“内疚反思”。“可接受性故事”要么将被动吸烟的风险定位为处于可控且可接受的水平，要么对二手烟造成的风险程度提出质疑。“否认能动性”借鉴成瘾和共同责任的话语来免除母亲的责任或罪责。当叙述中出现矛盾时，尤其是在决策中的能动性和合理性讨论方面，就会出现“内疚反思”。该研究说明了道德责任的建构，特别是与成为“好母亲”相关的建构，如何构建了母亲们在面对风险时对吸烟的叙述。研究得出结论，如果儿科医生要更有效地促进与被动吸烟相关的降低风险措施，就需要更多地考虑母亲们向他人解释其吸烟行为的方式。
