National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland.
Soc Sci Med. 2010 Sep;71(5):877-83. doi: 10.1016/j.socscimed.2010.05.036. Epub 2010 Jun 16.
Drawing on qualitative interviews with forty smokers, aged 24-58 years, in Finland, this study aimed to identify key accounts that smokers used to respond to the hegemonic claim that smoking is harmful to health. While the smokers defended themselves in the face of the presumed health risk argument, they both agreed with and challenged the predominant medical and epidemiological discourses. The five most frequently observed account types that the smokers used were: health risk perspective, moderate use is not harmful, counter-evidence, compensatory behaviour, and smoking as the lesser evil. The accounts seemed to have two purposes. First, they served to protect the smokers from self-blame as well as blame from others. The smokers presented themselves as risk-aware and calculating actors, who have nevertheless made their choice to smoke. Second, the smokers tried to convince the interviewers and themselves of the harmlessness and acceptability of their own smoking. The results of the study with respect to smoking further the understanding about the way laypeople make sense of information about health risks that relates directly to their own 'unhealthy' behaviours and how they use this knowledge to justify their behaviour. Based on the findings of our study, we recommend that future anti-smoking campaigns and interventions should take into account and target lay epidemiological health accounts that are applied by smokers themselves. Rather than trying to motivate and persuade smokers to quit with information translated from epidemiological and medical research, the anti-smoking advocates and health promotion specialists should provide answers to the questions that smokers themselves are pondering and answering, too. Consequently, the results can be used in relation to other pleasurable but 'unhealthy' activities, such as unhealthy eating or drinking, by offering insights into how individuals manage to rationalise and maintain activities which the hegemonic public health perspective terms unhealthy.
本研究通过对芬兰 40 名年龄在 24-58 岁的吸烟者进行定性访谈，旨在确定吸烟者用来回应吸烟有害健康这一主流观点的关键说法。虽然吸烟者在面对假定的健康风险论点时为自己辩护，但他们既同意也质疑主要的医学和流行病学论述。吸烟者使用的最常见的五种说法类型是：健康风险观点、适度使用无害、反证、补偿行为和吸烟是较小的罪恶。这些说法似乎有两个目的。首先，它们可以保护吸烟者免受自责和他人的指责。吸烟者表现得像有风险意识和算计的人，他们已经做出了吸烟的选择。其次，吸烟者试图让采访者和自己相信自己吸烟的无害性和可接受性。这项关于吸烟的研究结果进一步了解了外行人如何理解与自己“不健康”行为直接相关的健康风险信息，以及他们如何利用这些知识为自己的行为辩护。基于我们研究的结果，我们建议未来的反吸烟运动和干预措施应该考虑并针对吸烟者自己应用的外行人流行病学健康说法。反吸烟倡导者和健康促进专家不应该试图用从流行病学和医学研究中翻译出来的信息来激励和说服吸烟者戒烟，而应该为吸烟者自己正在思考和回答的问题提供答案。因此，这些结果可以应用于其他令人愉悦但“不健康”的活动，如不健康的饮食或饮酒，为个人如何合理化和维持被主流公共卫生观点视为不健康的活动提供了见解。
