Olson Rebecca E, Wen Ek Xuan, Staines Zoe, Goh Felicia, Marshall Henry M
University of Queensland, Australia.
The Prince Charles Hospital, Australia.
Health (London). 2023 Nov;27(6):1115-1134. doi: 10.1177/13634593221099108. Epub 2022 Jun 6.
Tobacco control policies reinforce a health imperative that positions citizens as duty-bound to manage their health by abstaining from or quitting smoking. Limited attention is paid to the repercussions - especially for lung screening - of anti-smoking rhetoric emphasising individual responsibility. Drawing on interviews with 27 long-term smokers involved in an international lung screening trial, this study analysed Australian smokers' narratives of smoking. By attending to stigma and the use of public health rhetoric within personal narratives, we show how narratives underscoring individual responsibility for quitting were layered with conflicting explanations of biological responsibility and normative expectations. Ironically, narratives of individual responsibility potentially undermine smoking cessation. In positioning smokers as responsible for their own healthy choices, such rhetoric also positions smokers as responsible for managing their emotional health, which some did smoking. Thus, anti-smoking campaigns pit the neoliberal imperative of health against the happiness imperative. These findings have implications for the design and delivery of lung screening campaigns. They also support calls to move beyond health messaging emphasising individual choice, towards acknowledging the moral power of structures and public health campaigns to discipline citizens in unintended ways.
烟草控制政策强化了一项健康要求，即让公民承担起通过戒烟或避免吸烟来管理自身健康的责任。人们很少关注强调个人责任的反吸烟言论所带来的影响，尤其是对肺部筛查的影响。本研究通过对参与一项国际肺部筛查试验的27名长期吸烟者进行访谈，分析了澳大利亚吸烟者关于吸烟的叙述。通过关注个人叙述中的污名化以及公共卫生言论的使用，我们展示了强调戒烟个人责任的叙述是如何与关于生物责任和规范期望的相互矛盾的解释交织在一起的。具有讽刺意味的是，个人责任的叙述可能会破坏戒烟。在将吸烟者定位为对自己的健康选择负责的同时，这种言论也将吸烟者定位为对管理自己的情绪健康负责，而有些人在吸烟时就是这样做的。因此，反吸烟运动将新自由主义的健康要求与幸福要求对立起来。这些发现对肺部筛查运动的设计和开展具有启示意义。它们还支持了这样的呼吁，即超越强调个人选择的健康信息，转而承认结构和公共卫生运动以意想不到的方式规范公民的道德力量。
