An exploration of the problems faced by young women living in disadvantaged circumstances if they want to give up smoking: can more be done at general practice level?

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Abstract
Objectives. The purpose of this study was to explore the barriers faced by women living in deprived circumstances if they want to give up smoking and to determine what help they would like at general practice level. Methods. The study was set in general practice in an area of socio-economic deprivation in North West Edinburgh. The practice has >10 000 patients. In the first stage of the study, GPs and nursing staff at the practice were asked about their opinions of the effectiveness of well-known smoking cessation interventions using a Likert scale format (n = 23). In the second stage, a random sample of 18 female smokers in the 18–40 age group were contacted by post and asked to complete the following four measures: (i) the Hospital Anxiety and Depression Scale; (ii) a self-complete measure of knowledge of health risks for themselves and for babies and children of women smokers; (iii) opinions on effectiveness of well-known smoking cessation interventions (as completed by GPs and nursing staff); and (iv) an open-ended questionnaire, allowing qualitative responses about their smoking. Results. The findings gave insights into how the women felt about their smoking habit, their knowledge of health risks, their mental health, the needs that smoking meets for them, the difficulties faced in attempts at smoking cessation and what they think would help. Conclusions. Smoking for the women in the study group is a socially and culturally ingrained behaviour pattern with influences dating back to childhood. It is a coping mechanism—many of the women displayed anxiety symptoms which they thought smoking helped with. Guilt was the overwhelming emotion associated with their habit, and this related to worries about their children’s and their own health in particular. Most had tried to give up but had failed, and there was a sense of hopelessness about this relating to the difficulty involved for them. Most of the study group were highly motivated to give up, and this needs to be harnessed effectively in cessation support. Smokers and health care workers have different beliefs about what will be effective in smoking cessation. A reluctance to receive help at general practice level highlights the importance of the approach taken by GPs.