Naturalising non-smoking: A grounded theory study of smoking cessation

Abstract

Tobacco smoking is one of the leading causes of preventable death worldwide. Most smokers have attempted to quit smoking, but they often find it hard to achieve success in these attempts. Nevertheless, some people manage to achieve tobacco cessation. Using a constructivist grounded theory methodology, the present study set out to explore what happens during a successful quit attempt and to construct a theoretical model to explain it. Experiential accounts from 14 participants who had first-hand experience of giving up smoking and becoming nonsmokers were generated via in-depth interviews. Participants were migrant health professionals, who started to smoke in a country other than New Zealand and then gave up smoking in New Zealand. Simultaneous data generation and analysis led to the construction of the theory of naturalising non-smoking. The constructed theory argues that becoming a non-smoker requires the naturalisation of non-smoking. In turn, the naturalisation of non-smoking involves three processes: giving up smoking, socialising as a non-smoker, and normalising non-smoking. The two processes of socialising as a non-smoker and normalising non-smoking are advanced by participating in what is called here a non-smoking milieu. Becoming a non-smoker, then, is presented as a relational and contextually sensitive process. These findings underscore the potential benefits of re-examining assumptions embedded in how smoking cessation is commonly explained and studied, such as those present in theories that rely heavily on psychological constructs. These findings also provide insights into prospective new spaces for actions that could be implemented in supporting smokers to become non-smokers.