BMJ 2003;326:962 ( 3 May )

Primary care

Understanding influences on smoking in Bangladeshi and Pakistani adults: community based, qualitative study

Judith Bush, ESRC/ODPM postdoctoral research fellow, ^a Martin White, senior lecturer in public health, ^a Joe Kai, professor, ^b Judith Rankin, senior research associate, ^a Raj Bhopal, Bruce and John Usher chair of public health. ^c

^a School of Population and Health Sciences, University of Newcastle, Newcastle upon Tyne NE2 4HH, ^b Division of Primary Care, School of Community Health Sciences, University of Nottingham Medical School, Nottingham NG7 2UH, ^c Division of Community Health Sciences, Public Health Sciences Section, University of Edinburgh Medical School, Edinburgh EH8 9AG

Correspondence to: J Bush Judith.bush{at}ncl.ac.uk

Objective: To gain detailed understanding of influences on smoking behaviour in Bangladeshi and Pakistani communities in the United Kingdom to inform the development of effective and culturally acceptable smoking cessation interventions.
Design: Qualitative study using community participatory methods, purposeful sampling, one to one interviews, focus groups, and a grounded approach to data generation and analysis.
Setting: Newcastle upon Tyne, during 2000-2.
Participants: 87 men and 54 women aged 18-80 years, smokers and non-smokers, from the Bangladeshi and Pakistani communities.
Results: Four dominant, highly inter-related themes had an important influence on smoking attitudes and behaviour: gender, age, religion, and tradition. Smoking was a widely accepted practice in Pakistani, and particularly Bangladeshi, men and was associated with socialising, sharing, and male identity. Among women, smoking was associated with stigma and shame. Smoking in women is often hidden from family members. Peer pressure was an important influence on smoking behaviour in younger people, who tended to hide their smoking from elders. There were varied and conflicting interpretations of how acceptable smoking is within the Muslim religion. Tradition, culture, and the family played an important role in nurturing and cultivating norms and values around smoking.
Conclusion: Although there are some culturally specific contexts for smoking behaviour in Bangladeshi and Pakistani adultsnotably the influence of gender and religionthere are also strong similarities with white people, particularly among younger adults. Themes identified should help to inform the development and appropriate targeting of smoking cessation interventions.

What is already known on this topic Smoking is common among Bangladeshi and Pakistani men in Britain but rare among the women Smoking is particularly common in Bangladeshi men Socioeconomic status is thought to influence smoking uptake in Bangladeshi men Influences on smoking in South Asians in Britain are poorly understood What this study adds Smoking among Pakistani and Bangladeshi men is strongly seen as socially acceptablea "normal" part of being a man Smoking in Bangladeshi men is more deeply socially ingrained than in Pakistanis, contributing to group cohesion and identity Smoking in Bangladeshi and Pakistani women is associated with a strong sense of cultural taboo, stigma, and non-acceptance Islam forbids addiction and intoxicants, but opinions differ on whether the Muslim religion allows smoking Culturally sensitive smoking cessation interventions for Bangladeshis and Pakistanis are needed

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© 2003 BMJ Publishing Group Ltd
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