Abstract
This thesis aimed to explore possible mechanisms behind the delay between research in the 1950s linking smoking to disease and the 2007 United Kingdom public smoking ban, with a focus on scientific knowledge, advertising and the views of consumers and those who sell tobacco products. This thesis consists of five studies using both qualitative and quantitative approaches. The first study used a bibliometric analysis to evaluate the citation patterns of four key papers published by Doll and Hill, in the 1950s. The results showed that the original Doll and Hill paper, published in 1950 consistently received the highest number of citations of the four papers analysed, with citations increasing drastically between the 1990s and 2000s. All four papers analysed were most commonly cited in research articles in The Lancet and The British Medical Journal. The second study involved a quantitative content analysis of 240 pro and anti-tobacco advertisements published in the UK between 1950 and 2003. The results showed that throughout the decades, pro-smoking adverts became increasingly implicit, along with an increase in adverts that displayed the cigarette box but did not display someone smoking. In the pro-smoking adverts quality, flavour and cost were amongst the most utilised messages to promote tobacco products, whilst anti-smoking adverts focused on a health message. Study three involved qualitative content analysis of the pro smoking adverts and highlighted three key themes: choice; positive aspects of the brand and adverts functioning to consolidate the identity of a smoker as positive. This analysis also demonstrated the importance of the historical context in which the adverts were published. Study 4 was an interview study with consumers and ex-consumers of tobacco products, aged over seventy, and illustrated a key role for a cost benefit analysis between present gains and future risks and the role of identity in smoking. Finally, study 5 was an interview study with the sellers of tobacco products, and highlighted the perceived influences on smoking behaviour and the tripartite roles of the newsagent in relation to cigarette sales. Overall, the five studies offer several explanations for the delay between research and policy and highlight a key role for identity, the credibility of evidence and social norms. Further the results suggest that the positive images sold by tobacco advertising, combined with the sole focus on health messages in the anti-smoking advertising, as well as the focus of smokers on the here and now, rather than the risks of the future all provide an explanation for why the decline in smoking was slower than one may have expected, despite the evidence linking it to disease. These findings are discussed in the context of theories of persuasion and behaviour change and the reasons why scientific knowledge is not sufficient to change either policy or individual behaviour.