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9 YT-RAR: Research Methods
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Summary
YT-RAR uses multiple methods for collecting information on tobacco. This chapter gives examples of their use for assessing tobacco in the community.
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Chapter Contents
- Research skills
- Using existing information
- Common sampling techniques for YT-RAR
- Interviewing people about tobacco
- Focus groups on tobacco
- Observing tobacco marketing and use
- Surveys of tobacco use
- Mapping where tobacco is marketed and used
- Visual methods
- Estimating the size of populations
- Additional research methods
In TG-RAR you will find a description of these methods and how to use them (TG-RAR Ch 9.0 Methods Modules) ... It includes the following:
1 Research skills
TG-RAR gives advice on research skills including asking questions, building rapport, using interpreters, recording data, improving the reliability and validity of data, and managing data.
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2 Using existing information
Various sources of existing information are likely to be available for the YT-RAR. The Initial Consultation (Ch. 8.1) is a useful starting point for finding information. See Annex 1 for general sources of information. In many countries data will be scarce. In the few countries where tobacco has been extensively investigated the team will need to be selective in their review of existing data. The number of research studies carried out in the United States is overwhelming. The team should focus attention on only those areas important for informing the study.
Epidemiological and survey data may be available on:
- tobacco consumption and prevalence
- tobacco-related mortality and morbidity
- knowledge, attitudes and opinions concerning tobacco and health issues
- measures of public support for tobacco related issues and policies
- production, distribution, import, export information related to crops and products
- sales and tax information
Documentary information in reports and policy documents may be available on:
- the tobacco industry
- groups likely to support or oppose tobacco control policies
- social, economic and political factors related to tobacco control issues
Sources of information include:
- country and city statistics
- government agencies (national census and statistics office, national and city planning office, Ministry of Health, Ministry of Finance, Ministry of Interior, national and local health and social programmes);
- specialist political, health, economic libraries, university and social research units
- international and national agencies, including UN agencies
- market research surveys of public opinion, young people, products, lifestyles, media, and tobacco
- media tracking agencies
- tobacco company annual reports, press releases, recruitment materials
- news reports and business news, and tobacco trade journals
- organizations that promote tobacco use; tobacco industry associations; tobacco growers' associations; smokers' freedom societies
Information may also be gained from key informants:
- civil servants, police officers, customs officials, religious ministers, journalists, NGO officials, international agency representatives.
- social science, health, political science, and tobacco control researchers
- tobacco distributors, shopkeepers unions, bar and restaurant associations and owners, advertisers, arts associations
- pharmacists, counselors, nurses and physicians
- medical facilities that deal with young people's health
- help lines
- youth recreation centers; educational centres
Care is needed when interpreting statistical data:
- what definitions were used for tobacco use (eg smoker, non-smoker, previous smoker, daily smoker; cigarettes, pipes, smokeless
- what age ranges define 'adult', 'child', 'youth'?
- which populations were included and which were excluded?
- which tobacco products were included and which were excluded?
- how well does the study population reflect the YT-RAR study community?
- when was the research conducted?
- how were questions asked and might this have influenced how they were answered?
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Interpreting information from tobacco industry organisations
Data from organizations with a direct or indirect interest in tobacco promotion should be carefully scrutinized and cautiously interpreted. For instance, statistics reporting the number of people who directly and indirectly benefit from tobacco production, marketing and sales are likely to be over reported by tobacco companies, while data reporting the financial contributions to political parties may not exist or be underreported.
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3 Common sampling techniques for YT-RAR
In tobacco research, representative sampling is often used with large scale smoking prevalence surveys. These are usually too expensive for the team to conduct (See TG-RAR Ch 9.3 Sampling and Access).
Purposive samples are selected as the project develops - experience suggests what kind of information will be useful, and guides which samples will provide the information you need. Select samples that quickly maximize understanding of wider social processes and activities. Data are collected and interpreted as the sampling evolves.
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Example: opportunistic sampling in the field
A lone informant mentions that among young people it is common to suck mentholated lozenges while smoking, to prevent sore throats associated with smoking. To check whether this practice actually occurs, a YT-RAR team member asks a group of young people whether they know anything about the practice. This sample of young people smoking in a nearby restaurant, serves as an opportunistic sample.
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Example: network sampling (also known as snowball sampling)
The team establishes contact with a tobacco seller who is sympathetic to tobacco control who is willing to share information about the practices of the tobacco companies in relation to sellers. This individual may be able to identify other like-minded tobacco sellers who are also willing to share their perspectives and experiences. The team may learn how 'grey' market (non-taxed) smuggled tobacco products are made available to shopkeepers – or how tobacco companies might encourage tobacco sellers turn a blind eye and allow young people to steal cigarettes without difficulty.
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Block sampling may be useful for situations such as sampling billboard postings close to schools to determine what proportion of them are tobacco related. Similarly, this approach process may be useful for seeking the underage sales patterns (or the variety of tobacco products available to the consumer) keeping the sample of shops to those who are within a particular geographic area – such as a city block.
Quota sampling is used to control the type and number of study cases. For example you may want to determine whether there are tobacco related issues specific to subpopulations of young people. Sampling members of identified sub-populations, such as members from athletic, drama, academically minded, arts focused, science, and rebellious youth groups, will give insights into different aspects of youth tobacco use. This is particularly useful for determining whether particular groups are especially at risk.
Practical considerations are:
- respondents' perceptions of the research team may influence their willingness to participate, or to recommend others for participation
- the times of day during which the RAR team is seeking individuals may be times when young people are not available
- parents' perceptions of the project may influence their willingness to allow their children to participate
Gate keepers related to tobacco and young people may include:
- members of NGO groups that work with young people in the study area
- school teachers
- local youth organizations
- young peoples' sports captains, coaches
- community leaders – religious, law enforcement, political, professional, business, and respected community members
Guides include young smokers who are willing to take the researcher to such places as where young people purchase tobacco, where they spend time, where they smoke. They can make introductions and provide information about what happens at these locations.
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4 Interviewing people about tobacco
Interviews can be held with a wide range of people
Young people – consisting of relevant subpopulations (smokers, non-smokers, previous smokers, boys, girls, different age groups, geographic areas, and socioeconomic levels) and locally specific youth-cultural groups such as a 'athletes', 'academics', 'drop-outs', and 'problem groups' who may be at different levels of risk for tobacco use.
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Types of interview questions
- fact - 'What brand of tobacco did you first start using?'
- opinion – 'What do other people say about those who don't use tobacco?'
- clarification - 'You said you wouldn't use Marlboro Reds because they are too much for you – what did you mean when you said that?'
- compare/contrast - 'What is the difference between Marlboro Reds and Lights?'
- representativeness - 'You mentioned that you think that the tobacco company is deceiving the public and stealing their money – do other people also think this?'
- hypothetical questions - 'Imagine that a young guy wants to get some tobacco and use it without others knowing – what are his options for purchasing and smoking it?'
- ordering - 'In order of strength, which tobacco brands are weakest and which are strongest, in your opinion?'
- probes - 'You said 'those anti-tobacco crazies' – what kinds of people are they?
- prompts – 'What would have been a better way to talk to your kids about smoking?'
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Adults, including parents - their input can offer some perspective on community and national trends that may influence on tobacco use (e.g. youth behavior, youth culture, popularity of particular activities and participation in places where smoking take places; extent to which adults can play a role in influencing their children's activities).
Elders may be able to offer an historical overview, and information on differences between the past and the present.
Key informants can give information on the location and activities of adolescent smokers, their environments, locations of purchase, and/or ways to access groups of young people and other important community members.
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Example: interviewing health workers
Health workers may have years of experience in the community. They may have insights into: the prevalence of tobacco use among young people; whether young people are seeking help for their tobacco use; local views on tobacco use (health effects, benefits, treatments); people who are concerned about tobacco issues.
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Case study – politicians as key informants
The Deputy Mayor of the City prior to political office was in the advertising industry. He was keen to assist in local tobacco control. He participated in NGO meetings and when interviewed offered advice on issues that others had little experience with. His involvement played an important role in understanding local politics and the advertising industry, and brought a candid and unique perspective important in building local interest for tobacco control, and identifying supportive individuals and institutions.
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Targeted individuals or groups include individuals who have particular skills (shopkeepers), insights (trendsetters in youth culture), perspectives (young person who started community ad-hoc movement against youth alcohol and tobacco use), or experiences (youth participant of tobacco industry sponsored disco event).
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Case study – interviews with shopkeepeers
Through building rapport and speaking with a shopkeeper we learned that shopkeepers in Karnataka, India, made different levels of profit from different tobacco products. Products making the most profit were the most eye catching and most accessible to and used by adolescents. The smallest size, least expensive, gutkha products (sold as individual 5 gram packs), offer the shopkeeper the greatest profit per unit sold. Larger packs that are more affordable to adults (20 grams, 2 rupees) make less profit. This may have played a role in the increase in gutkha use among Indian adolescents.
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Community groups and representatives of NGOs who may have an interest in health issues, education and young people
Local employers, as well as those who might have an interest in tobacco sales and promotion (shopkeepers, advertisers, bar and restaurant owners). Their experiences may give the RAR team insights into likely obstacles and considerations that will need to be made in drafting and enforcing policies that effect the owners and their customers.
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Example of interview field guide for tobacco initiation
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GUIDE: Smoking history of the individual
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When did the individual start using tobacco?
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- How old?
- Who with, where, why?
- What brand? Why that one?
- What form of tobacco?
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What trend in tobacco use?
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- From brand to brand
- Form to form (bidi to cigarette, cigarette to bidi)
- Factors that influenced change (eg., cost, promotions, etc.)
- Preferences for taste, advertising, etc
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What kind of experiences have they had with tobacco?
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- Durations and circumstances of non-use
- Effects tobacco has – physical and mental
- Personal motivations for use
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In what contexts do they use tobacco?
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- When, where, who with, what doing?
- Circumstances and reasons for use in the past
- How often by type of context
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Nature of contexts of tobacco use
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- Who may use tobacco and where?
- What is appropriate, inappropriate by type of person?
- Ritual, non-ritual environments
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5 Focus groups on tobacco
Focus groups are useful for:
- understanding why young people feel the way that they do about particular products, types of smokers, or issues (e.g. tobacco control policies)
- understanding behaviour – purchasing tobacco, smoking in groups, youth culture
- getting reactions – such as tobacco company promotional materials, or an anti-tobacco prevention message.,
Focus groups can be facilitated by:
- using images of young people and asking participants to describe whether they think each would use tobacco, what kind, and why or why not.
- showing advertisements for tobacco products, and asking participants what they know and think about the different brands. Which are the most popular, the strongest, the brands that reflect different lifestyles and aspirations?
- listing ways to get around tobacco restrictions and the costs of using tobacco
- asking about measures to prevent tobacco use: e.g. current and proposed policies, programmes, and educational campaigns
- discussing ways that companies promote tobacco use.
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Example: using focus groups to cross-check other findings
It may be useful to conduct a focus group when there is a range of perceptions about the effects of tobacco. For instance: 'A lot of people have mentioned that tobacco use causes the lips to darken in colour. Tell us what you know about this.' This might be followed with questions probing other effects mentioned in interviews - 'Others mentioned shrunken cheeks, yellowing of the eyes, relaxation, improvement in digestion and bowel movements, and tobacco smoke as a treatment for tooth aches'. The discussion is likely to raise additional questions, and facilitate a fervent discussion.
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Example of a focus group field guide for non-smokers
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Activities, interests. Show a photograph of a teenager. 'Take us through a day in this person's life'
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- How are your lives different?
- How would a weekend be different for you?
- What are some of the things that you might do?
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Starting to smoke. 'Think back to the first time you thought about trying a cigarette'
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- When was it? Where were you? Who were you with? How did you feel? Did you try smoking? What brand did you try? And what happened?
- What do you think would change in your life if you became a regular smoker?
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The act of smoking
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- What are some of the good things about smoking? What does it do for people? What are some of the popular brands? Why?
- What do you NOT like about smoking? [Probe for health, athletic competition, peer rejection, appearance, trouble with parents or authorities, cost, image, unhealthy behaviors]
- What do you think are the disadvantages of smoking? [Probe for peer rejection, bad health, appearance, trouble with parents/authorities, cos,t image, addiction.]
- What are some of the ways that you have been able to avoid smoking?
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Risk. 'Earlier you mentioned some things that you do. [recall topics from list.] Are any of these risky? Which ones?'
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- Are there any other things kids your age do that are risky? What? [Probe for truancy, doing drugs, carrying a gun, having sex.]
- Some people think that smoking is risky. How are these things different in risk from smoking?
- What do you think about the average person who uses 'X' brand?
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Influences. 'Let's go over what you have seen and heard recently about tobacco.'
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- What would your friends do if they discovered you had started to smoke? What would your neighbours do or think about it?
- What about billboards, radio and TV, movies, cigarette packages, and the stuff you can get from cigarette makers?
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Facilitators can provoke discussion and argument by introducing contentious statements (rather than trying to be neutral).
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Case study: provoking discussion in focus groups
We selected statements from interviews that indicated strong and conflicting opinions about tobacco – for example:
- 'As long as someone eats enough good food, illnesses from smoking can be avoided'
- 'Babies who have been kissed by smokers should be washed'
- 'Smoking is OK so long as the person does not lose control'
- 'It is every person's duty to tell smokers that they should not smoke in public'
- 'If people from my community saw me smoke they would tell my parents'
- 'There is no treatment available to help someone stop smoking'
- 'There should be more smoking bans than there are now'
- 'Smoking prevention groups overestimate the negative effect of smoking'
- 'If a man doesn't have a job he shouldn't smoke'
- '[the local tobacco company] is responsible for all of the illness related to smoking'
Focus groups discussed these statements. This was a welcome departure from the normal focus group approach and resulted in rich information on these issues.
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6 Observing tobacco marketing and use
Because the promotion, use, and control of tobacco are largely public, observation is particularly well suited to YT-RAR.
The team can observe regular events such as: they way people make purchases, light their product or prepare it for chewing, how they inhale, exhale (or spit), hold the tobacco product, and dispose of it. Regular events also include common activities for young people – in the home, among friends, in sports facilities, recreation centers, and shopping areas; preferred locations for using tobacco; and marketing devices used for product promotion. Unusual events are likely to be difficult to observe on another occasion. This may include things said between people in a particular context (confrontation on public transport regarding tobacco use), unusual ways of using tobacco, special events (parties, festivals, carnivals, ritual occasions), or locations where it may be difficult to re-gain access.
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Observation of a memorial service
We attended the three month anniversary of a friend's deceased relative. Such events are commonly accompanied by heavy tobacco use. The event included family members and close friends hosting a group of local monks - most of whom were under 20 years of age – who made prayers through the night commemorating the deceased. Tobacco in the form of pan was available to all, and the monks especially requested of the grieving family that cigarettes be made available to them, citing the need to stay awake through the night (and that it was customary practice). We participated in and observed the event, took photos, and later pieced together from memory a description of the event.
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The team can undertake planned observations using a pre-established record form, for example
- mapping outdoor advertising and marketing promotions – noting location, type, and brand –
- observing customers and purchase patterns over the course of a day in shop
- observing the social context of youth smoking.
- carrying out spot checks to determine the extent to which people observe public restrictions on smoking
- observing tobacco industry sponsored events and venues.
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Case study: systematic record of a protest against a tobacco company
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Observation guide
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Fieldnotes
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Setting: Where, when, layout, types of objects present
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In grounds outside NGO office, midnight, 1 truck, 3-wheeler taxi, cans of paint, glue, paper for posters
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People: Who, type of person, age, why here?
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60 or so 15-22 yr old male youth part of anti-tobacco NGO, (no girls, too late at night), active members in group keen to protest tobacco companies
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Activities
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Making glue, diluting paint; developing slogans, painting signs, posters; dividing up tasks, determining locations for posting, and snacking on food; calling political and financial supporters to ensure approval
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Signs and meanings attached to behaviors
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Enthusiastic endeavor, everyone is participating, there is a fever to their work with a deadline of 2am for all of the posters to be completed so that other teams can place them all over the town.
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Activities
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Manju appears to be orchestrating the event. Specific individuals are responsible for sub-tasks: Sathis for making glue and diluting paint; Babi for guaranteeing food and drinks are provided; Manaf for slogan development (in 3 languages) and posters
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Special or regular event
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Special event to coincide with and counter the annual Bristol cigarette brand bicycle race that will be going through town the next morning
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Time: in what order do things happen? Is there reason for this?
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Late at night to avoid obstacles posed by tobacco industry – order seems to follow a chain of events for similar kinds of protest activities – this phase at the NGO includes: dividing up tasks, making glue from flour and water in big buckets, determining slogans and making posters, eating prepared food, having a cool drink, collecting posters, dividing up into teams, posting slogans throughout town all though the night
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Goals: What are people trying do accomplish?
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Protest a tobacco sponsored sports event in a stealthy manner, avoiding tobacco companies – using humorous slogans to point out the irony of the tobacco company sponsoring a sporting event
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Connections: How do they know each other?
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Individuals are all a part of the anti-tobacco NGO. Some are veteran members who appear to have come only for this type of event (I don't recognize them). Others appear new and are shown how to do things.
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Narrative report of event
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It was 1 a.m. and the LIFE headquarters in Kandy, Sri Lanka bustled with activity. A single light bulb illuminated the scene: hundreds of hand-painted posters and placards; a three-wheeler taxi; a borrowed truck festooned with a 'Kiss a Non-smoker and See the Difference' banner; donated fish curry lunch packs and spiced milk tea for the 60 volunteers who had come to help through the night. This was the beginning of a campaign opposing the 'Bristol [cigarettes] Bike Race' for which the youth group had been many days and nights in preparation. LIFE had secured local community support, purchased supplies, called in the volunteers, and acquired the funding necessary for their activities (the latter, however, only one nerve-racking day before the scheduled campaign). It is not easy to protest the island-wide Bristol Cigarette Brand Bike Race, which is extremely popular among the hundreds of communities along its route.
Manju, the charismatic 27-year-old leader of the youth movement, delegated tasks to the 15- to 25-year-old male volunteers. Many were hand painting slogans capturing the spirit of their movement: 'Do not let [Ceylon Tobacco Company] tobacco chairman Mr. Fenn to cheat our youths by tobacco addvatisements [sic.]', or 'Sports and tobacco don't mix'. Others used the three-wheeler taxi to travel through the surrounding areas pasting posters, an all-night activity. The following day, LIFE volunteers drew crowds away from the bike race with live skits, singing and slogans that aimed to expose the tobacco company as knowing promoters of a substance that harms people….
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Special demonstrations can be a useful way to understand particular behaviors that may be difficult to observe in the field naturally
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Case study: demonstration of using tobacco products
We learned that there were different ways to smoke tobacco and wanted to understand the significance of the different ways. We asked a regular smoker to demonstrate how people used different types of tobacco. He showed what distinguished bidis, cigarettes, and cigars, including differences between brands, how each needed to be lit and smoked, and what particular gestures and ways of holding the products represented in the community. We learned that cigars have more kahate (local term representing undesirable impurities) than cigarettes, that some people smoke in a way to minimize the undesirable perceived darkening of the lips caused by smoking, and that particular ways of holding a tobacco product are considered deferential and necessary in the presence of elders or superiors. We used the pictures he allowed us to take in subsequent interviews to provoke discussion on these issues.
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7 Surveys of tobacco use
Surveys and questionnaires have a long tradition in tobacco control research. A survey might consider what types of tobacco products are used, and the frequency and amount smoked by different groups of people.
Surveys can be used for quantifying issues discovered though other research methods. For instance the team could survey health providers to quantify their experiences and the services offered for adolescents interested in obtaining cessation support. Such a survey could consist of a mixture of closed- and open-ended questions that could be quickly completed by the health worker.
Surveys can be used for screening individuals to determine the characteristics of those participating in other data collection methods. For example, use a screening survey prior to a focus group exercise, to ensure that participants represent the necessary characteristics of 13-15 year old, male, low income, current gutkha users.
Focused opinion surveys – administered to a small number of people, can quickly determine opinions on particular topics, such as possible interventions or reactions or particular policy initiatives.
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Case study: survey of media preferences
A survey was used to establish preferred media sources. It was administered in person with 200 male and female 13-18 year olds at community youth centers. The five minute questionnaire covered:
- preferred radio station and television station
- preferred radio and television programmes
- current cultural heroes (athletics, film, music, radio, television, politics)
- frequency of accessing television, radio, internet, etc.
- frequency of participation in common youth activities
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Surveys can be used to test theories and validate whether, and to what degree, ideas, behaviours and opinions arising from other methods represent those of the study population.
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Case study: using a survey to cross check issues from focus groups and interviews
We surveyed young people to check information from focus groups and interviews. The YT-RAR team identified several factors – such as being in manual labour jobs, tobacco provided as payment for employment, tobacco use allowed in the workplace - that appeared to influence whether young men became tobacco users after leaving school. Using a survey, we aimed to determine whether, and the extent to which, payment and workplace policies influence tobacco initiation and use among young people.
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Surveys can be used to measure changes over time, and this is useful for evaluation of the impact of interventions. For example, an evaluation survey might aim to determine the impact of a proposed second-hand smoke information campaign. The pre-intervention survey will ascertain baseline knowledge, attitudes and behaviour relating to second-hand smoke among a sample of the target population. Following the informational campaign, the post-intervention survey will obtain corresponding information from the population. In addition to asking questions that were asked in the baseline survey, the follow-up survey will include questions that ascertain the level of exposure to the intervention.
In the YT-RAR, surveys should be brief, easy to understand, simple to analyse, and limited to a few topics. With young people, the shorter the better.
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Example: survey of health providers
Q1 Approximately how many patients per month come to your health facility seeking assistance for their use of tobacco? ____
Q2 What support does your health facility offer to those who use tobacco and wish to quit? (circle all of those that apply – if none, leave blank)
(a) We talk to them about the effect of tobacco use on their health
(b) We provide published health information on the effect of tobacco on their health
(c) We talk to them about what options are available to them regarding quitting.
(d) We provide them with published information about tobacco cessation approaches
(e) We refer them to health facilities with expertise in tobacco cessation
(f) We prescribe or advise particular medicaments for cessation.
Q3 If training sessions were freely made available to you on the topic of tobacco cessation, would you be interested in participating? YES or NO
Q4 Based on your experiences as a health worker, please feel free to offer your comments, suggestions, ideas on the topic of tobacco use and cessation:
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Where relevant GYTS standardized questions should be used (see Annex 1). The GYTS questions areas include: prevalence, knowledge and attitudes, access and availability, environmental tobacco smoke, cessation, media and advertising, and school prevention programs. These questions are standardized and enable international comparison. Additional questions can be added reflecting priorities specific to your local needs.
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8 Mapping where tobacco is marketed and used
Spatial mapping helps understand the geographic distribution of tobacco promotion, sale, purchase and use. Places have special meaning for the people who live there and use them. The local café may be a café, but for those who live in the study area the café may represent a place they gather to play cards, or where young people can purchase alcohol (below legal age) and smoke tobacco.
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Case study: places used by young men
We asked a group of Christian young men to draw a map of significant places in their village. They emphasized features the Muslim groups at the other side of the village did not - the temple, the cemetery, the railway station and tracks, favorite corners to hang out, two shops, and the football pitches. Non-smoking areas included the temple, library, school, and anywhere where family members might see them. While there were approximately 20 shops in the village, only one was where they commonly gathered, purchased snacks and drinks, and loitered. There they bought tobacco products for their fathers, and in recent times for themselves. The cemetery was a place – during daylight - where young people spent time out of the watchful eyes of the community and families. A couple of boys mentioned the railway tracks as place they found solace (at night) when they wanted a place to walk and get away from others. They mentioned smoking in both of these locations, but for different reasons. Smoking was not appropriate at the small sports grounds, but when big matches between rival schools or clubs were held at the larger sports ground, it was expected that local whisky and smoking were consumed by spectators from both sides.
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Be aware of the local language used to describe salient aspects of the map, for example
- terminology delineating types of places and their relationship to tobacco use
- types of behaviours related to tobacco use (e.g. 'when I smoke on the railway tracks, I usually smoke alone, to forget my problems')
- characterization of types of tobacco users and relation to particular places (e.g. 'only an addicted smoker would smoke there')
- language used to describe face-value restrictions on tobacco use vs. social restrictions that are not apparent at face value
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Case study: who smokes where
People noted that those who 'do not smoke openly, and only smoke when they are in 'hidden places' like the 'gang house' or the 'cemetery' while among friends are not considered 'real smokers'. They are considered social smokers – and might refer to themselves as such. Individuals who smoke in public 'out in the open where people can see them are very different than social smokers.' Individuals mentioned that it would be unacceptable for people their ages (15-17), who are without jobs or still at school, and living with their parents, to smoke in public. Smoking openly - at the bus stop, the market, or along the alleys of the residential part of the village - was acceptable only for people who are older, employed and living apart from their parents.
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Early in the YT-RAR it will be useful to map community features relevant to young people and tobacco. These include:
- community facilities (public transport, recreation facilities, movie theatres, shops)
- environments of significance to young people: athletics, studies, food establishments
- stores that sell tobacco (small shops, groceries)
- other purchase points (restaurants, vending machines, cafés, movie theatres)
- environments where it is apparent that people use tobacco
- spaces where tobacco use is designated as 'prohibited'
- gathering points and environments where young people spend time
- spaces where people are at risk for using tobacco
- tobacco advertising and promotions
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Example: mapping exercise among young people
The half hour mapping exercise included questions such as:
- tell us about what you have drawn
- tell us about the places that are important to you and why they are important
- what kinds of places have you not included?
- where do young people use tobacco? Why not other places?
- where do young people not use tobacco? What happens if you used tobacco here?
- where do you obtain tobacco? What is the difference between the various places?
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Microsite mapping records the features of a particular building, shop, or other specific site directly or indirectly related to tobacco. For instance, a microsite map of a pharmacy in the USA, located in a neighbourhood with several schools, revealed that certain products (such as chewing tobacco) were located adjacent to sweets and balloons, at young children's eye level.
Body mapping can be used to understand what participants know about health effects related to tobacco use and the language used to describe the physiological process of tobacco use and its health effects. It may also give some understanding of local misperceptions and myths, and perceptions of risk among the young population.
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Example: body mapping exercise- tobacco and health
Give the group a large piece of paper with outline of human figure. Describe the aims of the exercise; emphasize that it is a group process, and not a biology lesson or a test. Ask about what happens once tobacco enters the mouth. Have them talk about and illustrate the smoke and the body parts it affects. How does it do that? What are immediate, short term and long term effects (good and bad)? Have them represent these effects and processes on the image of the figure. Have them describe and illustrate how this will be different for different types of people: female, male; young, old; healthy, unhealthy.
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Network mapping uses diagrams to illustrate the political, economic, or other types of network connections that might explicitly or implicitly exist and play a role in community and structural level influences effecting the potential for intervention implementation.
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9 Visual methods
Tobacco marketing and use are very visible. The environment of tobacco use and the range of products, marketing devices and purchase points can be well captured using visual methods. Video is particularly good at capturing events for advocacy, training, and teaching. Photography and video can:
- document items, behaviours, products, approaches that would be difficult or impossible to describe in another way – advertisements, product types, ways of using tobacco, ways of selling tobacco
- obtain images that can be used with other methods – for interviews, focus groups
- document issues for advocacy purposes
- provide community members with 'thank you' pictures you have taken of them
The following images might be considered
- tobacco products; tobacco advertisements and promotion events; purchase points
- health promotion materials, campaigns
- types of individuals defined by occupation, lifestyle, age, and/or clothing style
- places where smoking may or may not take place
- ways of using different tobacco products
- demonstrations by key informants of places to smoke and ways to smoke
- how people circumvent existing restrictions (underage tobacco purchasing, smoking in public places where it is restricted, etc.)
- NGO activities related to tobacco control - meetings, public demonstrations, conferences, information campaigns.
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Case study – using images to elicit information
We photographed people in different occupations and lifestyles. Images included a policeman, lawyer, doctor, vegetable seller, various youth lifestyles, monk, and taxi driver in the context of their work/lifestyle. These images were later shown in a focus group. They were asked whether they thought the different individuals were smokers, and what brands they were likely to use. This elicited responses such as 'He definitely smokes bidis – he smokes to refresh himself when he carries heavy loads'; or 'He's not a smoker – you can tell because he is an athlete. See, he doesn't have shrunken cheeks and his lips are not black.' These were comments we had not previously come across.
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Photographs of tobacco advertisements can be introduced to informants to encourage them to reflect on their impressions of the products, and the advertisements themselves. Photographs of promotions, such as tobacco company sponsored events like music concerts, discos, sports events, promotional events (including free giveaways) are particularly powerful in making the case that tobacco companies need to be better regulated, and in showing ways that they circumvent existing restrictions.
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10 Estimating the size of populations
Sometimes the team needs to estimate population sizes that cannot be measured directly. For example the team may want to estimate: the size of a difficult to count population e.g., underage smokers; the scale of interventions required e.g., the number of young people who would benefit from cessation support; the coverage of an intervention. TG-RAR outlines several estimation techniques – one of these is illustrated in the box below.
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Example: estimating the number of underage youth who purchase tobacco
We used the multiplier technique to estimate this number as follows. Benchmark: according police records, 32 underage youth were fined during 1999 for purchasing tobacco products. Multiplier: according to a recent survey of underage youth, 1/1000 who said they purchased tobacco products in 1999 were fined for doing so.
N (population to be estimated) x 1/1000 = 32
therefore N = 32,000
Thus, we estimated that 32,000 underage youth purchased tobacco products in 1999.
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11 Additional research methods
Role play is particularly good with young people. It makes participating in the project fun, while being a productive research tool. Role play allows them to project their experiences, perceptions and beliefs onto fictional characters. Interviews and focus groups will suggest issues that are suitable. For example:
- how underage young people buy tobacco. Where do they buy it? What time is best to purchase? Who buys? Subplots could be shopkeepers, community members seeing them purchasing, and a parent seeing the group smoking.
- young people discuss what they might do in their spare time. Someone introduces tobacco. What happens?
- smoker and non-smoker interactions. Non-smokers and smokers in the household – between spouses, children and parents and elders. Community member enforcement of no smoking in public (eg. on public transport, restaurant).
- tobacco use timeline. Events leading to starting to smoke. What peer pressure to smoke is like. Learning to use tobacco. Differences between brands. Ways of smoking. Quitting. Illnesses from tobacco use
Character types might represent:
- different types of young people (athlete, academic, troublemaker)
- prevalent stereotypes (poor rural illiterate, wealthy educated urban, the foreigner, anti-smoker, pro-smoker)
- occupations (schoolteacher, manual laborer, policeman, community elder)
- characters based on widely held beliefs (followers of traditional medicine, followers of western medicine; non-smokers, smokers, ex-smokers)
Role play should be followed by a facilitated discussion - dealing with how representative such experiences are, what issues were left out, and the extent to which individuals have experienced such issues.
Brainstorming draws on existing knowledge and experience from participants in a focussed and constructive expression of ideas.
Narrative methods can be used in role play to determine the sequence of events that commonly take place. For example tobacco purchase, transition points such as starting tobacco, quitting tobacco, joining the tobacco-control movement, participating in environments that are known to put young people at increased risk of tobacco use, starting to smoke in front of family members, gaining employment, changing schools, changing jobs.
Case studies might demonstrate: how particular groups identified tobacco as a problem and began to address; how a woman started tobacco use, how one family struggles with tobacco use; how a young person was able to give up tobacco use. Case studies benefit from a write-up that highlights the experiences from the participants' perspective, using their language and emphasizing the context of their experience.
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