Keith

Age at interview: 59

Brief Outline: Keith, 59, gave up smoking when he was 58. He is White British, works as a Head Teacher, is married and has a son. He started smoking with his friends down the football field when he was 11. He smoked since he was a teenager, despite a few attempts to give up, but gave up for good when he had a TIA (Transient Ischaemic Attack or minor stroke) last year.

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Keith first started smoking when he was 11 and he says he tried to be ‘big’. He smoked on the football field after school so he couldn’t be seen. He felt like he was ‘one of the chaps’ and that smoking was a ‘rite of passage’ into adulthood. As he was the son of the village policeman, he didn’t want to get caught smoking. Keith says that his mother smoked until she was 50 and then decided that she would stop and stopped ‘suddenly’. He remarks that smoking was much more socially acceptable when he was a child and thinks he can even remember a GP smoking. Keith used to smoke after school and then later when he was working, as he had a lot more disposable income. He says he mainly smoked in social situations. The amount of money he earned affected the amount he smoked, but he remembers that even when he had a young family, and didn’t have that much money, he still smoked, albeit not as much. He says that he enjoyed smoking, and never stopped enjoying smoking. Keith liked the ritual of smoking and felt it became part of his persona. He felt that others too saw him as a smoker. However, he found that if he tried to break the routine of smoking it wasn’t easy, and that there was some informal pressure to continue. He says that when he trained as a PE teacher there were quite a few people at college who didn’t smoke. He says that he knew smoking was a ‘bad deal’ but that ‘knowing that’ was never enough to make him stop. He was convinced that nothing was going to happen to him, and now he doesn’t know why. Later in life he became a head teacher, and consequently had a more stressful workload and smoked more. He isn’t ‘absolutely sure’ that his smoking and stress were related, but he felt he wanted to smoke at this job. Keith tried to stop after college, and then later when his son was around. He says that the main influence on his attempts at stopping was his wife. Keith said that he would use ‘all sorts of excuses’, and would smoke further and further away from the house, but still carry on. Cutting down ‘seemed even more tormenting’, whereas stopping seemed like a ‘big hit’ and he ‘felt it’. Now he regrets smoking in front of his son, although he hid it from him earlier on.

Over the years he gave up smoking for one month, six months, and nine months, but always went back to it. When he was 58 he was smoking 10 cigarettes a day during the working day and around 20 a day in holidays. He then had a TIA (a minor stroke) and lost his speech for a short while. When in hospital he was given clear advice about how to improve his health and he says it was obvious that he should stop smoking. Giving up smoking felt like a ‘great weight off his shoulders’. He stopped instantly after seeing people who were worse off than him in hospital. He hasn’t smoked again since his TIA, although he has sometimes wanted to. Keith said that the first thing he did when he returned home was to get rid of all the paraphernalia to do with smoking. He didn’t discuss giving up with his wife but he knew that both his wife and son wanted him to give up smoking. Since he has given up smoking he has put on just over a stone but is now consciously ‘attacking that’ and is ‘trying to cut back on things and bring [his] weight down’. Since stopping smoking he doesn’t get a ‘claggy’ feeling in the morning, his clothes don’t smell and he doesn’t feel so guilty. He felt guilty because he was a teacher, even though he says he never smoked in front of children. He thinks that smoking has become less socially acceptable. In the past he tried nicotine patches, and says that despite itching slightly they did take away the desire to smoke but didn’t ‘have a long-term effect’. Previous to this, his GP had offered him ‘stop smoking’ support and this was ‘very good’ but not ‘overstated’.

Keith remembers that he could go all day at work without smoking, but had a ‘contextual’ habit and smoked on the way home from work, after sport and in pubs. Now he feels proud of not smoking and finds it interesting how many people in his friendship group are giving up. He thinks that the smoking ban may be contributing towards this. Now he says that in the back of his mind he thought the smoking ban would be a good way to help him stop smoking. He finds it easier to think of one thing and then to do it and wants to let people know that giving up is possible.

Keith was told about a Stop Smoking group at his GP surgery, but didn’t go because he didn’t want to admit to himself that he couldn’t give up smoking without support.

And there was every chance for me to join the non smoking clinic at the practice and apparently it’s very effective. But I didn’t.

Thank you. I mean support groups aren’t for everybody. What would be your feelings about going to a non smoking group or a clinic?

I think probably it wouldn’t suit me, I think probably it’s the probably the shame thing really, of going to a group to show that I haven’t got the willpower to pack up smoking in my own right and I think that was the main factor why I didn’t take it up. It would have been sensible to do it. But to admit that you haven’t got the willpower to give up smoking or I suppose I didn’t really want to as I said earlier. So that was the main factor for not going.

Would it be shame in a group or just sort of shame even admitting it, even one to one?

Admitting to myself, I think, really, rather than to anyone else. I suppose once you’ve made the step and you’ve gone through to be, going into a group you’ve actually taken up the offer as it were, then it wouldn’t matter if it was a group or an individual. The thing is admitting to yourself that you’re overcoming this, this block.

When Keith returned home from hospital after having had a TIA (or mini stroke), he felt like a non-smoker and was relieved.

When I got home I threw all the lighters away as a little gesture. A big gesture. And any old stray cigarette packets or anything to do with smoking at all. Just threw it out, with some pleasure, and put it in the bin, and that was it. That was the actual symbol of me not smoking any more.

What was the pleasure about it at that stage?

Oh I was just relieved. It was like a great weight off my shoulders. It was one threat to my health that I’d got rid of. Of course it didn’t stop the desire to smoke at all. But it was a symbolic and actual gesture of stopping smoking yes.

So it was. It was a real relief that I generally believed that I was a non smoker from that time. It was true, yes. I was.

After quitting smoking Keith put on just over a stone, but his lungs felt better.

In terms of physical, how I feel since the, since giving up smoking. I checked on my weight and I put on just over a stone in the year since packing up smoking but I’m consciously attacking that now and trying to cut back on things and bring my weight down and indeed it is coming back down again now so…

And I mean that was also tied in with other things. I had knee problems so I couldn’t get about as much. I was more sedentary anyway and so I think the two connected but the knee is getting better now, so I can move around more at the same time that I’m doing a bit more exercise and eating less I suppose. But feeling much better for it, and my lungs are clearer. I don’t get that sort of claggy feeling in the morning which was very disgusting.

When Keith had a TIA, he appreciated the clarity with which a doctor told him about lifestyle changes that he needed to make, which included giving up smoking.

Can you remember how health professionals managed giving the information to you about the stroke and about changes in your life that you might want to think about?

Yes, they were absolutely clear. A series of people came to see me at various times. It’s all a bit jumbled, but I can remember my last meeting with the doctor who came and gave quite clear advice you need to stop smoking. I asked him the question what would be. Stop smoking, keep body weight... keeping decent, don’t get too overweight not too much drinking, but no need to stop altogether, but keep it within moderation, everything within moderation I suppose really. A good diet. We asked him about smoking. You shouldn’t smoke. But then it’s a daft question really because everybody knows that, well I knew that I shouldn’t smoke.

It was very, very interesting. He was very clear and concise and to the point. Hm.

And did he give you or anybody else give you advice about how to do a number of these things?

No. No. No. They didn’t.

And would you have wanted that or…?

I’ve stopped smoking without it. So no. As I say it’s a bit jumbled, so I can’t really remember if there was advice to hand really. I think probably I decided that that was it, so I didn’t look for it. It may have been there, because there was an array of information in written form and always, always nurses, well nurses in particular to ask advice.

Before he was 16 Keith smoked down the football field, hiding from his Dad, the village policeman.

Can you remember having that, having that first cigarette?

Oh I can clearly yes. It was at the football field, and it used to be the thing. We would go to the football field after school and sports being a big part of my life interestingly, being a smoker, but most, again, I suppose memory fades with age, but most of those people, they were a wide range of people from my age at that time, ten, eleven years old to eighteen years old and after work and when they finished work and I’d finished school along with lots of others we used to go to the local field and have a massive kick around and somebody just offered me a cigarette and I took it. And I can’t remember which one it was, but I can remember smoking it, and I can remember smoking it by the hedge so I wouldn’t be seen [laughs].

So when you were hiding behind the hedge who were you hiding from?

My Father was the village policeman, so I was hiding from his well hiding from him most of all, I suppose. I’m not sure, I knew it was wrong to smoke before you were 16 and I suppose it added to the sense of daring and doing something, breaking the rules a little bit, which is always exciting isn’t it, yes. So I guess that’s what it was.

Other people saw me there smoking. Other people got into smoking in just the same way at my age, which doesn’t make it any better. But that was the way it was.

As a PE teacher, Keith tried to maintain a healthy lifestyle by doing exercise and watching his diet.

You were saying quite into sport at the time.

Hm.

What sports were you into?

Oh it varied, mainly team games when I was younger, football, physical contact games like football, rugby and alongside that squash and badminton, and I trained as a PE teacher and I smoked through that time as well, which is just ridiculous. Mind you I wasn’t the only smoking on the PE course, but yes, trained as a PE teacher and so loved all sports really and then taught PE for 13 years and thoroughly enjoyed that as well.

So, I was fully aware of the health implications of smoking and not smoking, the implications of exercise and good diet and all of those things surrounding a healthy lifestyle. But I didn’t live up to it.

And the other things surrounding a healthy lifestyle that you would have done, so the good diet and so on that you were obviously be learning about as a PE teacher, did you sort of do other things like that as conscious sort of choices to be healthy or …?

I think I did. I think I tried to keep a healthy diet as much as, as much as I possibly could, and try and keep things in moderation I think, tried to keep things in moderation. I didn’t make it, it was nowhere near as sophisticated as it is now. I mean people, sports science is very intensive I think and very, very detailed, and it was nowhere near as intense and… whether the knowledge was about or, or not I don’t know, but I certainly didn’t. I wasn’t as aware. I mean you know, the advantages of a good balanced diet, and yes, I did try, try to live to those years.

Keith was determined to give up smoking after having a TIA (minor stroke).

I was just terrified in hospital, I was, I was quite deeply worried and it was a real shock to my system, and if there’s anything good that’s come out of it it’s meant that I have stopped smoking and taking more care of my health overall or at least thinking more about my health overall. Smoking just wasn’t an option after that. That was such a shock, and looking round and seeing people much, much worse off than I was. And seeing how they couldn’t get about, they couldn’t move without help and they were really in need, they’d lost all their independence and that really did shock me and so what did, I thought then that I was going to have to do everything I possibly could to make sure I didn’t end up in that position. Because once people have had a stroke, a minor stroke, apparently the chances of having a full stroke or a further stroke is heightened and so I’m determined to try and do everything I can to, including stopping smoking, to lower the risk.

And how did you know what those things were?

Well I took advice and when, we were in the [name of hospital], we had absolutely excellent support and was given good information and good backup support, and a lot of information and I read a lot about it, and I didn’t need anybody to tell me that smoking isn’t good for you per se. If it didn’t cause the stroke, if it wasn’t the factor it could cause, it could have been a contributory factor and probably was, but it could cause all the other things that go along with smoking, such as lung cancer and goodness knows what else. Hm.

So did I think about it when I was lying there? As a part of the whole package yes. I just knew as I was in hospital that I was never going to smoke again. And I won’t.

In the longer term Keith thought that the ban might help him give up smoking.

I do remember it coming in and I fully supported it and even though I was a smoker at the time. I thought that it was a really good thing. I thought, I suppose at the back of my mind I thought it would be a way to stop me smoking and I suppose it was in the really long run, but short term I carried on just the same. I was a firm believer in stopping smoking in public places and in pubs and I think it has been a really good move. I’m not aware of the statistics, but I wouldn’t be surprised if the number of smokers has decreased significantly because of it and that’s another thing. I hope so anyway.

When Keith first started work, he could afford to smoke more. Even when he had a young family and was worse off, he still smoked.

It certainly increased and certainly since I had more disposable income and went out when I was a little older 17, 18. I had two years after school, after doing ‘A’ levels when I didn’t take on further education. I earned quite a lot, relatively a lot of money then, so it was great, so a lot of disposal income and I smoked more or less you know, straight through that time really. I could afford to do so. So I suppose that enabled me to do it looking back. Yes.

And when would you smoke mainly when you were sort of in your late teens?

Late teens. I think socially again. The two years I had I could smoke during work, it was possible to smoke during work in those days, and in public places and I had all sorts of jobs. All sorts of, I worked in labouring and, and delivering bread and lorry driving, or lorry drivers mates really. All sorts of, I needed time away from institutions really. And I was very well paid for doing it. I was relatively well off, so smoked most of the time I think.

And would the amount you earned affect the amount you smoked?

Well if I hadn’t have got the money, I wouldn’t have been able to smoke as many I did, yes, that’s, that’s certainly been a factor. Although when I was first married and bringing up my family, we were pretty hard up then to start with and I still carried on smoking. Probably not as much but still carried on smoking.

And did you …

So it was quite sorry to interrupt….

No.

But it just goes to show what a powerful. It’s totally illogical isn’t it, to smoke is totally illogical? But it’s such a powerful force that it overcomes all of the internal blocks and checks that you have. And you end up rationalising something illogical to yourself and you know that it doesn’t make sense.