Forbidden fruit: An exploration of meaning construction of tobacco smoking of people living with Chronic Obstructive Pulmonary Disease (COPD)

ABSTRACT Background: Smoking is an avoidable risk factor for diseases, impacting socioeconomic and health care systems globally. The meaning, purposes, and values related to continued smoking after being diagnosed with COPD have not yet been sufficiently explored from an occupational perspective. Gaining an understanding of why people continue to engage in health-compromising or harmful occupations facilitates a more inclusive view on and discussion of occupation. The purpose of this study was to explore meaning construction regarding the occupation of tobacco smoking of people living with COPD in Germany. Methods: This study applied an interpretative phenomenology analysis (IPA) approach to explore the lived experience of people living with COPD who continue to smoke. Four participants were interviewed. Their accounts were then analysed following IPA guidelines. Findings: Three themes emerged from the data: Set in stone, Forbidden fruit, and To wear sackcloth and ashes. Smoking was experienced as a meaningful occupation, and it was especially valued for how it structured the day. Smoking was a familiar habit, and it supported emotional, physical, and cognitive well-being, and contributed to sense of identity. Conclusion: The findings illustrate the importance of understanding occupations that are not positively related to physical health and well-being because of their harmful nature. The findings of this study suggest that occupations do not need to be health-promoting, productive, or reasonable to be meaningful to individuals—meaning is constructed by subjective perceptions of enjoyment, pleasure, and well-being and by experiencing a sense of restoration and reward when engaging in them.