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Asyary A, Veruswati M. Smoking Behavior and Cigarette Expenditure in a Household: Evidence for Smoke-Free Houses Initiation in Indonesia. Int J Prev Med 2023; 14:7. [PMID: 36942034 PMCID: PMC10023842 DOI: 10.4103/ijpvm.ijpvm_113_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 06/18/2021] [Indexed: 01/26/2023] Open
Abstract
Background The household is considered as a private area that is untouched tobacco control policies in developing countries, especially in Indonesia, which has not ratified the Framework Convention on Tobacco Control (FCTC) treaty. Objectives This study aims to identify smoking behavior and expenditure on cigarettes in the household, which are part of the initiation of a policy including a smoke-free home, so it assumes that the home is a public domain in Tegal Regency, Central Java Province, Indonesia. Methods This research is an observational study with a quantitative descriptive design. A total of 225 subjects in the seven regions designated as smoke-free areas were all selected as samples in this study and were willing to be the subject of research. Results The results found that 76.1% of smokers smoked with their nuclear family (wife/children/husband) present. Smoking behavior with the nuclear family inside the home (39.13%) and outside the home (36.96%) was more common than not smoking with the nuclear family. Expenditure for cigarettes per month was one-third of household revenue (IDR 607,521.74) based on the regency minimum wage (UMR) set by the local government. Conclusions The study concludes that smokers who smoke with family still lack knowledge on smoking's impact on health and household economics. The smoke-free regulation that is initiated should include households as a parameter.
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Affiliation(s)
- Al Asyary
- Department of Environmental Health, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
- Center for Educational and Community Services, Faculty of Public Health, Universitas Indonesia (P3M FKM-UI), Depok, Indonesia
- Address for correspondence: Dr. Al Asyary, Department of Environmental Health, Faculty of Public Health, Universitas Indonesia, C Building 2nd Floor, Kampus FKM-UI, Depok - 16424, Indonesia. E-mail:
| | - Meita Veruswati
- Center for Educational and Community Services, Faculty of Public Health, Universitas Indonesia (P3M FKM-UI), Depok, Indonesia
- PhD Program in Business and Management, Management and Science University (MSU), Selangor Darul Ehsan, Malaysia
- Department of Public Health Science, Faculty of Health Sciences, Universitas Muhammadiyah Prof. Dr. HAMKA (UHAMKA), Jakarta, Indonesia
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O'Donnell R, Amos A, Turner SW, Adams L, Henderson T, Lyttle S, Mitchell S, Semple S. 'They only smoke in the house when I'm not in': understanding the limited effectiveness of a smoke-free homes intervention. J Public Health (Oxf) 2021; 43:647-654. [PMID: 32323719 PMCID: PMC8458016 DOI: 10.1093/pubmed/fdaa042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 11/14/2019] [Accepted: 01/14/2020] [Indexed: 11/17/2022] Open
Abstract
Background Children’s second-hand smoke (SHS) exposure in the home is highest in socio-economically disadvantaged areas. Personalized household air-quality measurements can promote changes in smoking that reduce SHS exposure. The ‘First Steps 2 Smoke-free’ (FS2SF) intervention is the first to trial this approach delivered as part of health professionals’ routine work. This paper reports the findings of qualitative interviews with participants that explored their experiences of the intervention and why outcomes varied. Methods 120 women were recruited from the NHS First Steps Programme, which supports disadvantaged mothers. They received either personalized feedback on their home air quality and advice on reducing SHS or standard SHS advice. Qualitative interviews with 15 mothers were analyzed thematically using the Capability, Opportunity, Motivation, Behaviour (COM-B) model. Results The intervention increased women’s capability to change home-smoking behaviour, through increasing awareness and salience of SHS risks to their children, and motivation to act. However, taking effective action was constrained by their limited social and environmental opportunities, including others’ smoking in the home. Conclusions The FS2SF intervention was ineffective as it was unable to fully address the precarious, complex life circumstances that make creating a smoke-free home particularly difficult for women experiencing intersecting dimensions of disadvantage.
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Affiliation(s)
- R O'Donnell
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK
| | - A Amos
- Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - S W Turner
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - L Adams
- NHS Lanarkshire, Airdrie ML6 6DB, UK
| | | | - S Lyttle
- NHS Lanarkshire, Hamilton ML3 0TA, UK
| | | | - S Semple
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK
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Ward E, Dawkins L, Holland R, Notley C. Responsibility, normalisation and negotiations of harm: E-cigarette users' opinions and experiences of vaping around children. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 88:103016. [PMID: 33161295 DOI: 10.1016/j.drugpo.2020.103016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 10/08/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Concern about youth uptake of vaping is widespread. Regulation and education campaigns aim to protect children from initiating use, yet it is likely that children will be primarily influenced by the behaviour of people in their immediate environment. This is the first known study exploring e-cigarette users' views and reported experiences of vaping around children. METHODS Following informed consent, semi-structured qualitative interviews were conducted with 40 adults who had attempted to give up smoking by vaping. Participants were recruited from England as part of a wider study into e-cigarette use trajectories and smoking relapse (ECtra study). Data were extracted from 28 interviews where participants had spontaneously discussed vaping around children. Extracted data were analysed thematically and situated in previous analysis of vaping identity which distinguished between recreational and medicinal vapers. RESULTS Vaping behaviour around children was in part a habituated replication of smoking norms but also guided by broad vaping identity; recreational users were more permissive and medicinal users more secretive. Vaping in the home appeared to be determined by caregivers' need to reconcile vaping behaviour so that it was congruent with parental identity as a responsible caregiver. Participant perspectives reflected existing moral discourses applied to e-cigarettes around the use of "harm reduction for smokers" and "potential for youth harm". CONCLUSION Vaping is likely to be role modelled within the community and home despite attempts by e-cigarette users to conceal the behaviour. The ambivalent contextualisation of e-cigarettes means that e-cigarette users may lack a clear narrative to draw on when discussing vaping with children. Public health guidance for vaping around children could be helpful, but to be most effective, should take into consideration users' vaping identity.
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Affiliation(s)
- Emma Ward
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, United Kingdom.
| | - Lynne Dawkins
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, 103 Borough Road, London, SE1 0AA, United Kingdom
| | - Richard Holland
- Centre for Medicine, George Davis Centre, University of Leicester, Lancaster Road, Leicester, LE1 7HA, United Kingdom
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, United Kingdom
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Willand N, Nethercote M. Smoking in apartment buildings - Spatiality, meanings and understandings. Health Place 2020; 61:102269. [PMID: 32329734 DOI: 10.1016/j.healthplace.2019.102269] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/22/2019] [Accepted: 12/04/2019] [Indexed: 11/16/2022]
Abstract
Increased higher density urban living may exacerbate exposure to environmental tobacco smoke. Using a social practices lens, this research explored the locations, experiences and governance of smoking in apartment buildings in Melbourne, Australia, through semi-structured interviews in high-rise buildings ranging from subsidised housing to luxury apartments. Tacit rules on acceptable locations, building rules and smoke alarms in public areas consigned smoking to balconies and building entrances. The perceived health threat from second hand smoke and mental stress due to invasion of olfactory and visual privacy undermined the full enjoyment of the home environment. Interventions may benefit from targeting the link between smoking and balconies.
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Affiliation(s)
- Nicola Willand
- School of Property, Construction and Project Management, Royal Melbourne Institute of Technology (RMIT) University, 124 La Trobe Street, Melbourne, GPO Box 2476V, Melbourne, Victoria, 3001, Australia.
| | - Megan Nethercote
- School of Global, Urban and Social Studies, RMIT University, GPO Box 2476V, Melbourne, Victoria, 3001, Australia.
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Thomas JL, Schreier M, Luo X, Lowry S, Hennrikus D, An L, Wetter DW, Ahluwalia JS. Promoting Smoke-Free Homes Through Biomarker Feedback Documenting Child Exposure to Tobacco Toxins: Protocol for a Randomized Clinical Trial. JMIR Res Protoc 2019; 8:e12654. [PMID: 31588910 PMCID: PMC6913685 DOI: 10.2196/12654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Exposure to secondhand smoke (SHS) early in life increases the risk of sudden infant death syndrome (SIDS), asthma, and respiratory illnesses. Since children's primary exposure to SHS occurs in the home, these most vulnerable members of our society are not fully protected by recent increases in the adoption of smoking bans in public spaces. Although exposure to SHS is a quickly reversible cause of excess morbidity, few low-income homes strictly enforce smoking restrictions. OBJECTIVE This study aims to test a novel approach to motivate the adoption of home smoking restrictions and to eliminate child SHS exposure by providing parents with objective data documenting home SHS exposure and "biomarker feedback" of child ingestion of tobacco toxins, that is, objective, laboratory-based results of assays performed on child urine, documenting levels of nicotine; cotinine; and NNAL (4-[methylnitrosamino]-1-[3-pyridyl]-1-butanol), which is a metabolite of the known tobacco carcinogen NNK (4-[methylnitro-samino]-1-[3-pyridyl]-1-butanone). METHODS From 2011 to 2013, 195 low-income, female smokers with children aged ≤10 years residing in their homes were recruited into a two-arm randomized clinical trial. Participants were assigned to one of two groups: biomarker feedback (n=98) and health education (n=97). In-home assessments were administered at baseline, week 16, and week 26. Children's home SHS exposure and nicotine, cotinine, and NNAL levels from urine samples, measured through a passive nicotine dosimeter and a surface sample of residual tobacco smoke (ie, thirdhand smoke), were collected at all three time points. Primary outcome was dosimeter-verified, self-reported complete home smoking restrictions at 6 months after randomization. Secondary outcomes included parental self-report of smoking behavior change and child urine tobacco toxin (biomarker) change. RESULTS Data collection and analyses are complete, and the results are being interpreted. CONCLUSIONS The study protocol describes the development of a novel community-based controlled trial designed to examine the efficacy of biomarker feedback documenting home and child exposure to SHS on parental smoking behavior change. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/12654.
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Affiliation(s)
- Janet Leigh Thomas
- Program in Health Disparities Research, Department of Medicine, Division of General Internal Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Meredith Schreier
- Program in Health Disparities Research, Department of Medicine, Division of General Internal Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Xianghua Luo
- School of Public Health, Division of Biostatistics, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States
| | - Sue Lowry
- Clinical and Translational Sciences Institute, University of Minnesota, Minneapolis, MN, United States
| | - Deborah Hennrikus
- Department of Epidemiology, University of Minnesota, Minneapolis, MN, United States
| | - Lawrence An
- Center for Health Communications Resarch, University of Michigan, Ann Arbor, MI, United States
| | - David W Wetter
- Center for Health Outcomes and Population Equity, Huntsman Cancer Center, University of Utah, Salt Lake City, UT, United States
| | - Jasjit S Ahluwalia
- Brown University School of Public Health and Alpert School of Medicine, Providence, RI, United States
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Rahman M, Hasan SMM, Haque SE, Haque N, Rahman M, Mostofa G, Zahan S, Huda D, Sobaihi SA, Ahmed K, Mahmud HMM. Secondhand smoking, knowledge/attitudes and socioeconomic status among married Bangladeshi women: a cross-sectional study. SAO PAULO MED J 2019; 137:13-24. [PMID: 31116265 PMCID: PMC9721222 DOI: 10.1590/1516-3180.2018.0292071218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 12/07/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is a paucity of research on knowledge/attitudes regarding the dangers of exposure to secondhand smoking (SHS) among women. The relationship between exposure to SHS, socioeconomic status (SES) and knowledge/attitudes regarding the risks of SHS has often been ignored. We therefore aimed to examine (1) whether SES and exposure to SHS were independently associated with knowledge/attitudes regarding the risks of SHS; and (2) whether women with low SES and exposure to SHS were uniquely disadvantaged in terms of deficient knowledge and more dismissive attitudes towards the risks of SHS. DESIGN AND SETTING Cross-sectional study in the Rajshahi district, Bangladesh. METHODS A total of 541 women were interviewed. Knowledge of and attitudes towards the risks of SHS were the outcomes of interest. RESULTS A majority of the respondents were exposed to SHS at home (49.0%). Only 20.1% had higher levels of knowledge, and only 37.3% had non-dismissive attitudes towards the risks of SHS. Participants in the low SES group and those exposed to SHS had lower odds of higher knowledge and their attitudes towards the risks of SHS were more dismissive. Regarding deficient levels of knowledge and scores indicating more dismissive attitudes, women in the low SES group and who were exposed to SHS were not uniquely disadvantaged. CONCLUSIONS Exposure to SHS and low SES were independently associated with deficient knowledge and scores indicating more dismissive attitudes. Regarding knowledge/attitudes, the negative effect of exposure to SHS extended across all socioeconomic backgrounds and was not limited to women in either the low or the high SES group.
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Affiliation(s)
- Mosiur Rahman
- MSc, MHSc, PhD. Associate Professor, Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh, and JSPS Postdoc Fellow, Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, Japan.
| | | | | | - Nuruzzaman Haque
- PhD. Professor, Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh.
| | - Mosfequr Rahman
- PhD. Associate Professor, Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh.
| | - Golam Mostofa
- PhD. Professor, Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh.
| | - Sarwar Zahan
- PhD. Senior Educational Professional, Institute of Educational Development, BRAC University, Dhaka, Bangladesh.
| | - Durrul Huda
- MBBS. Director, Diabetic Association, Chapai Nawabganj, Bangladesh.
| | - Saber Al- Sobaihi
- PhD. Postdoc fellow, Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Kapil Ahmed
- MPH, PhD. Deputy Director (Research and Evaluation), Bangladesh Center for Communication Programs (BCCP), Dhaka, Bangladesh.
| | - Howlader Mohammad Miraz Mahmud
- MSc. Research Coordinator (Research and Evaluation), Bangladesh Center for Communication Programs (BCCP), Dhaka, Bangladesh.
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7
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Huang CM, Liao JY, Huang SF, Hsu YT, Hsu HP, Guo JL. Patterns of parents' perspectives on protecting young children from secondhand smoke exposure: A Q-methodology study. J Adv Nurs 2019; 75:2591-2602. [PMID: 30993733 DOI: 10.1111/jan.14029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/29/2019] [Accepted: 03/05/2019] [Indexed: 11/29/2022]
Abstract
AIMS To identify and describe the various patterns of parents' perspectives on avoiding secondhand smoke exposure. DESIGN Q methodology was applied to investigate the parental perspectives of 50 parents. METHODS The study was implemented from September-December 2016. Forty-two Q-statements were constructed based on the literature related to parental attitudes and prevention practices regarding preventing young children from experiencing secondhand smoke exposure. A series of Q-sorts was performed by the participants to rank the statements into a Q-sort grid. PQMethod 2.35 software was used to perform principal component analysis to identify different patterns of parents' perspectives. RESULTS Five patterns of shared perspectives, which accounted for 62% of the total variance, were derived from the analysis: (a) lack of confidence to confront smokers in non-smoking areas; (b) awareness of health hazards but not ready to take preventive actions; (c) emphasis on parental responsibility and behavioural guidance; (d) awareness of health rights protected by legislation; and (e) strong willingness to take protective actions. CONCLUSION Our findings revealed the shared perspectives of five groups of parents. The exploration of clusters of parents could assist healthcare professionals in acknowledging parents' tendencies related to attitudes and responses towards secondhand smoke exposure. IMPACT Using a forced distribution through the Q-sorting technique, the particular perspective patterns of parents' experiences would be captured. These findings can serve as a useful guide for researchers and practitioners to develop tailored intervention programs for parents with the purpose of reducing secondhand smoke exposure in young children.
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Affiliation(s)
- Chiu-Mieh Huang
- Institute of Clinical Nursing, School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Jung-Yu Liao
- Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei, Taiwan
| | - Su-Fei Huang
- Department of Senior Citizen Service, Mackay Junior College of Medicine, Taipei, Taiwan
| | | | - Hsiao-Pei Hsu
- Institute of Clinical Nursing, School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Jong-Long Guo
- Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei, Taiwan
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Escoffery C, Mullen P, Genkin B, Bundy L, Owolabi S, Haard�rfer R, Williams R, Savas L, Kegler M. Coaching to create a smoke-free home in a brief secondhand smoke intervention. HEALTH EDUCATION RESEARCH 2017; 32:555-568. [PMID: 29253133 PMCID: PMC5914313 DOI: 10.1093/her/cyx072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 11/09/2017] [Indexed: 06/07/2023]
Abstract
Few community interventions exist to reduce secondhand exposure to tobacco smoke in the home. This study presents the coaching process of a larger intervention to promote smoke-free homes across an efficacy and 2 effectiveness trials. It furthers assesses the coaching call's reach and participants' satisfaction with the call across three intervention sites. The sources of the data were from baseline and 3-month follow-up surveys, coaching forms or online tracking system and interviews with coaches. Reach for the coaching call across trials was fairly high from 72% to 92%. Overall, the majority of participants were highly satisfied with the intervention (M = 3.76) and found it useful in creating a smoke-free home (M = 3.63). Common goals set were changing the environment to support a home smoking ban (e.g. putting up signs, removing ashtrays) (82%) or picking a date (60%). Challenges to a smoke-free home were consistent with other literature on barriers related to household smoking restrictions, including need for assistance in quitting, outside weather and smokers who do not want to quit. Additional research is needed to explore differential reach and reactions to the coaching call as it is disseminated and the impact of coaching call on the outcome of a smoke-free home.
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Affiliation(s)
- Cam Escoffery
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Patricia Mullen
- Department of Health Promotion & Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Brooke Genkin
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Lucja Bundy
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Shade Owolabi
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Regine Haard�rfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Rebecca Williams
- Center for Health Promotion and Disease Prevention , University of North Carolina at Chapel Hill, Chapel Hill, Carrboro, NC 27510, USA
| | - Lara Savas
- Department of Health Promotion & Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Michelle Kegler
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
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Glenn NM, Lapalme J, McCready G, Frohlich KL. Young adults' experiences of neighbourhood smoking-related norms and practices: A qualitative study exploring place-based social inequalities in smoking. Soc Sci Med 2017; 189:17-24. [DOI: 10.1016/j.socscimed.2017.07.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 06/07/2017] [Accepted: 07/24/2017] [Indexed: 11/28/2022]
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Milcarz K, Bak-Romaniszyn L, Kaleta D. Environmental Tobacco Smoke Exposure and Smoke-Free Rules in Homes among Socially-Disadvantaged Populations in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E447. [PMID: 28430128 PMCID: PMC5409647 DOI: 10.3390/ijerph14040447] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 04/05/2017] [Accepted: 04/19/2017] [Indexed: 11/17/2022]
Abstract
This study aims to examine the prevalence of exposure to environmental tobacco smoke (ETS) in homes among socially-disadvantaged populations in Poland, along with the prevalence and correlates of voluntary implementation of smoke-free home rules. Data concerning 1617 respondents from a cross-sectional study completed in the Piotrkowski District were used, which was part of the "Reducing Social Inequalities in Health" program. Overall, 19.4% of the respondents declared exposure to ETS at home. In the non-smokers group, 15.5%, including 6.6% males and 18.3% females, were exposed to ETS in their place of residence (p < 0.0001). Complete smoke-free rules were adopted by 22.1% of the study participants. Two factors, smoker status and lack of ETS-associated health risk awareness, were found to be significantly associated with no adoption of total smoking bans at home. Socially-disadvantaged non-smokers, especially females from rural areas in Poland, still constitute a large population exposed to ETS in their homes-a challenge from the perspective of public health. Focused efforts are required to address social norms around exposing others to ETS.
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Affiliation(s)
- Katarzyna Milcarz
- Department of Tobacco Control, Preventive Medicine Department, Medical University of Lodz, 90-752 Lodz, Poland.
| | - Leokadia Bak-Romaniszyn
- Department of Nutrition in Digestive Tract Diseases, Medical University of Lodz, 93-338 Lodz, Poland.
| | - Dorota Kaleta
- Department of Tobacco Control, Preventive Medicine Department, Medical University of Lodz, 90-752 Lodz, Poland.
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Disadvantaged Parents' Engagement with a National Secondhand Smoke in the Home Mass Media Campaign: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13090901. [PMID: 27618085 PMCID: PMC5036734 DOI: 10.3390/ijerph13090901] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 09/01/2016] [Accepted: 09/05/2016] [Indexed: 11/24/2022]
Abstract
Mass media campaigns can be effective in tobacco control but may widen health inequalities if they fail to engage disadvantaged smokers. This qualitative study explored how parents with young children living in disadvantaged circumstances engaged with a national campaign which aimed to raise awareness of the importance of smokefree homes. Individual semi-structured interviews were carried out with 17 parents before and after the Scottish 2014 “Right Outside” mass media campaign. A conceptual framework exploring meaningful exposure (recall and understanding), motivational responses (protecting children from secondhand smoke (SHS)) and opportunities to act (barriers) was used to thematically analyse the findings. Campaign recall and engagement, and motivation to protect children were high. Parents identified with the dramatized scenario and visual impact of SHS harm to children in the TV advertisement. Some reported changed smoking practices. However, supervising young children in limited accommodation when caring alone constrained opportunities to smoke outside. Instead, parents described actions other than smoking outside that they had taken or were planning to take to create smokefree homes. Mass media campaigns using emotive, real-life circumstances can be effective in engaging parents about SHS. However, the behavioural impact may be limited because of difficult home environments and circumstances.
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"I Was a Full Time Proper Smoker": A Qualitative Exploration of Smoking in the Home after Childbirth among Women Who Relapse Postpartum. PLoS One 2016; 11:e0157525. [PMID: 27308829 PMCID: PMC4911111 DOI: 10.1371/journal.pone.0157525] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 06/01/2016] [Indexed: 11/19/2022] Open
Abstract
Background Many women stop smoking during pregnancy but relapse shortly afterwards, potentially putting their infants at risk of secondhand smoke (SHS) exposure. Women who were able to stop during pregnancy may be a motivated group, receptive to making behaviour changes postpartum to protect their infant from SHS exposure. Understanding more about their experiences of relapse, and if this influences home smoking behaviours and children’s exposure to SHS in the home may help to inform intervention development to prevent infant SHS exposure. Methods Guided by interpretative phenomenological methodology we conducted and analysed nine semi-structured interviews with women who quit smoking during pregnancy, but relapsed ≤3 months postpartum. Findings Central to mothers’ accounts of their smoking behaviours during pregnancy and postpartum was their desire to be a ‘responsible mother’. Mothers described using strategies to protect their infant from SHS exposure, and held strong negative attitudes towards other smoking parents. After relapsing, mothers appeared to reposition themselves as ‘social’ or ‘occasional’ smokers rather than ‘regular’ smokers. Conclusions Findings suggest that interventions to prevent/reduce infants' home SHS exposure should build on mothers' intentions to be responsible parents. As mothers who relapse principally view themselves as ‘social’ or ‘occasional’ smokers, interventions that are highlighted as relevant for women with these types of smoking patterns may be more likely to be responded to, and, ultimately, be effective.
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13
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Passey ME, Longman JM, Robinson J, Wiggers J, Jones LL. Smoke-free homes: what are the barriers, motivators and enablers? A qualitative systematic review and thematic synthesis. BMJ Open 2016; 6:e010260. [PMID: 26988351 PMCID: PMC4800143 DOI: 10.1136/bmjopen-2015-010260] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To thematically synthesise primary qualitative studies of the barriers, motivators and enablers of smoke-free homes (SFHs). DESIGN Systematic review and thematic synthesis. DATA SOURCES Searches of MEDLINE, EBM Reviews (Cochrane Database of Systematic Reviews), PsycINFO, Global Health, CINAHL, Web of Science, Informit and EMBASE, combining terms for families, households and vulnerable populations; SFH and secondhand smoke; and qualitative research, were supplemented by searches of PhD theses, key authors, specialist journals and reference lists. STUDY SELECTION We included 22 articles, reporting on 18 studies, involving 646 participants. INCLUSION CRITERIA peer-reviewed; English language; published from 1990 onwards (to week 3 of April 2014); used qualitative data collection methods; explored participants' perspectives of home smoking behaviours; and the barriers, motivators and enablers to initiating and/or maintaining a SFH. DATA EXTRACTION 1 of 3 authors extracted data with checking by a second. DATA SYNTHESIS A thematic synthesis was performed to develop 7 core analytic themes: (1) knowledge, awareness and risk perception; (2) agency and personal skills/attributes; (3) wider community norms and personal moral responsibilities; (4) social relationships and influence of others; (5) perceived benefits, preferences and priorities; (6) addiction and habit; (7) practicalities. CONCLUSIONS This synthesis highlights the complexity faced by many households in having a SFH, the practical, social, cultural and personal issues that need to be addressed and balanced by households, and that while some of these are common across study settings, specific social and cultural factors play a critical role in shaping household smoking behaviours. The findings can inform policy and practice and the development of interventions aimed at increasing SFHs. TRIAL REGISTRATION NUMBER CRD42014014115.
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Affiliation(s)
- Megan E Passey
- University Centre for Rural Health—North Coast, School of Public Health, University of Sydney, Lismore, New South Wales, Australia
| | - Jo M Longman
- University Centre for Rural Health—North Coast, School of Public Health, University of Sydney, Lismore, New South Wales, Australia
| | - Jude Robinson
- Department of Sociology, Social Policy and Criminology, School of Law and Social Justice, University of Liverpool, Liverpool, UK
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Laura L Jones
- UK Centre for Tobacco and Alcohol Studies & Institute for Applied Health Research, University of Birmingham, Birmingham, UK
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Kegler MC, Haardörfer R, Bundy LT, Escoffery C, Berg CJ, Fernandez M, Williams R, Hovell M. Do partial home smoking bans signal progress toward a smoke-free home? HEALTH EDUCATION RESEARCH 2016; 31:24-35. [PMID: 26661723 PMCID: PMC4883035 DOI: 10.1093/her/cyv066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 11/06/2015] [Indexed: 06/05/2023]
Abstract
Understanding who establishes partial home smoking bans, what these bans cover, and whether they are an intermediate step in going smoke-free would help to inform smoke-free home interventions. Participants were recruited from United Way of Greater Atlanta's 2-1-1 contact center. Data were collected at baseline, 3 and 6 months via telephone interview. Participants (n = 375) were mostly African American (84.2%) and female (84.3%). The majority (58.5%) had annual household incomes <$10,000. At baseline, 61.3% reported a partial smoking ban and 38.7% reported no ban. Existence of a partial ban as compared with no ban was associated with being female, having more than a high school education, being married and younger age. Partial bans most often meant smoking was allowed only in designated rooms (52.6%). Other common rules included: no smoking in the presence of children (18.4%) and smoking allowed only in combination with actions such as opening a window or running a fan (9.8%). A higher percentage of households with partial bans at baseline were smoke-free at 6 months (36.5%) compared with households with no bans at baseline (22.1%). Households with partial smoking bans may have a higher level of readiness to go smoke-free than households with no restrictions.
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Affiliation(s)
- Michelle C Kegler
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA 30322,
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA 30322
| | - Lucja T Bundy
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA 30322
| | - Cam Escoffery
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA 30322
| | - Carla J Berg
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA 30322
| | - Maria Fernandez
- School of Public Health, University of Texas Health Sciences Center, Houston, TX 77030
| | - Rebecca Williams
- Gillings School of Global Public Health, Chapel Hill, University of North Carolina, Chapel Hill, NC 27510 and
| | - Mel Hovell
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA 91941, USA
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15
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Exploring the story of the smoking ban in Ireland as a neo-liberal project. SOCIAL THEORY & HEALTH 2015. [DOI: 10.1057/sth.2015.32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kegler MC, Haardӧrfer R, Berg C, Escoffery C, Bundy L, Williams R, Mullen PD. Challenges in Enforcing Home Smoking Rules in a Low-Income Population: Implications for Measurement and Intervention Design. Nicotine Tob Res 2015; 18:976-81. [PMID: 26246049 DOI: 10.1093/ntr/ntv165] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 07/23/2015] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Smoke-free homes reduce exposure to secondhand smoke, contribute to lower levels of consumption, and help smokers to quit. Even when home smoking rules are established however, they may not be consistently enforced. METHODS This study uses data from a randomized controlled trial of a brief intervention to create smoke-free homes among callers to the United Way of Greater Atlanta 2-1-1. Participants with partial or full home smoking bans at 6-month follow-up were asked about enforcement challenges, rooms where smoking occurred, and exceptions to the rules. Air nicotine monitors were placed in a subset of homes. RESULTS Participants (n = 286) were mostly female (84.6%) and African American (84.9%). Most were smokers (79.0%) and reported at least half of their friends and relatives smoked (63.3%). Among those with a full ban, 4.3% reported their rules were broken very often whereas 52.6% stated they were never broken. Bad weather and parties were the most common exceptions to rules. Among nonsmokers with full bans, 16% reported exposure to secondhand smoke in the home 1-3 days in the past week. In multivariate analyses, having a partial ban, being a nonsmoker, and living with three or more smokers predicted higher levels of enforcement challenges. CONCLUSIONS Findings suggest the majority of households with newly adopted smoke-free rules had no or rare enforcement challenges, but about one-fifth reported their rules were broken sometimes or very often. Interventions to create smoke-free homes should address enforcement challenges as newly adopted rules may be fragile in some households. IMPLICATIONS Interventions that promote smoke-free homes should address enforcement challenges.
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Affiliation(s)
- Michelle C Kegler
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA;
| | - Regine Haardӧrfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Carla Berg
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Cam Escoffery
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Lucja Bundy
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Rebecca Williams
- Cancer Prevention and Control Research Network, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Patricia Dolan Mullen
- Center for Health Promotion and Prevention Research, Department of Health Promotion and Behavioral Sciences, University of Texas School of Public Health, Houston, TX
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Mao A, Robinson J. Home smoking restrictions before, during and after pregnancy-a qualitative study in rural China. Health Promot Int 2015; 31:606-13. [PMID: 26071606 DOI: 10.1093/heapro/dav050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Worldwide, many nonsmokers (often women and children) are exposed to second-hand smoke (SHS) in home settings, as men retain their traditional power and control within their family and women and children have limited agency to intervene. This study, set up to explore home smoking management in rural China, found that some women were able to positively intervene to restrict men's smoking at three key stages: prior to conception, during their pregnancy and at the early years of their children's lives. By utilizing dominant social, health and political narratives about the importance of raising a healthy child supported by the One-Child Policy in China, combined with the fear of health risks of SHS to young children, the women were able to use their elevated status as bearer and carers of the only children to subvert the pre-eminence of men in domestic environments, enabling them to positively influence home smoking. While this study highlights the possibility for future smoking cessation initiatives in China by incorporating family carers' elevated awareness of protection of children's health in key stages of childhood, there is also a need for further health education, as family members were unsure why they needed to keep children smoke-free, which may partially explain why few households were smoke-free.
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Affiliation(s)
- Aimei Mao
- Kiang Wu Nursing College of Macau, Est. Repouso No. 35, R/C, Macau, China
| | - Jude Robinson
- School of Law and Social Justice, University of Liverpool, Liverpool L69 7WW, UK
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Rowa-Dewar N, Lumsdaine ,C, Amos ,A. Protecting Children From Smoke Exposure in Disadvantaged Homes. Nicotine Tob Res 2015; 17:496-501. [DOI: 10.1093/ntr/ntu217] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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19
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Spanier AJ, Beck AF, Huang B, McGrady ME, Drotar DD, Peake RWA, Kellogg MD, Kahn RS. Family hardships and serum cotinine in children with asthma. Pediatrics 2015; 135:e416-23. [PMID: 25583915 PMCID: PMC4306794 DOI: 10.1542/peds.2014-1748] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/24/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE A better understanding of how poverty-related hardships affect child health could highlight remediable intervention targets. Tobacco smoke exposure may be 1 such consequence of family hardship. Our objective was to explore the relationship between family hardships and tobacco exposure, as measured by serum cotinine, a tobacco metabolite, among children hospitalized for asthma. METHODS We prospectively enrolled a cohort of 774 children, aged 1 to 16 years, admitted for asthma or bronchodilator-responsive wheezing. The primary outcome was detectable serum cotinine. We assessed family hardships, including 11 financial and social variables, through a survey of the child's caregiver. We used logistic regression to evaluate associations between family hardship and detectable cotinine. RESULTS We had complete study data for 675 children; 57% were African American, and 74% were enrolled in Medicaid. In total, 56% of children had detectable cotinine. More than 80% of families reported ≥ 1 hardship, and 41% reported ≥ 4 hardships. Greater numbers of hardships were associated with greater odds of having detectable cotinine. Compared with children in families with no hardships, those in families with ≥ 4 hardships had 3.7-fold (95% confidence interval, 2.0-7.0) greater odds of having detectable serum cotinine in adjusted analyses. Lower parental income and educational attainment were also independently associated with detectable serum cotinine. CONCLUSIONS Family hardships are prevalent and associated with detectable serum cotinine level among children with asthma. Family hardships and tobacco smoke exposure may be possible targets for interventions to reduce health disparities.
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Affiliation(s)
- Adam J Spanier
- Department of Pediatrics, Penn State Milton S. Hershey Children's Hospital, Hershey, Pennsylvania;
| | - Andrew F Beck
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio; and
| | - Bin Huang
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio; and
| | - Meghan E McGrady
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio; and
| | - Dennis D Drotar
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio; and
| | - Roy W A Peake
- Clinical Epidemiologic Research Laboratory, Boston Children's Hospital, Boston, Massachusetts
| | - Mark D Kellogg
- Clinical Epidemiologic Research Laboratory, Boston Children's Hospital, Boston, Massachusetts
| | - Robert S Kahn
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio; and
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Fenton B, Thankappan KR, Champagne B, Lv J, Anthony D. Increased knowledge of the effects of smoking and second-hand smoke encourages smoke-free homes. J Res Nurs 2014. [DOI: 10.1177/1744987114525963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To establish the drivers for smoke-free homes among current daily smokers. Design A cross-sectional study employing interviews (adults) and self-completed surveys (schoolchildren). Sample Children aged 12 and 14 in schools in four cities in China, India, Mexico and England. Adults in the community. Measurements Knowledge, attitude, beliefs and behaviour relevant to second-hand smoke in home. Intervention None. Results A total of 8994 adults and 14,756 children were surveyed. Knowledge of some of the effects of tobacco is high, but other effects are poorly understood in all cities. In Thiruvananthapuram, there is a lack of awareness of the addictiveness of tobacco, and Hangzhou has poor knowledge in general. Conclusions Messages about reducing tobacco usage are effective in support of smoke-free homes in the city with poorest knowledge (Hangzhou) but other factors are more important where knowledge is high.
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Affiliation(s)
- Brenda Fenton
- Director, Community-based Research and Evaluation, MATRIX Public Health Solutions Inc., USA
| | - Kavumpurathu Raman Thankappan
- Professor, Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, India
| | | | - Jun Lv
- Associate Professor, Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, China
| | - Denis Anthony
- Statistical consultant, Oxford Health Alliance, UK; Chair in Applied Health Research, University of Leeds, UK
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Rowa-Dewar N, Amos A, Cunningham-Burley S. Children's perspectives on how parents protect them from secondhand smoke in their homes and cars in socioeconomically contrasting communities: a qualitative study. Nicotine Tob Res 2014; 16:1429-35. [PMID: 24951494 DOI: 10.1093/ntr/ntu096] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Children are particularly vulnerable to the health effects of secondhand smoke (SHS) and are mainly exposed in the home and the car. Reducing children's SHS exposure is a tobacco control goal, yet few studies have explored children's perspectives on SHS. This study examines children's accounts of the strategies family members employ to protect them from SHS and is the first to examine how these may be constrained or facilitated in communities with contrasting smoking prevalence rates. METHODS Individual, paired, and group interviews using topic guides and visual stimulus methods were conducted with 38 children aged 10-15 years who lived in 2 Scottish communities of contrasting socioeconomic status and had a close family member who smoked. Transcripts were analyzed thematically. RESULTS Parents were reported to employ spatial and dispersal measures to reduce children's SHS exposure in homes and cars. Smoking was restricted to certain rooms and to times when those considered more vulnerable were absent. Less distance between smokers and children and more smoking in the home were reported in the disadvantaged community, reflecting less space within homes and greater parental smoking. Participants expressed strong negative views about smoking in cars and the perceived ineffectiveness of dispersal measures in this context. CONCLUSIONS Although there was general awareness that SHS exposure was potentially harmful, SHS in the home was considered safe by some participants if certain conditions were met, particularly by those from the disadvantaged area. The implications of these findings for tobacco control programs and media campaigns, particularly those targeted at disadvantaged groups, are discussed.
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Affiliation(s)
- Neneh Rowa-Dewar
- UK Centre for Tobacco and Alcohol Studies, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK;
| | - Amanda Amos
- UK Centre for Tobacco and Alcohol Studies, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
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Butler KM, Rayens MK, Ashford K, Adkins S, Gombeski B, Britt J, Hahn EJ. Smoke-free homes, strength of smoke-free law, and children in the home. Nicotine Tob Res 2013; 16:485-90. [PMID: 24302637 DOI: 10.1093/ntr/ntt191] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Secondhand smoke (SHS) is a leading cause of childhood illness and premature death, especially in rural areas. The study examined the relationship of having a smoke-free home, strength of smoke-free law (SFL) in the county of residence, having one or more minor children in the home, rural/urban location, and demographics. METHODS An Internet-based panel survey was administered to Kentucky residents from 2007 to 2012. Sample size ranged from 400 to 513 per year; N = 2,653 total. Most were female, aged 35-54, had at least some college education, and lived in a smoke-free home. Almost half lived in a county with a comprehensive SFL; 14% lived in a county with a moderate or weak law. RESULTS Multivariate logistic regression revealed that the significant predictors of a smoke-free home included having education beyond high school, being a nonsmoker, living in an urban county, and having a year of participation in the survey. Controlling for smoking status and other personal characteristics, those who responded to the survey in the last 2 years of administration were more likely to have a smoke-free home compared to the reference year of 2007. Respondents living in urban counties were nearly 2 times more likely to report a smoke-free home than rural dwellers. CONCLUSIONS Smoke-free homes in urban areas, where SFLs may be the norm, may be more typical than in rural communities. Public awareness campaigns and education about the benefits of smoke-free homes is needed, especially in rural areas, targeting smokers, those with less education, and those with children living in the home.
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Affiliation(s)
- Karen M Butler
- Tobacco Policy Research Program, College of Nursing, University of Kentucky, Lexington, KY
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Bottorff JL, Oliffe JL, Kelly MT, Johnson JL, Chan A. Reconciling parenting and smoking in the context of child development. QUALITATIVE HEALTH RESEARCH 2013; 23:1042-1053. [PMID: 23774626 DOI: 10.1177/1049732313494118] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In this article we explore the micro-social context of parental tobacco use in the first years of a child's life and early childhood. We conducted individual interviews with 28 mothers and fathers during the 4 years following the birth of their child. Using grounded theory methods, we identified the predominant explanatory concept in parents' accounts as the need to reconcile being a parent and smoking. Desires to become smoke-free coexisted with five types of parent-child interactions: (a) protecting the defenseless child, (b) concealing smoking and cigarettes from the mimicking child, (c) reinforcing smoking as bad with the communicative child, (d) making guilt-driven promises to the fearful child, and (e) relinquishing personal responsibility to the autonomous child. We examine the agency of the child in influencing parents' smoking practices, the importance of children's observational learning in the early years, and the reciprocal nature of parent-child interactions related to parents' smoking behavior.
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Affiliation(s)
- Joan L Bottorff
- Institute of Healthy Living and Chronic Disease Prevention, University of British Columbia's Okanagan Campus, 3333 University Way, Kelowna, British Columbia, Canada.
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Carlsson N, Johansson A, Abrahamsson A, Andersson Gäre B. How to minimize children's environmental tobacco smoke exposure: an intervention in a clinical setting in high risk areas. BMC Pediatr 2013; 13:76. [PMID: 23672646 PMCID: PMC3660282 DOI: 10.1186/1471-2431-13-76] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 05/02/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Despite the low prevalence of daily smokers in Sweden, children are still being exposed to environmental tobacco smoke (ETS), primarily by their smoking parents. A prospective intervention study using methods from Quality Improvement was performed in Child Health Care (CHC). The aim was to provide nurses with new methods for motivating and supporting parents in their efforts to protect children from ETS exposure. METHOD Collaborative learning was used to implement and test an intervention bundle. Twenty-two CHC nurses recruited 86 families with small children which had at least one smoking parent. Using a bundle of interventions, nurses met and had dialogues with the parents over a one-year period. A detailed questionnaire on cigarette consumption and smoking policies in the home was answered by the parents at the beginning and at the end of the intervention, when children also took urine tests to determine cotinine levels. RESULTS Seventy-two families completed the study. Ten parents (11%) quit smoking. Thirty-two families (44%) decreased their cigarette consumption. Forty-five families (63%) were outdoor smokers at follow up. The proportion of children with urinary cotinine values of >6 ng/ml had decreased. CONCLUSION The intensified tobacco prevention in CHC improved smoking parents' ability to protect their children from ETS exposure.
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Affiliation(s)
- Noomi Carlsson
- Department of Clinical and Experimental Medicine, Division of Paediatrics, Faculty of Health Sciences, Linköping University, SE-581 83, Linköping, Sweden
- Department of Public Health and Medical Care, Jönköping County Council, Box 1024, SE-551 11 Jönköping, Sweden
| | - AnnaKarin Johansson
- Department of Medicine and Health, Division of Nursing Science, Faculty of Health Sciences, Linköping University, SE-581 83, Linköping, Sweden
| | - Agneta Abrahamsson
- Department of Health and Society, University College of Kristianstad, SE-291 88, Kristianstad, Sweden
| | - Boel Andersson Gäre
- Department of Clinical and Experimental Medicine, Division of Paediatrics, Faculty of Health Sciences, Linköping University, SE-581 83, Linköping, Sweden
- Futurum – the Academy for Healthcare, Jönköping County Council, SE-551 85, Jönköping, Sweden
- The Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Box 1026, SE-551 11 Jönköping,Sweden
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Atkinson O, Coleman T, McNeill A, Lewis S, Jones LL. The role of nicotine replacement therapy for temporary abstinence in the home to protect children from environmental tobacco smoke exposure: a qualitative study with disadvantaged smokers. BMC Public Health 2013; 13:262. [PMID: 23521825 PMCID: PMC3620522 DOI: 10.1186/1471-2458-13-262] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 03/08/2013] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Nicotine replacement therapy (NRT) has recently been licensed to help smokers to abstain from smoking for short time periods and recent studies have shown that 8-14% of smokers are regularly using NRT to cope when they cannot or are not allowed to smoke. These data suggest that, potentially, NRT for temporary abstinence might be an acceptable method to help smoking caregivers, who are not able to stop smoking completely, to avoid smoking whilst inside their home in order to protect their children from the harms of environmental tobacco smoke (ETS). The aim of this study was therefore to explore the concept of using NRT for temporary abstinence in the home, to protect children from exposure to ETS. METHODS Qualitative in-depth interviews were conducted with thirty six disadvantaged smoking parents who were currently, or had recently stopped smoking in the home with at least one child under the age of five. Parents were recruited from Children's Centres and Health Visitor Clinics in Nottingham, UK. Interviews were audio recorded and transcribed verbatim. Data were coded and analysed thematically to identify emergent main and subthemes. RESULTS Overall, participants responded negatively to the concept of attempting temporary abstinence in the home in general and more specifically to the use of NRT whilst at home to reduce children's exposure to ETS. Many parents would prefer to either attempt cutting down or quitting completely to make a substantial effort to change their smoking behaviour. There was limited interest in the use of NRT for temporary abstinence in the home as a first step to quitting, although some parents did express a willingness to use NRT to cut down as a first step to quitting. CONCLUSION Disadvantaged smoking parents were reluctant to initiate and maintain temporary abstinence with or without NRT as a way of making their homes smoke free to protect their children's health. More education about the specific risks of ETS to their children and the utility of NRT for use in the home might be needed to have a public health impact on children's health.
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Affiliation(s)
- Olesya Atkinson
- UKCTCS and Division of Primary Care, University of Nottingham, Nottingham, UK
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Robinson J, Holdsworth C. 'They don't live in my house every day': How understanding lives can aid understandings of smoking. CONTEMPORARY DRUG PROBLEMS 2013; 40:47-70. [PMID: 27695141 PMCID: PMC5044980 DOI: 10.1177/009145091304000104] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
While the prevalence of smoking in western countries has substantially reduced following the introduction of comprehensive tobacco control programs, reduction strategies such as the introduction of smokefree legislation, media campaigns and individual and group support for people trying to quit have been less successful with people living on low income, suggesting the need for new ways to engage with people who smoke. We argue that, rather than focusing solely on researching smoking behaviors to generate new understandings of why people smoke, people working in the broad area of public health should look more widely at peoples' lives in order to understand their smoking. Using a biographical, narrative perspective as part of a wider ethnographic study of 12 families living in one community within Liverpool in 2006, we argue that understandings that position smoking purely as a harmful, deviant behavior, fail to capture the cultural complexity of the lives of smokers and the changing place and meaning of cigarettes over a person's lifetime, and may explain why smokers fail to engage with smoking cessation services and continue to smoke.
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Mao A. Space and power: young mothers' management of smoking in extended families in China. Health Place 2013; 21:102-9. [PMID: 23454731 DOI: 10.1016/j.healthplace.2013.01.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 01/25/2013] [Accepted: 01/29/2013] [Indexed: 11/26/2022]
Abstract
Multigenerational co-residence is a widespread phenomenon in China but there is little knowledge about the impact of power dynamics on smoking behaviors among extended family residents. Using a gender lens, this ethnographic study explored how young mothers in extended families in mainland China managed the smoking of their husbands and other family members. Analysis of data resulted in a model of 'two units-three domains' to reflect gendered relationships between young mothers and other family members, and young mothers' participation in family management. Exploration of the mothers' efforts to deal with household smoking using the model provided an explanation for why the young mothers had limited control over household space and could only impose partial restrictions on home smoking in the extended family.
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Affiliation(s)
- Aimei Mao
- Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, Canada V1V 1V7.
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Wilson IS, Ritchie D, Amos A, Shaw A, O'Donnell R, Mills LM, Semple SE, Turner SW. 'I'm not doing this for me': mothers' accounts of creating smoke-free homes. HEALTH EDUCATION RESEARCH 2013; 28:165-178. [PMID: 22843328 DOI: 10.1093/her/cys082] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This article explores mothers' narratives of changing home smoking behaviours after participating in an intervention (Reducing Families' Exposure to Smoking in the Home [REFRESH]) aimed at reducing families' exposure to secondhand smoke (SHS) in homes in Scotland. An analysis of qualitative findings illuminates quantitative changes in levels of SHS exposure. Prospective quantitative and qualitative data were drawn from 21 smoking mothers with at least one child under 6 years. Quantitative change was measured by home air quality, i.e. fine particulate matter <2.5μg (PM(2.5)). These measurements guided the organization of mothers into categories of change (smoke-free home at baseline [SFB], smoke-free home at final, some change and no change [NC]). Qualitative data from 17 mothers with non-SFB were analysed thematically within and across these categories. Three comparative case studies illustrate the varying changes made, barriers to change and how mothers valued such changes. The outcomes varied post-intervention, with homes smoke-free, partially smoke-free or making NC. The changes in home smoking behaviour were incremental, yet beneficial to reducing SHS exposure, and related to the nature of the restrictions and personal circumstances in the home pre-intervention. Across all change categories, mothers valued the changes they had made and expressed an intention to increase the changes.
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Affiliation(s)
- Inga S Wilson
- Scottish Centre for Indoor Air, University of Aberdeen, Aberdeen AB25 2ZG, UK
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Longman JM, Passey ME. Children, smoking households and exposure to second-hand smoke in the home in rural Australia: analysis of a national cross-sectional survey. BMJ Open 2013; 3:bmjopen-2013-003128. [PMID: 23833145 PMCID: PMC3703579 DOI: 10.1136/bmjopen-2013-003128] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This paper aimed to explore the association between rurality and (1) household smoking status and (2) home second-hand smoke exposure, in households with children aged 0-14 years. DESIGN Cross-sectional study. SETTING Households across Australia. PARTICIPANTS Households across the country were randomly selected to provide a nationally representative sample. Respondents were persons aged 12 years or older in each household who were next going to celebrate their birthday. PRIMARY OUTCOME MEASURES Household smoking status and smoking inside the home. METHODOLOGY The 2010 Australian National Drug Strategy Household survey data were analysed to explore the prevalence of household smoking and home second-hand smoke exposure in rural and urban households with children. Multivariable logistic regression was used to explore the association of rurality with household smoking and with home second-hand smoke exposure, controlling for potential confounders. RESULTS Households with children were more likely to be smoking households (35.4%, 95% CI 34.2% to 36.5%) than households without children (32.1%, 95% CI 31.3% to 32.8%). Both household smoking (43.6% (95% CI 41.5% to 45.7%) vs 31.4% (95% CI 30.0% to 32.8%)) and home second-hand smoke exposure (8.0% (95% CI 6.8% to 9.1%) vs 5.2% (95% CI 4.5% to 5.8%)) were significantly more common for rural children. In multivariate analyses controlling for confounding factors, rurality remained associated with smoking households (OR 1.21, 95% CI 1.07 to 1.37), whereas it did not remain associated with children's home second-hand smoke exposure (OR 1.07, 95% CI 0.85 to 1.35). Larger household size, low socioeconomic status and being a single-parent household were the main drivers of home second-hand smoke exposure. CONCLUSIONS The proportion of smoking households with children, and the number of children regularly exposed to second-hand smoke in their homes remain important public health concerns. Smoking cessation support and tobacco control policies might benefit from targeting larger and/or socioeconomically disadvantaged households including single-parent households.
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Affiliation(s)
- Jo M Longman
- University Centre for Rural Health, University of Sydney School of Public Health, University of Sydney, Lismore, New South Wales, Australia
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McEwen A, Hackshaw L, Jones L, Laverty L, Amos A, Robinson J. Evaluation of a programme to increase referrals to stop-smoking services using Children's Centres and smoke-free families schemes. Addiction 2012; 107 Suppl 2:8-17. [PMID: 23121355 DOI: 10.1111/j.1360-0443.2012.04081.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
AIMS To assess the feasibility and effectiveness of a new service using referral liaison advisers to increase the number of referrals of parents/carers at selected Children's Centres to National Health Service (NHS) Stop Smoking Services (SSS) and/or smoke-free families schemes (SFS). DESIGN This mixed-methods pilot study collected numerical data on indicators of smoking behaviours and carried out face-to-face and telephone interviews. SETTINGS Thirteen Children's Centres in Liverpool and Nottingham using local providers of smoking cessation services, from September 2010 to April 2011. PARTICIPANTS Parents and carers registered with, and staff working for, Children's Centres. MEASURES Number of smokers referred to smoking cessation services and/or smoke-free family schemes and the views of service providers and users on the new service. FINDINGS In Liverpool, 181 referrals to NHS SSS were made from 331 identified smokers (54.7%); extrapolated to 12 months, this represents a 182% increase in referrals from baseline and a similar extrapolation indicates a 643% increase from baseline of referrals to smoke-free families schemes. There were no reliable baseline data for Nottingham; 31 referrals were made (30.7% of smokers) to SSS and 44 referrals to SFS from 52 contacts (84.6%). The interviews highlighted the need for sustained personal contact with parents/carers to discuss smoking behaviours and concerns and their willingness to be referred to SFS as part of caring for their child. CONCLUSIONS Routine recording of smoking status and appropriate follow-up by trained staff in Children's Centres can lead to significant numbers of clients attending stop-smoking services, although relatively few stop smoking.
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Affiliation(s)
- Andy McEwen
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK.
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Abdullah AS, Hua F, Xia X, Hurlburt S, Ng P, MacLeod W, Siegel M, Griffiths S, Zhang Z. Second-hand smoke exposure and household smoking bans in Chinese families: a qualitative study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2012; 20:356-364. [PMID: 22029412 DOI: 10.1111/j.1365-2524.2011.01035.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
As workplace smoking restrictions spread, smoking in the home is becoming the predominant source of exposure to second-hand smoke (SHS) among children and other non-smokers in the household. This study explored issues around children's exposure to SHS. Focus group discussions (FGDs) and in-depth interviews (IDI) were conducted among 31 Chinese households in urban Shanghai, China. All FGDs/IDIs were audio recorded and analysed thematically. The findings suggest that there are gaps in knowledge of the health consequences of smoking and SHS among the participants. Although there was a lack of knowledge about the health risk of exposure to SHS, most were willing to protect their child from the SHS exposure. In 16/31 households, families had partial home-smoking restrictions; there were no complete restrictions in any of the smokers' homes. Many families do not openly discuss smoking or smoking restrictions at home. Barriers to adopting a smoke-free home included the social acceptability of smoking (22/31), hosting social gatherings at home, which would involve smoking (12/31), authoritative attitudes of the husband or father-in-law (10/31), and difficulties with visitors who smoke (7/31). Most (28/31) participants stated they would accept a counselling intervention to reduce SHS exposure to children and suggested various measures to implement it. The findings from this intervention have implications for designing intervention strategies to reduce SHS exposure at home among children in China.
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Affiliation(s)
- Abu S Abdullah
- School of Public Health, Guangxi Medical University, Nanning, China.
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Exploration of parental smokers' experience, perceptions, and family's influences on their smoking in the presence of children. ANS Adv Nurs Sci 2012; 35:E1-13. [PMID: 22293613 DOI: 10.1097/ans.0b013e3182445525] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to explore parents' experience and perceptions of smoking in the presence of children. Findings regarding patterns of parents' smoking in the presence of children were situation specific. When thinking of smoking with children around, parents engaged in a process of weighing the importance of the need to smoke and adverse effects from exposure to environmental tobacco smoke, a consideration based mostly on their experience. A pattern of correspondence was identified between family's level of concern and promoting change among smokers. Many strategies participants used to prevent children's environmental tobacco smoke exposure were relatively ineffective and needed to be addressed.
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Evans KA, Sims M, Judge K, Gilmore A. Assessing the knowledge of the potential harm to others caused by second-hand smoke and its impact on protective behaviours at home. J Public Health (Oxf) 2011; 34:183-94. [PMID: 22201034 DOI: 10.1093/pubmed/fdr104] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Smokers' knowledge of the risks of second-hand smoke (SHS) and the role this plays in implementing behaviours to reduce the SHS exposure of others have not been thoroughly explored. Mass media health promotion is used to promote behaviour change partly by providing information on the consequences of behaviour. In England, between 2003 and 2006, frequent mass media campaigns highlighted the toxicity of SHS. OBJECTIVES To examine peoples' knowledge of SHS-related illnesses in England over time, identify the determinants of good knowledge and to assess its importance in predicting SHS-protective behaviours. METHODS Statistical analysis of repeat cross-sectional data (1996-2008) from the Omnibus Survey to explore the trends and determinants of knowledge of SHS-related illnesses and the determinants of SHS-protective behaviours. RESULTS Only 40% of smokers had 'good' knowledge of SHS-related illnesses compared with 65% of never smokers. Knowledge increased markedly when frequent SHS-related mass media campaigns (2003-06) ran, compared with earlier years (1996-2002). Smokers with better knowledge were more likely to have smoke-free homes [odds ratio (OR): 1.10, 1.04-1.16] and abstain from smoking in a room with children (OR: 1.11, 1.09-1.14). CONCLUSIONS The low levels of knowledge of some SHS-related conditions, especially among smokers, and the relationship between knowledge and SHS-protective behaviours, suggest that greater efforts to educate smokers about the risks associated with SHS are worthwhile.
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Affiliation(s)
- Karen A Evans
- Department for Health, University of Bath, Claverton Down, Bath BA2 7AY, UK.
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Highet G, Ritchie D, Platt S, Amos A, Hargreaves K, Martin C, White M. The re-shaping of the life-world: male British Bangladeshi smokers and the English smoke-free legislation. ETHNICITY & HEALTH 2011; 16:519-533. [PMID: 21671202 DOI: 10.1080/13557858.2011.578734] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To explore how male Bangladeshi smokers adapted to the English smoke-free legislation. DESIGN We draw on data derived from the Evaluation of Smoke-free England (ESME), a qualitative, longitudinal study conducted between 2007 and 2008 in two English metropolitan areas. Repeat interviews (n = 34) were conducted before and after the legislation with 15 male Bangladeshi panel informants and from two focus groups: one with Bangladeshi men and the other with Bangladeshi women. RESULTS Bangladeshi smokers who participated in this study had largely accommodated to the smoke-free legislation and most had reduced their consumption of cigarettes, albeit to a modest degree. However, at the same time some Bangladeshi smokers appeared to have increased their use of shisha, a popular alternative method of smoking tobacco in this community. Smoke-free legislation also had an impact on the social and cultural forces that shape smoking behaviour in this group. In particular, family homes continued to be a key space where tobacco is consumed, although the legislation may have helped to shift the balance in favour of forces that oppose smoking and against enduring cultural pro-smoking norms. Smoking in public was also less socially acceptable, especially in the vicinity of local mosques and at community events. In some older groups, however, smoking remains a deeply embedded social habit which can undermine smokers' efforts to quit. CONCLUSION For maximum impact, tobacco control interventions aimed at whole populations may need to be supplemented by culturally sensitive measures in local areas where there is a high concentration of Bangladeshi people. Similar considerations may apply to other minority communities with a high prevalence of smoking.
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Affiliation(s)
- Gill Highet
- Centre for Population Health Sciences, University of Edinburgh, GP Section, 20 West Richmond Street, Edinburgh, EH8 9DX, UK.
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Hipple B, Lando H, Klein J, Winickoff J. Global teens and tobacco: a review of the globalization of the tobacco epidemic. Curr Probl Pediatr Adolesc Health Care 2011; 41:216-30. [PMID: 21821205 DOI: 10.1016/j.cppeds.2011.02.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Worldwide, the burden of suffering to children caused by tobacco does not just originate from exposure to tobacco smoke or smoking, but includes exposure to tobacco-friendly media, poverty associated with money spent on tobacco, increased incidence of tobacco-related fires, and the harms related to child labor in tobacco cultivation. Despite global efforts through human rights acts, the Framework Convention on Tobacco Control, and the MPOWER report, tobacco use continues to accelerate in most countries. While the efforts that have been taken, such as smoking bans in public, are worthy actions, not enough is being done to protect children and teens. More can be done at the policy level, by individuals, and by health care providers.
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Affiliation(s)
- Bethany Hipple
- Center for Child and Adolescent Health Policy, Massachusetts General Hospital for Children, Boston, MA, USA
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Jones LL, Atkinson O, Longman J, Coleman T, McNeill A, Lewis SA. The motivators and barriers to a smoke-free home among disadvantaged caregivers: identifying the positive levers for change. Nicotine Tob Res 2011; 13:479-86. [PMID: 21447837 DOI: 10.1093/ntr/ntr030] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The aims of this study were to explore home smoking behaviors and the motivators and barriers to smoke-free homes among a group of disadvantaged caregivers for young children and to identify the positive levers that health care professionals can utilize when supporting smoking behavior change. METHODS In-depth qualitative interviews were conducted between July and September 2009, with 22 disadvantaged smoking caregivers, accessing Children's Centre Services in Nottingham, UK. Interviews were audiorecorded and transcribed verbatim. Data were coded and analyzed thematically to identify emergent main and subthemes. RESULTS Caregivers had some general understanding of the dangers of secondhand smoke (SHS), but their knowledge appeared incomplete and confused. All interviewees described rules around smoking in the home; however, these tended to be transient and fluid and unlikely to be effective. Caregivers were often living in difficult and complex circumstances and experienced significant barriers to creating a smoke-free home. The motivators for change were more strongly linked to house decor and smell than children's health, suggesting that visible evidence of the harm done by SHS to children might help promote smoke-free homes. CONCLUSIONS Findings suggest that further tailored information on the effect of SHS is required, but to instigate caregiver behavior change, providing demonstrable evidence of the impact that their smoking is having on their children's health is more likely to be effective.
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Affiliation(s)
- Laura L Jones
- UK Centre for Tobacco Control Studies, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
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Robinson J, Ritchie D, Amos A, Greaves L, Cunningham-Burley S. Volunteered, negotiated, enforced: family politics and the regulation of home smoking. SOCIOLOGY OF HEALTH & ILLNESS 2011; 33:66-80. [PMID: 21039621 DOI: 10.1111/j.1467-9566.2010.01273.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The protection of children from secondhand smoke in their homes remains a key objective for health agencies worldwide. While research has explored how parents can influence the introduction of home smoking restrictions, less attention has been paid to the role of wider familial and social networks as conduits for positive behaviour changes. In this article we explore how people living in Scotland have introduced various home smoking restrictions to reduce or eliminate children's exposure to tobacco smoke, and how some have gone on to influence people in their wider familial and social networks. The results suggest that many parents are willing to act on messages on the need to protect children from smoke, leading to the creation of patterns of smoking behaviour that are passed on to their parents and siblings and, more widely, to friends and visitors. However, while some parents and grandparents apparently voluntarily changed their smoking behaviour, other parents found that they had to make direct requests to family members and some needed to negotiate more forcefully to protect children, albeit often with positive results.
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Affiliation(s)
- Jude Robinson
- The Health and Community Care Research Unit, University of Liverpool, Liverpool, UK.
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Dillon KA, Chase RA. Secondhand smoke exposure, awareness, and prevention among African-born women. Am J Prev Med 2010; 39:S37-43. [PMID: 21074676 DOI: 10.1016/j.amepre.2010.08.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Revised: 08/13/2010] [Accepted: 08/24/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Little research exists on exposure to the health risks of secondhand smoke among women and children in African immigrant communities. PURPOSE This exploratory study aims to understand the prevalence of secondhand smoke exposure; assess levels of awareness of the dangers of secondhand smoke; and identify strategies for building increased awareness of these issues in African immigrant communities in Minnesota. METHODS Key informant interviews with ten African women community leaders, focus groups with 29 female African youth, and surveys of 223 African women were conducted between August 2008 and March 2009. The focus groups and key informant interviews were in English, and the surveys were in English, French, Oromo, and Somali. RESULTS Over one quarter of African women reported daily exposure to cigarette smoke, and one in ten women reported daily exposure to smoke from shisha (fruit-flavored tobacco smoked in a hookah or waterpipe). Many respondents had general awareness of the health impacts of tobacco smoke, but some were unsure. The majority felt that increased awareness was badly needed in their communities. Awareness of the health impacts of shisha smoking was particularly low. Strategies for increasing awareness include: using media and visual images, attending large gatherings, and appealing to community members' priorities, including protecting their children. CONCLUSIONS Exposure to secondhand smoke among women and children in African immigrant communities in Minnesota is substantial. Awareness about the health impacts of secondhand smoke exposure in these communities needs to be increased. Disseminating visual information at existing community gatherings or appealing to individual priorities may be the best approaches to increase awareness and motivate change.
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Robinson J, Ritchie D, Amos A, Cunningham-Burley S, Greaves L, Martin C. 'Waiting until they got home': gender, smoking and tobacco exposure in households in Scotland. Soc Sci Med 2010; 71:884-90. [PMID: 20580143 DOI: 10.1016/j.socscimed.2010.04.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 10/22/2009] [Accepted: 04/19/2010] [Indexed: 11/27/2022]
Abstract
The introduction in March 2006 of legislation banning smoking in public places in Scotland raised concerns that smokers would smoke more at home and so increase the exposure of those living with them to tobacco smoke. Drawing on interviews from two qualitative studies conducted after the implementation of the legislation, this article uses a gendered analysis to explore where and why smokers, who lived with non-smokers including children, continued to smoke in their homes. Although very few people attributed any increased home smoking to being a direct consequence of the legislation, many who already smoked there continued, and most women reported little or no disruption to their home smoking post-legislation. Also, because of the changing social environment of smoking, and other life circumstances, a minority of women had increased their levels of home smoking. Compared to the men in these studies, women, particularly those who didn't work outside the home, had restricted social lives and thus were less likely to have smoked in public places before the legislation and spent more time socialising in the homes of other people. In addition, women with children, including women who worked outside their homes, were more likely to spend sustained periods of time caring for children compared to fathers, who were more likely to leave the home to work or socialise. Although home smoking was linked to gendered caring responsibilities, other issues associated with being a smoker also meant that many women smokers chose to keep smoking in their homes.
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Affiliation(s)
- Jude Robinson
- The Health and Community Care Research Unit (HaCCRU), University of Liverpool, Thompson Yates Building, The Quadrangle, Brownlow Hill, Liverpool L69 3GB, United Kingdom.
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Bottorff JL, Kelly MT, Oliffe JL, Johnson JL, Greaves L, Chan A. Tobacco use patterns in traditional and shared parenting families: a gender perspective. BMC Public Health 2010; 10:239. [PMID: 20459752 PMCID: PMC2881096 DOI: 10.1186/1471-2458-10-239] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Accepted: 05/10/2010] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Although researchers have focused on women's smoking during pregnancy and the postpartum period and the influence of household interactions on their tobacco reduction efforts, little attention has been given to parents' efforts to regulate smoking during the child-rearing years. The objective of this study was to examine how parenting young children and gender relations reflected in couple dynamics influence household tobacco use patterns and, specifically, women's tobacco reduction efforts. METHODS As part of a longitudinal, grounded-theory study with 28 couples to examine the place of tobacco in the lives of new parents, each parent participated in one or two individual, semi-structured interviews during the first three years postpartum. Grounded theory methods and a gender relations framework were used to analyze transcribed data. RESULTS Two different parenting styles that couples adhered to were identified. These parenting styles reflected performances of femininities and masculinities, and were associated with particular smoking patterns. Traditional parenting reinforced by women's alignment with emphasized femininities and men's alignment with hegemonic masculinities placed women with smoking partners at risk for relapse. Women's actions to be supportive partners facilitated couples' continued smoking. In shared parenting dyads, egalitarian practices tended to support successful transitions to smoke-free homes. Women's ability to exert more influence around family decision making, and the acceptance of new masculine identities associated with fatherhood were influential. In non-smoking dyads where the mother, father, or both reduced or stopped smoking, we observed a subtext of potential conflict in the event either the mother or father relapsed. CONCLUSIONS Decisions about tobacco use are made within relationships and social contexts that vary based on each individual's relationship to tobacco, divisions of domestic labour and childcare, and other activities that impact tobacco use. Sensitive approaches to tobacco reduction for women and men must be developed building on greater understanding of gender relations and how tobacco use is integrated in spousal and parental roles.
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Affiliation(s)
- Joan L Bottorff
- Faculty of Health and Social Development, University of British Columbia, Kelowna, British Columbia, Canada
| | - Mary T Kelly
- Nursing and Health Behaviour Research Unit, University of British Columbia, Vancouver, British Columbia, Canada
| | - John L Oliffe
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joy L Johnson
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lorraine Greaves
- System Strategy Division, Ministry of Health and Long-Term Care, Province of Ontario, Canada
| | - Anna Chan
- Nursing and Health Behaviour Research Unit, University of British Columbia, Vancouver, British Columbia, Canada
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Sims M, Tomkins S, Judge K, Taylor G, Jarvis MJ, Gilmore A. Trends in and predictors of second-hand smoke exposure indexed by cotinine in children in England from 1996 to 2006. Addiction 2010; 105:543-53. [PMID: 20402999 DOI: 10.1111/j.1360-0443.2009.02805.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To explore trends in and predictors of second-hand smoke (SHS) exposure in children. To identify whether inequalities in SHS exposure are changing over time. DESIGN Repeated cross-sectional study with data from eight annual surveys conducted over an 11-year period from 1996 to 2006. SETTING England. PARTICIPANTS Nationally representative samples of children aged 4-15 years living in private households. MEASUREMENTS Saliva cotinine (4-15-year-olds), current smoking status (8-15-year-olds), smoking status of parents and carers, smoking in the home, socio-demographic variables. FINDINGS The most important predictors of SHS exposure were modifiable factors-whether people smoke in the house on most days, whether the parents smoke and whether the children are looked after by carers who smoke. Children from more deprived households were more exposed and this remained the case even after parental smoking status has been controlled for. Exposure over time has fallen markedly among children (59% decline over 11 years in geometric mean cotinine), with the most marked decline observed in the period immediately preceding smoke-free legislation. Declines in exposure have generally been greater in children most exposed at the outset. For example, in children whose parents both smoke, median cotinine declined annually by 0.115 ng/ml compared with 0.019 ng/ml where neither parent smokes (P < 0.05). CONCLUSIONS In the 11 years leading up to smoke-free legislation in England, the overall level of SHS exposure in children as well as absolute inequalities in exposure have been declining. Further efforts to encourage parents and carers to quit and to avoid smoking in the home would benefit child health.
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Affiliation(s)
- Michelle Sims
- School for Health, University of Bath, Bath BA2 7AY, UK.
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Sex, gender, and secondhand smoke policies: implications for disadvantaged women. Am J Prev Med 2009; 37:S131-7. [PMID: 19591752 DOI: 10.1016/j.amepre.2009.05.012] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Revised: 03/03/2009] [Accepted: 05/05/2009] [Indexed: 11/24/2022]
Abstract
CONTEXT Although implementation of secondhand smoke policies is increasing, little research has examined the unintended consequences of these policies for disadvantaged women. EVIDENCE ACQUISITION Macro-, meso-, and micro-level issues connected to secondhand smoke and women are considered to illustrate the range of ways in which sex, gender, and disadvantage affect women's exposure to secondhand smoke. A review of current literature, primarily published between 2000 and 2008, on sex- and gender-based issues related to secondhand smoke exposure and the effects of secondhand smoke policies for various subpopulations of women, including low-income girls and women, nonwhite minority women, and pregnant women, was conducted in 2008. These materials were critically analyzed using a sex and gender analysis, allowing for the drawing of inferences and reflections on the unintended effects of secondhand smoke policies on disadvantaged women. EVIDENCE SYNTHESIS Smoke-free policies do not always have equal or even desired effects on low-income girls and women. Low-income women are more likely to be exposed to secondhand smoke, may have limited capacity to manage their exposure to secondhand smoke both at home and in the workplace, and may experience heightened stigmatization as a result of secondhand smoke policies. CONCLUSIONS Various sex- and gender-related factors, such as gendered roles, unequal power differences between men and women, child-caring roles, and unequal earning power, affect exposure and responses to secondhand smoke, women's capacity to control exposure, and their responses to protective policies. In sum, a much more nuanced gender- and diversity-sensitive framework is needed to develop research and tobacco control policies that address these issues.
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Ritchie D, Amos A, Phillips R, Cunningham-Burley S, Martin C. Action to achieve smoke-free homes: an exploration of experts' views. BMC Public Health 2009; 9:112. [PMID: 19386111 PMCID: PMC2679738 DOI: 10.1186/1471-2458-9-112] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Accepted: 04/22/2009] [Indexed: 11/10/2022] Open
Abstract
Background Smoking in the home is the major cause of exposure to second-hand smoke in children in the UK, particularly those living in low income households which have fewer restrictions on smoking in the home. Reducing children's exposure to second-hand smoke is an important public health and inequalities issue. Drawing on findings from a qualitative Scottish study, this paper identifies key issues and challenges that need to be considered when developing action to promote smoke-free homes at the national and local level. Methods Two panels of tobacco control experts (local and national) from Scotland considered the implications of the findings from a qualitative study of smokers and non-smokers (who were interviewed about smoking in the home), for future action on reducing smoking in the home. Results Several key themes emerged through the expert panel discussions. These related to: improving knowledge about SHS among carers and professionals; the goal and approach of future interventions (incremental/harm reduction or total restrictions); the complexity of the interventions; and issues around protecting children. Conclusion The expert panels were very aware of the sensitivities around the boundary between the 'private' home and public health interventions; but also the lack of evidence on the relative effectiveness of specific individual and community approaches on increasing restrictions on smoking in the home. Future action on smoke-free homes needs to consider and address these complexities. In particular health professionals and other key stakeholders need appropriate training on the issues around smoking in the home and how to address these, as well as for more research to evaluate interventions and develop a more robust evidence base to inform effective action on this issue.
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Affiliation(s)
- Deborah Ritchie
- Nursing Studies, School of Health in Social Science, University of Edinburgh, Medical School, Teviot Place, Edinburgh, UK.
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Holdsworth C, Robinson JE. 'I've never ever let anyone hold the kids while they've got ciggies': moral tales of maternal smoking practices. SOCIOLOGY OF HEALTH & ILLNESS 2008; 30:1086-100. [PMID: 18564973 DOI: 10.1111/j.1467-9566.2008.01102.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Smoking in the home is, potentially, the next frontier in tobacco control in the developed world. As smoking regulations in public space are extended, attention is turning to private spaces and the contribution of parental, particularly maternal, smoking to children's health and socio-economic inequalities in family health. Yet relatively little is known about mothers' smoking practices within the home and the social meanings of smoking that are constructed by these practices. In this paper we explore how mothers who smoke construct moralities of their smoking behaviour, particularly in relation to where and with whom they smoke. Drawing on in-depth Biographic Narrative Interpretative Method, in interviews with 12 smoking mothers, and their partners, we consider how these moral tales involve comparisons with other smokers and the importance of community endorsement of smoking practices, particularly around children. We also consider the role of children in the home and how children are actively involved in the regulation of smoking behaviours. Finally, we consider the implications of these moral tales for interventions around smoke-free homes.
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Affiliation(s)
- Clare Holdsworth
- Department of Geography, University of Liverpool, Liverpool, UK.
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Abstract
Despite what is known about gender inequalities and the links between smoking, smoke exposure, and poverty, mothers who fail to protect their children from exposure to environmental tobacco smoke (ETS), are often stigmatized as uncaring mothers by the media. Here I describe the process of talking to mothers of young children about the wider social context(s) within which the act of smoking takes place, and their reflections on the paradox of why many women caring for young children still expose their children to tobacco smoke in home environments. By articulating the complex interrelationship between smoking, the maintenance of social relationships, caring for children, and coping with poverty, the women present an alternative conceptualisation as to why and how mothers direct their agency to enable them to care for their children in poverty, which questions the timing, messages and ultimate effect of giving home smoking advice to mothers with young children.
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Phillips R, Amos A, Ritchie D, Cunningham-Burley S, Martin C. Smoking in the home after the smoke-free legislation in Scotland: qualitative study. BMJ 2007; 335:553. [PMID: 17827488 PMCID: PMC1976533 DOI: 10.1136/bmj.39301.497593.55] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/31/2007] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To explore the accounts of smokers and non-smokers (who live with smokers) of smoking in their homes and cars after the Scottish smoke-free legislation; to examine the reported impact of the legislation on smoking in the home; and to consider the implications for future initiatives aimed at reducing children's exposure to secondhand smoke in the home. DESIGN AND SETTING A qualitative cross sectional study involving semistructured interviews conducted across Scotland shortly after the implementation of the legislation on 26 March 2006. PARTICIPANTS A purposively selected sample of 50 adults (aged 18-75) drawn from all socioeconomic groups, included smokers living with smokers, smokers living with non-smokers, and non-smokers living with smokers. RESULTS Passive smoking was a well recognised term. Respondents had varied understandings of the risks of secondhand smoke, with a few rejecting evidence of such risks. Children, however, were perceived as vulnerable. Most reported that they restricted smoking in their homes, with a range of restrictions across social classes and home smoking profiles. Spatial, relational, health, and aesthetic factors influenced the development of restrictions. Children and grandchildren were important considerations in the development and modification of restrictions. Other strategies were also used to militate against secondhand smoke, such as opening windows. The meaning of the home as somewhere private and social identity were important underlying factors. Respondents reported greater restrictions on smoking in their cars. There were diverse views on the smoke-free legislation. Few thought it had influenced their smoking in the home, and none thought it had affected how they restricted smoking in their homes. CONCLUSIONS These data suggest two normative discourses around smoking in the home. The first relates to acceptable social identity as a hospitable person who is not anti-smoker. The second relates to moral identity as a caring parent or grandparent. Awareness of the risks of secondhand smoke, despite ambivalence about health messages and the fluidity of smoking restrictions, provides clear opportunities for public health initiatives to support people attain smoke-free homes.
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Affiliation(s)
- Richard Phillips
- Public Health Sciences, Division of Community Health Sciences, University of Edinburgh, Medical School, Edinburgh EH8 9AG
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