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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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Rosen L, Zucker D, Guttman N, Brown N, Bitan M, Rule A, Berkovitch M, Myers V. Protecting Children From Tobacco Smoke Exposure: A Randomized Controlled Trial of Project Zero Exposure. Nicotine Tob Res 2021; 23:2003-2012. [PMID: 34021353 DOI: 10.1093/ntr/ntab106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 05/19/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Young children are vulnerable to harm from tobacco smoke exposure (TSE). This study assessed the effect of Project Zero Exposure-an intervention program designed to help parents protect children from TSE-on children's exposure. METHODS Randomized controlled trial of a home-based, theory-driven intervention. Parents of young children (<8 y) in families with a smoking parent were eligible. The intervention included feedback on child TSE (hair nicotine), and home air quality (PM2.5), with motivational interviewing. Families were randomized to: intervention group (IG, N = 69), regular control group (RCG, N = 70), or to a secondary enhanced control group, (ECG, N = 20). Child hair samples were taken at baseline and follow-up. We report on child TSE in the IG versus RCG at six months. RESULTS Most enrolled families completed the trial (IG: 98.6%[68/69], RCG: 97.1%[68/70]). Log hair nicotine (LHN [ng/mg]) decreased in both the IG (Baseline: -1.78 ± 1.91, Follow-up: -2.82 ± 1.87, p = .003) and RCG (Baseline: -1.79 ± 1.54, Follow-up: -2.85 ± 1.73, p = .002), but did not differ between groups at study end (p = .635). Three of five parentally-reported outcomes showed improvement over time in the IG, and one in the RCG. Among IG participants, 90% found hair nicotine feedback useful. CONCLUSIONS No difference between the intervention and control groups was found on the objective biomarker, LHN. Child TSE decreased during the trial in intervention and control groups. Trial participation, which included hair nicotine monitoring, may have contributed to decreasing exposure in both groups. Concurrent control group improvements may partially explain lack of proven intervention benefit. Biomarker monitoring warrants further investigation for reduction of child TSE. IMPLICATIONS Project Zero Exposure is an intervention program designed to help parents protect their children from TSE. Results from the randomized controlled trial of the program showed no difference between groups at study end, but a clear and substantial reduction in child exposure to tobacco smoke from beginning to end of the trial, in both intervention and control groups. Biomarker monitoring, a key element of the trial, was used with all participants. Biomarker monitoring of child exposure to tobacco smoke may help parents become aware of their child's exposure and better protect them, and should be explored as a means to reduce child TSE. Clinical Trial Registration: NCT02867241.
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Affiliation(s)
- Laura Rosen
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - David Zucker
- Department of Statistics, Hebrew University, Jerusalem, Israel
| | - Nurit Guttman
- Department of Communications, Tel Aviv University, Ramat Aviv, Israel
| | - Nili Brown
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Michal Bitan
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
- Department of Statistics, Tel Aviv University, Ramat Aviv, Israel
| | - Ana Rule
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mati Berkovitch
- Assaf Harofeh Medical Center, Be'er Ya'akov, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Vicki Myers
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
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Myers V, Lev E, Guttman N, Tillinger E, Rosen L. "I can't stand it…but I do it sometimes" parental smoking around children: practices, beliefs, and conflicts - a qualitative study. BMC Public Health 2020; 20:693. [PMID: 32408872 PMCID: PMC7226982 DOI: 10.1186/s12889-020-08863-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/06/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Many parents continue to smoke around their children despite the widely known risks of children's exposure to tobacco smoke. We sought to learn about parental smoking behavior around children from parents' perspective. METHODS Semi-structured interviews were conducted with 65 smoking parents or partners of smoking parents of children up to age 7, to learn about home smoking rules, behaviours performed to try to protect children, and smoking-related conflicts, from parents' perspective. Interviews were recorded and transcribed and thematic analysis performed. Recruitment was challenging due to the sensitive nature of the topic. RESULTS Many parents described smoking around their children in certain areas of the home, outdoors, and in what they consider to be open or ventilated areas. Participants emphasized efforts to protect their children and described various mitigating practices but held mixed views as to their effectiveness. Parents had different conceptions of which areas or distances were considered 'safe'. Many smoking parents described conflicts both internal and with other family members regarding the protection of children. Some parents who continue to smoke around their children despite understanding the health risks felt powerless to effect change, as well as being uncertain as to the effectiveness of their protective strategies; others were aware but reluctant to change. CONCLUSION Findings shed light on some of the difficulties faced by smoking parents and obstacles to maintaining a smoke-free environment for their children, providing insight for the type of information and support required to help parents better protect their children from exposure to tobacco smoke. Awareness of health risks associated with secondhand smoke was demonstrated, yet parents in smoking families were confused regarding which rules and behaviours best protect children from exposure to tobacco smoke. Parents were sometimes aware that their smoking 'rules' and mitigating practices were limited in their effectiveness. Guidelines should be provided explaining how and when exposure occurs and how to keep children safe.
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Affiliation(s)
- Vicki Myers
- Department of Health Promotion, School of Public Health, Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.
| | - Eimi Lev
- Department of Communications, Faculty of Social Sciences, Tel Aviv University, Tel Aviv, Israel
- Department of Communications, Gordon College of Education, Haifa, Israel
| | - Nurit Guttman
- Department of Communications, Faculty of Social Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Tillinger
- Department of Health Promotion, School of Public Health, Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Laura Rosen
- Department of Health Promotion, School of Public Health, Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
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Lee SR, Cho AR, Lee SY, Cho YH, Park EJ, Kim YJ, Lee JG. Secondhand smoke knowledge, sources of information, and associated factors among hospital staff. PLoS One 2019; 14:e0210981. [PMID: 30668578 PMCID: PMC6342318 DOI: 10.1371/journal.pone.0210981] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/05/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose To evaluate knowledge of secondhand smoke (SHS) risks, sources of information, and associated factors and behaviors among hospital staff. Methods We conducted a cross-sectional survey using a 40-item self-administered questionnaire among 328 employees at a university hospital. The questions on representative diseases related to SHS were used to measure the degree of knowledge of SHS. Multiple regression analysis was used to determine the correlation between SHS knowledge scores and variables. Results Females had better SHS knowledge scores than males, regardless of smoking status (p<0.05). SHS knowledge was positively correlated with cessation education in males, non-smokers, and the total sample (β = 3.950, 2.356, and 2.684, respectively, p<0.05). It was correlated with the experience of any SHS exposure-related symptoms in males, non-smokers, and the total sample (β = 3.950, 2.356, and 2.684, respectively, p<0.05) and discomfort when exposed to SHS in non-smokers and the total sample (β = 0.670 and 0.821, respectively, p<0.05). Conclusion SHS knowledge is high among females, when hospital staff are educated about SHS risks, and when they have experienced any SHS exposure-related symptoms or felt uncomfortable when exposed to SHS. SHS risk education is an effective tool to increase SHS knowledge in hospital staff.
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Affiliation(s)
- Sae Rom Lee
- Family Medicine Clinic, and Research Institute of Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - A-ra Cho
- Family Medicine Clinic, and Research Institute of Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Sang Yeoup Lee
- Family Medicine Clinic, and Research Institute of Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Department of Medical Education, Pusan National University School of Medicine, Yangsan, Republic of Korea
- * E-mail:
| | - Young Hye Cho
- Family Medicine Clinic, and Research Institute of Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Eun Ju Park
- Family Medicine Clinic, and Research Institute of Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Yun Jin Kim
- Department of Family Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Jeong Gyu Lee
- Department of Family Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
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Rosen LJ, Lev E, Guttman N, Tillinger E, Rosenblat S, Zucker DM, Myers V. Parental Perceptions and Misconceptions of Child Tobacco Smoke Exposure. Nicotine Tob Res 2018; 20:1369-1377. [PMID: 29059387 DOI: 10.1093/ntr/ntx169] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 08/06/2017] [Indexed: 12/16/2023]
Abstract
Introduction Forty percent of young children worldwide are exposed to the harmful effects of tobacco smoke, predominantly by parental smoking. Little is known about why parents regularly expose their children to these risks; perhaps parents underestimate the degree of exposure. Qualitative methods were used to investigate parental perceptions of tobacco smoke exposure. Methods Sixty-five in-depth interviews were conducted with parents of young children in smoking families in central Israel. Parents were asked to explain what "exposure to smoking" meant. Thematic analysis was performed, a conceptual model of perceptions was built, and misconceptions were identified. Results Parents reported that exposure occurs when smoke or smokers are visible, when smoke can be smelled, felt, or inhaled, or when it "reaches" an individual. Conversely, some believed that exposure does not occur in the absence of odor, visible smoke, or smokers or if smoking occurs outdoors or in indoor ventilated environments. Proximity in space and time affected perceptions of exposure; some parents believed that smoke does not spread far but dissipates rapidly. There was some uncertainty regarding whether or not exposure was occurring. Conclusions Awareness of child exposure to tobacco smoke among parents in this study was based on sensory perceptions in the context of the physical environment. The limited capacity of humans to perceive tobacco smoke can lead to misconceptions about exposure. In order to protect children, parents must be convinced that exposure can occur even in situations where they are unable to sense it. Implications Parents use sensory perceptions (sight, smell, and feel) in the context of the physical environment to assess whether or not their children are exposed to tobacco smoke. Because 85% of smoke is invisible and the sense of smell is unreliable, assessments based on sensory perceptions cannot provide accurate information about the presence of tobacco smoke. In order to protect children, parents must be convinced that exposure can occur even in situations where they are unable to sense it. The scientific information summarized here about exposure in common situations should be useful in persuading parents to protect their children. Clinical Trial Registration This study is registered as a Phase I study which is part of a larger research endeavor entitled: A program to protect young children from tobacco smoke exposure. Registration number: NCT01335178.
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Affiliation(s)
- Laura J Rosen
- Dept. of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eimi Lev
- Dept. of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Dept. of Communications, Faculty of Social Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Nurit Guttman
- Dept. of Communications, Faculty of Social Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Tillinger
- Dept. of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shira Rosenblat
- Dept. of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Dept. of Communications, Faculty of Social Sciences, Tel Aviv University, Tel Aviv, Israel
| | - David M Zucker
- Dept. of Statistics, Hebrew University, Jerusalem, Israel
| | - Vicki Myers
- Dept. of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Rowa-Dewar N, Rooke C, Amos A. Using e-cigarettes in the home to reduce smoking and secondhand smoke: disadvantaged parents' accounts. HEALTH EDUCATION RESEARCH 2017; 32:12-21. [PMID: 28087586 DOI: 10.1093/her/cyw052] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 11/23/2016] [Indexed: 06/06/2023]
Abstract
Electronic cigarettes (e-cigarettes) are subject to considerable public health debate. Most public health experts agree that for smokers who find it particularly challenging to quit, e-cigarettes may reduce harm. E-cigarette use in the home may also reduce children's secondhand smoke (SHS) exposure, although e-cigarette vapour may pose risks. This is the first qualitative study to explore disadvantaged parents' views and experiences of e-cigarettes in relation to reducing SHS exposure in the home. Interviews with 25 disadvantaged parents from Edinburgh who smoked and had children aged 1-3 were conducted in 2013, with 17 re-interviewed in 2014. Accounts of e-cigarette perceptions and use were analysed thematically. E-cigarettes were seen by some as potentially valuable in helping quitting or reducing smoking in difficult circumstances, and protecting children from SHS when smoking outside is constrained. However, parents raised concerns about safety issues and continuing their nicotine addiction. In relation to children, concerns included possible health effects of the vapour, children playing with them and role-modelling e-cigarette use. While significant concerns remain about e-cigarettes, for some parents who find it challenging to quit or safely leave their children to smoke outside, e-cigarettes may offer potential for reducing the harm to them and their children.
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Affiliation(s)
- Neneh Rowa-Dewar
- UK Centre for Tobacco and Alcohol Studies, Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh EH9 8AS, UK
| | - Catriona Rooke
- UK Centre for Tobacco and Alcohol Studies, Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh EH9 8AS, UK
| | - Amanda Amos
- UK Centre for Tobacco and Alcohol Studies, Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh EH9 8AS, UK
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Montreuil A, Hanusaik N, Cantinotti M, Leclerc BS, Kestens Y, Tremblay M, Cohen J, McGrath J, Datta GD, O'Loughlin JL. Social disparities in children's exposure to secondhand smoke in privately owned vehicles. Tob Control 2016; 26:663-668. [DOI: 10.1136/tobaccocontrol-2016-053347] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/03/2016] [Indexed: 11/04/2022]
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Everyday tactics in local moral worlds: E-cigarette practices in a working-class area of the UK. Soc Sci Med 2016; 170:106-113. [PMID: 27788410 PMCID: PMC5115649 DOI: 10.1016/j.socscimed.2016.10.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 10/11/2016] [Accepted: 10/14/2016] [Indexed: 02/04/2023]
Abstract
Research into e-cigarette use has largely focused on their health effects and efficacy for smoking cessation, with little attention given to their potential effect on health inequalities. Drawing on three years of ethnographic research between 2012 and 2015, I investigate the emerging e-cigarette practices of adult smokers and quitters in a working-class area of the UK. I first use de Certeau's notion of ‘tactics’ to describe the informal economy of local e-cigarette use. Low-priced products were purchased through personal networks and informal sources for financial reasons, but also as a solution to the moral problems of addiction and expenditure on the self, particularly for older smokers. E-cigarette practices were produced in local moral worlds where smoking and cessation had a complex status mediated through norms of age and gender. For younger men, smoking cessation conflicted with an ethic of working-class hedonism but e-cigarette use allowed cessation to be incorporated into male sociality. Continued addiction had moral implications which older men addressed by constructing e-cigarette use as functional rather than pleasurable, drawing on a narrative of family responsibility. The low priority which older women with a relational sense of identity gave to their own health led to a lower tolerance for e-cigarette unreliability. I draw on Kleinman's local moral worlds to make sense of these findings, arguing that smoking cessation can be a risk to moral identity in violating local norms of age and gender performance. I conclude that e-cigarettes did have some potential to overcome normative barriers to smoking cessation and therefore to reduce health inequalities, at least in relation to male smoking. Further research which attends to local meanings of cessation in relation to age and gender will establish whether e-cigarettes have similar potential elsewhere. Smokers and e-cigarette users bought cheap products for moral and financial reasons. Smoking cessation conflicted with an ethic of hedonism but e-cigarettes did not. Older men saw e-cigarette use as functional in a narrative of family responsibility. Older women gave their health low priority and found e-cigarettes too much trouble. E-cigarettes had potential to overcome some normative barriers to smoking cessation.
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Bates J, Machin A. Locality, loneliness and lifestyle: a qualitative study of factors influencing women's health perceptions. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:639-648. [PMID: 25944423 DOI: 10.1111/hsc.12242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/11/2015] [Indexed: 06/04/2023]
Abstract
The contribution of women to the achievement of global public health targets cannot be underestimated. It is well evidenced that within families, women are a key influence on the health and well-being of their children and partners. However, geographical differences in women's health inequalities persist and research focusing specifically on women's perceptions of locality factors influencing their own health and well-being is scarce. This paper presents an interpretive, qualitative research study undertaken in 2011 with a group of women living in one locality in the North East of England in the United Kingdom which aimed to better understand their health and well-being perceptions and locality influences on it. Fifteen women participated in two focus groups and six individual, semi-structured interviews. Thematic analysis yielded four key themes: health and well-being perceptions; mental resilience; low income and choice; and influence of place. The influence of women's geographical location in relation to amenities and services and loneliness were recurring factors in the discussion, each influencing lifestyle. It was evident that women in their local context were themselves assets through which their own physical and mental health could be improved. However, women's perceptions of protective factors and their influences on health and well-being varied. Connecting with women in the context of their immediate living circumstances and understanding their perceptions as individuals are important first steps in the process of gaining consensus and mobilising their assets to collectively build healthy local communities.
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Affiliation(s)
| | - Alison Machin
- Department of Healthcare, Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, UK
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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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Rosen LJ, Tillinger E, Guttman N, Rosenblat S, Zucker DM, Stillman F, Myers V. Parental receptivity to child biomarker testing for tobacco smoke exposure: A qualitative study. PATIENT EDUCATION AND COUNSELING 2015; 98:1439-45. [PMID: 26160037 DOI: 10.1016/j.pec.2015.05.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 02/20/2015] [Accepted: 05/30/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Widespread tobacco smoke exposure (TSE) of children suggests that parents may be unaware of their children's exposure. Biomarkers demonstrate exposure and may motivate behavior change, but their acceptability is not well understood. METHODS Sixty-five in-depth interviews were conducted with parents of young children, in smoking families in central Israel. Data were analyzed using thematic analysis. RESULTS Consent to testing was associated with desire for information, for reassurance or to motivate change, and with concerns for long-term health, taking responsibility for one's child, and trust in research. Opposition to testing was associated with preference to avoid knowledge, reluctance to cause short-term discomfort, perceived powerlessness, and mistrust of research. Most parents expressed willingness to allow measurement by urine (83%), hair (88%), or saliva (93%), but not blood samples (43%); and believed that test results could motivate behavior change. CONCLUSIONS Parents were receptive to non-invasive child biomarker testing. Biomarker information could help persuade parents who smoke that their children need protection. PRACTICE IMPLICATIONS Biomarker testing of children in smoking families is an acceptable and promising tool for education, counseling, and motivation of parents to protect their children from TSE. Additionally, biomarker testing allows objective assessment of population-level child TSE.
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Affiliation(s)
- Laura J Rosen
- Dept. of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Efrat Tillinger
- Dept. of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Dept. of Sociology, Faculty of Social Sciences, Bar Ilan University, Ramat Gan, Israel
| | - Nurit Guttman
- Dept. of Communications, Faculty of Social Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Shira Rosenblat
- Dept. of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Dept. of Communications, Faculty of Social Sciences, Tel Aviv University, Tel Aviv, Israel
| | - David M Zucker
- Dept. of Statistics, Hebrew University, Jerusalem, Israel
| | - Frances Stillman
- Dept. of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Vicki Myers
- Dept. of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Johnston R, Hearn L, Cross D, Thomas LT, Bell S. Parent voices guide smoking intervention development. HEALTH EDUCATION 2015. [DOI: 10.1108/he-03-2014-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose– While parents’ influence on their children’s smoking behaviour is widely recognised, little is known about parents of four to eight year olds’ attitudes and beliefs around smoking cessation and how they communicate with their children about smoking. The purpose of this paper is to explore parents’ perceptions of quitting smoking and their beliefs and actions related to the use of parenting practices to discourage smoking by their children.Design/methodology/approach– Four focus groups and 17 interviews were conducted with parents (n=46) of four to eight year old children in Perth, Western Australia.Findings– Many parents indicated their children strongly influenced their quitting behaviours, however, some resented being made to feel guilty about their smoking because of their children. Parents were divided in their beliefs about the amount of influence they had on their children’s future smoking. Feelings of hypocrisy appear to influence the extent to which parents who smoked talked with their child about smoking. Parents recommended a variety of resource options to support quitting and talking with their child about smoking.Practical implications– Interventions aimed at parents who smoke and have young children should: reinforce parents’ importance as role models; highlight the importance of talking to children about smoking when they are young and provide strategies for maintaining ongoing communication; be supportive and avoid making parents feel guilty; and emphasise that quitting smoking is the best option for their child’s health (and their own), while also providing effective harm minimisation options for parents who have not yet quit.Originality/value– Parents of children of lower primary school age can be highly influential on their children’s later smoking behaviours, thus, effective interventions that address the current beliefs and practices of these parents may be particularly advantageous.
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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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Chen YT, Hsiao FH, Lee CM, Wang RH, Chen PL. Effects of a Parent-Child Interactive Program for Families on Reducing the Exposure of School-Aged Children to Household Smoking. Nicotine Tob Res 2015; 18:330-40. [PMID: 25987674 DOI: 10.1093/ntr/ntv105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 05/06/2015] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Parental smoking has been identified as the major source of children's exposure to environmental tobacco smoke (ETS). Therefore, parental involvement is critical in ETS exposure prevention programs. This study examined the effects of a parent-child interactive program on reducing children's exposure to ETS at home and enhancing parents' and children's prevention strategies. METHODS A clustered randomized controlled trial was administered to 75 families of school-aged children from six primary schools in New Taipei City, Taiwan. Families in the intervention group received a parent-child interactive intervention, and parents in the control group received written materials on tobacco hazards. Data on children's exposure and the prevention of children's exposure to ETS at home were obtained at baseline, 8-week, and 20-week or 6-month assessments. RESULTS The percentage of children with urine cotinine levels greater than or equal to 6 ng/ml was significantly lower in the intervention group than it was in the control group at both the 8-week and 6-month assessments. The intervention significantly reduced parental smoking in the presence of children and increased parents' prevention of children's ETS exposure and children's ETS avoidance behavior from the baseline to the 20-week assessment. CONCLUSIONS This is a preliminary study design aimed at creating a program for reducing children's ETS exposure at home. Further research to produce evidence supporting the application of the parent-child interactive program in primary schools is suggested. The theoretical basis of the intervention design can serve as a reference for nursing education and the design of health education programs.
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Affiliation(s)
- Yu-Ting Chen
- School of Nursing, College of Medicine, Chang-Gung University, Tao-Yuan, Taiwan; Graduate Institute of Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan
| | - Fei-Hsiu Hsiao
- Department of Nursing, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Ching-Mei Lee
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei City, Taiwan
| | - Ruey-Hsia Wang
- School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ping-Ling Chen
- Graduate Institute of Injury Prevention and Control, College of Public Health and Nutrition, Taipei Medical University, Taipei City, Taiwan
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15
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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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16
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Rosen L, Kostjukovsky I. Parental risk perceptions of child exposure to tobacco smoke. BMC Public Health 2015; 15:90. [PMID: 25885053 PMCID: PMC4334419 DOI: 10.1186/s12889-015-1434-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 01/15/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Tobacco smoke exposure harms children and adults. Yet, 40% of children worldwide are exposed to tobacco smoke in their homes. Such widespread parental failure to protect children is puzzling, and may be related to risk perceptions. No consensus exists about how to measure parental risk perceptions of tobacco smoke exposure. METHODS The objective of this research was to study Parental Risk Perceptions of child Exposure to Tobacco Smoke (PRETS) using various dimensions of risk perceptions: likelihood of harm, susceptibility to harm, and severity of harm. We aimed to estimate PRETS and identify correlates of PRETS, and assess the association between PRETS, parental smoking status, and home smoking behaviors. We conducted 132 face-to-face interviews with parents of infants. RESULTS Parents who smoked regularly believed that infant tobacco smoke exposure was less dangerous than did other parents (p = .0158). Birthplace of parent was significantly associated with risk perception (p = .0019); parents of Russian origin believed the overall risk to be less than did those born elsewhere. Smoking status, ethnicity, and employment status were associated with smoking in the home. The relationship between smoking behavior in the home and risk perceptions was complex, and may have been modified by ethnicity. CONCLUSIONS Parental risk perceptions concerning child exposure to tobacco smoke are associated with smoking behavior and ethnicity. Understanding how to measure risk perceptions, and identifying risk perception dimensions which differ between families with and without home smoking bans, may contribute to the development of effective interventions to protect children from the harmful effects of tobacco smoke exposure.
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Affiliation(s)
- Laura Rosen
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
| | - Inessa Kostjukovsky
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
- Netanya Regional Health Bureau, Ministry of Health, Netanya, Israel.
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Olsen LL, Bottorff JL, Raina P, Frankish J. Low-Income Mothers' Descriptions of Children's Injury-Related Events: A Discourse Analysis. Glob Qual Nurs Res 2015; 2:2333393614565181. [PMID: 28462295 PMCID: PMC5342853 DOI: 10.1177/2333393614565181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 11/10/2014] [Accepted: 11/19/2014] [Indexed: 11/24/2022] Open
Abstract
The purpose of this study was to examine how mothers with young children who were living in low-income households used discursive strategies to explain their children's injury and near-miss events. In-person interviews were conducted with 17 mothers and a discourse analytic approach was used to analyze the data. Mothers used a variety of discursive strategies to explain injury events including minimizing the nature of events and expressing tensions between responsibility and resistance. Mothers also described challenges related to predicting children's behavior and dealing with competing demands. These discursive strategies reflected how societal expectations that mothers are held to in terms of keeping children safe conflicted at times with the constraints experienced by mothers living in economically challenging situations. The findings can be used to inform the design of injury prevention strategies that are sensitive to experiences of mothers of young children who are living with economic challenges.
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Affiliation(s)
- Lise L. Olsen
- University of British Columbia, Okanagan, Kelowna, British Columbia, Canada
| | - Joan L. Bottorff
- University of British Columbia, Okanagan, Kelowna, British Columbia, Canada
| | | | - Jim Frankish
- University of British Columbia, Vancouver, British Columbia, Canada
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Chen YT, Liao YM, Chen PL. Development and Psychometric Testing of Four Scales to Measure Perceptions and Family Influences on Parental Smoking in Taiwan. CHILDRENS HEALTH CARE 2014. [DOI: 10.1080/02739615.2013.865185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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19
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Rowa-Dewar N, Ritchie D. Protecting children from smoking in the home: an ethics of care perspective. Br J Community Nurs 2014; 19:214, 216-8. [PMID: 24784555 DOI: 10.12968/bjcn.2014.19.5.214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Community nurses are uniquely placed to help protect child health by facilitating the creation of smoke-free homes. However, there are a number of perceived barriers that may concern community nurses in their role of supporting parents in the creation of smoke-free homes, particularly those faced by disadvantaged parents. Arguments against intervening within the private domain of the home focus on concerns about protecting parents' autonomy to smoke within their own home and the potential for stigmatising parents who smoke, particularly mothers. Drawing on an ethics of care perspective, the authors propose an alternative perspective to the intervention in private settings. An ethics of care perspective may help to justify and encourage parents and community nurses to work in partnership to create a healthy environment for children and decrease the likelihood of children becoming smokers in the future.
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Affiliation(s)
| | - Deborah Ritchie
- Honorary Fellow, Nursing Studies, School of Health in Social Science, University of Edinburgh
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20
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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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21
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Rowa-Dewar N, Amos A, Cunningham-Burley S. Children's resistance to parents' smoking in the home and car: a qualitative study. Addiction 2014; 109:645-52. [PMID: 24304201 DOI: 10.1111/add.12435] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 09/26/2013] [Accepted: 11/25/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Reducing second-hand smoke exposure in the home is a key tobacco control goal, yet few studies have explored children's views and experiences of this. This study aimed to explore children's accounts of family members' smoking in the home and car and the impact of their socio-economic circumstances. DESIGN Individual and friendship group interviews using topic guides and visual stimulus methods. SETTING Two communities in Edinburgh, Scotland, one socio-economically advantaged, one socio-economically disadvantaged. PARTICIPANTS Thirty-eight children aged 10-15 years who had a close family member who smoked. MEASUREMENTS Focus group and interview topic guides. FINDINGS Participants in both communities expressed a strong dislike of family members' smoking and concern about the potential impact on the smoker's health. Participants described overt and covert acts of resistance, including challenging relatives about their smoking, expressing disgust and concern, hiding or destroying cigarettes. Some acts were carried out in collusion with a non-smoking parent and/or sibling. Resistant acts were constrained by expectations of negative responses, which appeared to increase with age, wider social norms around smoking and whether or not the young person smoked. CONCLUSIONS Some children and young people in the United Kingdom, irrespective of socio-economic status, may actively oppose parents' smoking in the home and car, although their influence may be limited by their position in the family and social norms.
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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
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22
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Wagener TL, Busch AM, Dunsiger SI, Chiang KS, Borrelli B. Changes in risk perception following a smoking cessation intervention: the role of acculturation in a sample of Latino caregivers. J Behav Med 2014; 37:1000-8. [PMID: 24504775 DOI: 10.1007/s10865-014-9554-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 01/16/2014] [Indexed: 10/25/2022]
Abstract
The present exploratory study examined the role of acculturation in the perception of the risks of smoking following a smoking cessation induction intervention among Latino caregivers of children with asthma. The sample consisted of 131 Latino smokers (72.9% female; 18.3% born in the U.S.) who were caregivers of a child with asthma. Caregivers were randomized to one of two smoking cessation interventions that were part of a home-based asthma program. Self-report measures of risk-perception were assessed at baseline, end of treatment (2 months after baseline), and 2- and 3-months post-treatment. At baseline, caregivers, regardless of level of acculturation, reported moderate to high levels of concern about the effects of secondhand smoke on their child's health as well as perceived risk regarding the effect of smoking on their own health. However, caregivers who were low in acculturation had a greater increase in concern about the effects of smoking on their child from pre-to post treatment compared to those who were high in acculturation (p = .001). Lastly, level of acculturation moderated the association between caregivers' concern about smoking on their child's health and their motivation to quit smoking (p < .05), but not cessation rates or reduced secondhand smoke exposure (p > .05). Specifically, motivation to quit at 3 months was greater for those with low acculturation. Though exploratory, these findings suggest that risk perception may be more easily influenced in low versus high acculturated populations and this should be considered in the design of clinical interventions and potentially mass media campaigns seeking to influence risk of caregiver behavior on child health with ethnic and racial minorities.
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Affiliation(s)
- Theodore L Wagener
- Section of General & Community Pediatrics, Department of Pediatrics, University of Oklahoma Health Sciences Center, 1200 Children's Ave., Suite 12400, Oklahoma City, OK, 73117, USA,
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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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24
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Liao YM, Chen YT, Kuo LC, Chen PL. Factors associated with parental smoking in the presence of school-aged children: a cross-sectional study. BMC Public Health 2013; 13:819. [PMID: 24015810 PMCID: PMC3846903 DOI: 10.1186/1471-2458-13-819] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 09/05/2013] [Indexed: 11/17/2022] Open
Abstract
Background In 2009, the Tobacco Hazards Prevention Act (Taiwan) was amended to more effectively restrict smoking in indoor public places and workplaces in Taiwan. However, the lack of prohibitions for smoking in private homes may place family members at increased risk for exposure to environmental tobacco smoke (ETS). The aim of our study was to determine the factors associated with parental smoking in the presence of children at home. Methods In 2010, we performed a cross-sectional study of factors associated with parental smoking in the presence of children at home in Taiwan using self-administered questionnaires. Quota sampling was used to select five primary schools from four different regions of Taiwan. Parents were surveyed to identify parental smokers and 307 parental smokers were selected for participation in our study. Questionnaire data regarding parental smoking in the presence of children at home and related interactions among family members were analyzed. Hierarchical logistic regression was used to determine the best-fit model for examining the relationships among the variables related to parental smoking in the presence of children at home. Results Two-thirds of parents who smoked reported smoking in the presence of their children. The results of the hierarchical logistic regression analysis identified the smokers’ compliance with their family’s antismoking responses, mutual agreement with smoking bans, daily smoking, smoking more than 20 cigarettes per day, the education level of the parental smoker, and the annual family income as determinants of smoking in the presence of children at home. Conclusions Households with smoking parents should be targeted for interventions to encourage the adoption and enforcement of home smoking bans. Educational interventions that promote smoke-free homes for children and provide support to help parents stop smoking are critical factors in reducing the frequency of children’s ETS exposure in the home.
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Affiliation(s)
- Yuan-Mei Liao
- Graduate Institute of Injury Prevention and Control, College of Public Health and Nutrition, Taipei Medical University, No, 250, Wu-Hsing Street, Taipei City 110, Taiwan.
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25
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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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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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Holdsworth C, Robinson J. Parental smoking and children's anxieties: An appropriate strategy for health education? CHILDREN'S GEOGRAPHIES 2013; 11:102-116. [PMID: 27695387 PMCID: PMC5044978 DOI: 10.1080/14733285.2013.743284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
While the prevalence of smoking has declined in the UK in recent years, class differentials in smoking behaviour have become more marked and smoking is increasingly recognised as a causal factor in inequalities in health. Health education initiatives to support both smoking cessation and to teach children about the health risks of smoking remain key initiatives in reducing health inequalities. However, teaching children about the risks of smoking and the impact of parental smoking in their health is not straightforward for children from backgrounds who are more likely to encounter smoking at home and in their local communities. These children have to reconcile the key messages taught at school and reinforced in smoking cessation campaigns with the knowledge that their parents and other family members smoke. In this paper we consider how children from smoking homes make sense of these education and health campaigns as observed by their parents, and the impact that this has on both parental smoking and relationships within the home. The paper thus seeks to challenge assumptions about the delivery of health education and the need to acknowledge family diversity.
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Affiliation(s)
- Clare Holdsworth
- Health and Community Care Research Unit, Thompson Yates Building,
Quadrangle, Brownlow Hill, University of Liverpool, Liverpool, L69 3GB
| | - Jude Robinson
- Health and Community Care Research Unit, Thompson Yates Building,
Quadrangle, Brownlow Hill, University of Liverpool, Liverpool, L69 3GB
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30
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Chen YT, Hsiao FH, Miao NF, Chen PL. Factors associated with parents’ perceptions of parental smoking in the presence of children and its consequences on children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:192-209. [PMID: 23296207 PMCID: PMC3564137 DOI: 10.3390/ijerph10010192] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 11/08/2012] [Accepted: 12/28/2012] [Indexed: 11/16/2022]
Abstract
Parental smoking is the major source of children’s secondhand smoke exposure and is influenced by parents’ perception of children’s exposure. However, the factors associated with these perceptions remain unclear. The objective of this study was to examine factors associated with parents’ perceptions about parental smoking in the presence of children and its consequences. We conducted a cross-sectional study on parents’ perceptions of parental smoking and measured their evaluations of its consequences using a self-report questionnaire. Other variables include socio-demographic characteristics and smoking-related experience. Results show that parents’ gender, education level, occupational type, smoking status, and agreement on a home smoking ban independently predict parents’ evaluation of the consequences of parental smoking in the presence of children. Parents’ gender, education level, annual family income, smoking status, agreement on a home smoking ban, and evaluation of the consequences of parental smoking independently predicted parents’ perceptions. Findings indicated that a specific group expressed greater acceptance of parental smoking and was less aware of its risks. Motivating parents to create a smoke-free home and increasing awareness of the adverse consequences of parental smoking is beneficial in reinforcing attitudes opposed to parental smoking.
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Affiliation(s)
- Yu-Ting Chen
- Graduate Institute of Nursing, College of Nursing, Taipei Medical University, No. 250, Wu-Hsing Street, Taipei City 110, Taiwan; E-Mail:
- School of Nursing, College of Medicine, Chang-Gung University, No. 259, Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan 333, Taiwan
| | - Fei-Hsiu Hsiao
- Department of Nursing, College of Medicine, National Taiwan University, No. 1, Sec. 4, Roosevelt Road, Taipei, 10617, Taiwan; E-Mail:
| | - Nae-Fang Miao
- School of Nursing, College of Nursing, Taipei Medical University, No. 250, Wu-Hsing Street, Taipei City 110, Taiwan; E-Mail:
| | - Ping-Ling Chen
- Graduate Institute of Injury Prevention and Control, College of Public Health and Nutrition, Taipei Medical University, No. 250, Wu-Hsing Street, Taipei City 110, Taiwan
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +886-223-771-379; Fax: +886-223-772-842
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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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Nicholson JS, Tyc VL, Lensing S. Parental psychosocial predictors of secondhand smoke exposure (SHSe) for children with cancer. J Child Health Care 2012; 16:211-23. [PMID: 22308542 DOI: 10.1177/1367493511426422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Children with cancer are at greater risk for the negative consequences of secondhand smoke exposure, making the identification of predictors of exposure critical. The current study investigated the impact of parents' psychosocial variables (perceived stress and vulnerability, self-efficacy), as well as health-related and demographic variables, on children's current exposure levels. Data were from 135 families whose children (M = 8.6 years old) lived with a smoker and were being treated for cancer. Self-efficacy was the consistent significant psychosocial predictor of exposure and the time since a child's diagnosis was indicative of lower exposure when limiting the sample to only smoking parents (n = 95). Both predictors of exposure have implications on motivation for behavioral change and may be suggestive of a teachable moment. Interventions may profit from tailoring programs to families based on these predictors of exposure, in particular for tobacco-based interventions for parents of medically compromised children, such as children with cancer.
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Affiliation(s)
- Jody S Nicholson
- Department of Psychology, St Jude Children's Research Hospital, Memphis, TN 38105, USA.
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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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Rosen LJ, Noach MB, Winickoff JP, Hovell MF. Parental smoking cessation to protect young children: a systematic review and meta-analysis. Pediatrics 2012; 129:141-52. [PMID: 22201152 DOI: 10.1542/peds.2010-3209] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Young children can be protected from much of the harm from tobacco smoke exposure if their parents quit smoking. Some researchers encourage parents to quit for their children's benefit, but the evidence for effectiveness of such approaches is mixed. OBJECTIVE To perform a systematic review and meta-analysis to quantify the effects of interventions that encourage parental cessation. METHODS We searched PubMed, the Cochrane Library, Web of Science, and PsycINFO. Controlled trials published before April 2011 that targeted smoking parents of infants or young children, encouraged parents to quit smoking for their children's benefit, and measured parental quit rates were included. Study quality was assessed. Relative risks and risk differences were calculated by using the DerSimonian and Laird random-effects model. RESULTS Eighteen trials were included. Interventions took place in hospitals, pediatric clinical settings, well-baby clinics, and family homes. Quit rates averaged 23.1% in the intervention group and 18.4% in the control group. The interventions successfully increased the parental quit rate. Subgroups with significant intervention benefits were children aged 4 to 17 years, interventions whose primary goal was cessation, interventions that offered medications, and interventions with high follow-up rates (>80%). CONCLUSIONS Interventions to achieve cessation among parents, for the sake of the children, provide a worthwhile addition to the arsenal of cessation approaches, and can help protect vulnerable children from harm due to tobacco smoke exposure. However, most parents do not quit, and additional strategies to protect children are needed.
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Affiliation(s)
- Laura J Rosen
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, POB 39040, Ramat Aviv, Israel.
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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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Chen X, Stanton B, Hopper J, Khankari N. Sources, locations, and predictors of environmental tobacco smoke exposure among young children from inner-city families. J Pediatr Health Care 2011; 25:365-72. [PMID: 22018427 DOI: 10.1016/j.pedhc.2010.04.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 04/27/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The purpose of this study was to determine the levels, sources, and locations of and influential factors for exposure to environmental tobacco smoke (ETS) among pediatric patients from inner-city families. METHOD Descriptive and associative analysis of ETS exposure in children 6 to 10 years of age was performed with survey data collected at Children's Hospital of Michigan through mothers' report and children's urine cotinine. RESULTS The sample included 397 participants, 82.4% of whom were African American. Urine cotinine levels were correlated with reported ETS exposure and 71% of children with urine cotinine levels > 10 ng/mL. The mean duration of ETS exposure was 14.3 minutes (SD = 11.0) in the past week and 58.9 minutes (SD = 50.8) in the past month. Smoking parents (∼30%), grandparents (∼30%), and non-family members (∼28%) were the major ETS sources, and relatives' homes (∼40%), the children's own homes (∼24%), automobiles (∼15%), and friends' homes (∼11%) were the main ETS locations. Child ETS exposure was inversely correlated with having a non-single mother, maternal education, income, use of prenatal preventive care, and satisfactory parenting. DISCUSSION ETS exposure in inner-city children was prevalent. Findings of this study may aid pediatric practitioners and public health workers in providing targeted interventions.
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Affiliation(s)
- Xinguang Chen
- Department of Pediatrics, Prevention Research Center, Wayne State University, Detroit, MI 48201, USA
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Rosen LJ, Guttman N, Hovell MF, Noach MB, Winickoff JP, Tchernokovski S, Rosenblum JK, Rubenstein U, Seidmann V, Vardavas CI, Klepeis NE, Zucker DM. Development, design, and conceptual issues of project zero exposure: A program to protect young children from tobacco smoke exposure. BMC Public Health 2011; 11:508. [PMID: 21711530 PMCID: PMC3141467 DOI: 10.1186/1471-2458-11-508] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 06/28/2011] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Tobacco smoke exposure (TSE) is a serious threat to child health. Roughly 40% of children worldwide are exposed to tobacco smoke, and the very young are often "captive smokers" in homes in which others smoke.The goal of this research project is to develop and evaluate an intervention to reduce young child tobacco smoke exposure. The objective of this paper is to document our approach to building the intervention, to describe the planned intervention, and to explore the conceptual issues regarding the intervention and its evaluation. METHODS/DESIGN This project is being developed using an iterative approach. We are currently in the middle of Stage 1. In this first stage, Intervention Development, we have already conducted a comprehensive search of the professional literature and internet resources, consulted with experts in the field, and conducted several Design Workshops. The planned intervention consists of parental group support therapy, a website to allow use of an "online/offline" approach, involvement of pediatricians, use of a video simulation game ("Dr. Cruz") to teach parents about child TSE, and personalized biochemical feedback on exposure levels. As part of this stage we will draw on a social marketing approach. We plan to use in-depth interviews and focus groups in order to identify barriers for behavior change, and to test the acceptability of program components.In Stage II, we plan to pilot the planned intervention with 5-10 groups of 10 parents each.In Stage III, we plan to implement and evaluate the intervention using a cluster randomized controlled trial with an estimated 540 participants. DISCUSSION The major challenges in this research are twofold: building an effective intervention and measuring the effects of the intervention. Creation of an effective intervention to protect children from TSE is a challenging but sorely needed public health endeavor. We hope that our approach will contribute to building a stronger evidence base for control of child exposure to tobacco smoke.
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Affiliation(s)
- Laura J Rosen
- Dept, of Health Promotion, School of Public Health, Sacker Faculty of Medicine, Tel Aviv University, POB 39040, Ramat Aviv 69978 Israel.
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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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Effect of Depression and Psychosocial Stressors on Cessation Self-Efficacy in Mothers who Smoke. Matern Child Health J 2010; 15:620-6. [DOI: 10.1007/s10995-010-0640-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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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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Greaves L, Hemsing N. Women and tobacco control policies: social-structural and psychosocial contributions to vulnerability to tobacco use and exposure. Drug Alcohol Depend 2009; 104 Suppl 1:S121-30. [PMID: 19520523 DOI: 10.1016/j.drugalcdep.2009.05.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2008] [Revised: 05/01/2009] [Accepted: 05/04/2009] [Indexed: 10/20/2022]
Abstract
This article explores the psychosocial and social-structural vulnerability in relation to women's tobacco use, smoke exposure and responses to policy, and examines these issues in the context of women's lives and roles, describing forward looking strategies that could improve research and equity in outcomes for women. Various literatures on smoking among women and girls, and how women and sub-populations of women respond to tobacco control policies are reviewed. Specific sub-populations exhibiting more tobacco use and exposure are described, such as young pregnant and mothering women and low-income women. Emerging evidence also reveals links between smoking and experiences such as childhood sexual abuse, interpersonal violence, post-traumatic stress disorder, mental health issues and alcohol and drug dependence. Varied sub-populations of women respond in different ways to price and taxation, sales restrictions and location restrictions. However, tobacco control policies have, to date, been fashioned as broad instruments, not taking into account social context, trauma backgrounds, gendered roles such as mothering, unequal power relations affecting women in relationships and workplaces, and differences in access to resources and social support. When these issues are considered, the implications for tobacco policy development include: widening the policy purview, accounting for uneven and differential responses to policies, committing to an ethical framework, extending sex, gender and diversity based analyses, and improving research methods and approaches.
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Affiliation(s)
- Lorraine Greaves
- British Columbia Centre of Excellence for Women's Health, BC, Canada
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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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Living with childhood asthma: parental perceptions of risk in the household environment and strategies for coping. Prim Health Care Res Dev 2009. [DOI: 10.1017/s1463423608001011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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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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