Parents’ Perceptions of Barriers and Facilitators to Smoke-Free Homes and

Vehicles

Rosemary Herbert PhD(c)CPHA, 2008

Researchers

Rosemary Herbert RN, PhD(c) Anita Gagnon RN, MPH, PhD Janet Rennick RN, MScN, PhD Jennifer O’Loughlin PhD

Acknowledgments

CTCRI CNRS CNF Nursing Care Partnership PEI Lung Association PEI Cancer Control

Background

Children’s ETS Exposure in the Home

▪ 9.2% Canadian children <12 years

(Health Canada, 2007)

▪ 35% American children <18 years

(ALA, 2007)

▪

Adverse Effects ETS

Respiratory problems Low birth weight SIDS Ear infections Cardiovascular problems Behavioral problems, learning difficulties

(California Environmental Protection Agency, 1997; Gidding, 1999; Health Canada, 2004; Mitchell & Milerad, 1999; Strachan & Cook,1997,1998; WHO, 1999).

Research Objective

To describe parents’ perceptions of barriers to making homes and vehicles smoke-free, and to identify facilitators used by parents to manage these barriers.

Methods

RCT tested intervention designed to empower parents to make homes smoke-free

Semi-structured interview data about barriers and facilitators to smoke-free homes and vehicles collected at 6 months follow-up

Eligibility Criteria

At least one cigarette per day was smoked within the home

The family had one or more children aged ≤5 years who resided in the home at least 50% of the time

One parent (not necessarily a smoker) willing to participate in the intervention

Data Collection

What the barriers were to making homes and vehicles smoke-free, including the greatest barriers

What they did to overcome barriers and what worked best

What they would recommend to others

Data Analysis

Inductive approach Data coded by two people Themes assigned to codes with similar

meaning Coders reached consensus

(Thomas, 2008; Ulin, Robinson, & Tolley, 2005)

Results

Participants 33 mothers, 3 fathers, aged 18-42 11 (31%) < high school 16 (44%) < $15,000 household income 21 (58%) >1 child 28 (78%) of the families, mothers smoked during

pregnancy 29 (80%) of the families, mothers were current

smokers

Barriers to Smoke-Free Homes

Themes congruent with ecological model of health promotion

Intrapersonal (within individual) Interpersonal (between individuals) Physical Environmental

(McLeroy et al.,1988; Stokols,1996)

Most Common Barriers to Smoke-Free Homes

Intrapersonal Barriers Nicotine addiction Time and effort required to make the

change

“I can’t quit. It’s the addiction part of it.”

(20 year old, single mother of two)

Barriers to Smoke-Free Homes

Interpersonal Barriers Supervising young children Partners and relatives wanting to

smoke in the home

“It’s hard to bundle her up and go outside. I can’t leave her unattended.”

(20 year old single mother of a one year old)

Barriers to Smoke-Free Homes

Physical Environmental Barriers Inclement Weather Lack of access to the outside

“My daughter is too young to leave alone.”

(27 year old single mother of a three year old child who lived in a third floor apartment with no balcony).

Barriers to Smoke-Free Vehicles

Intrapersonal Barriers Habit of smoking while driving“I love to smoke when I’m driving.” (27 year old mother of two children )

Interpersonal Barriers Habits and routines of partners and

relatives

Facilitators to Smoke-Free Homes and Vehicles

Intrapersonal Quitting or considering quitting, smoking less, altering smoking location, reminding self of the change, making the decision to go smoke-free

“ I tried ‘I’ statements learned in the group instead of ‘You should.’ ”

(27 year old mother of four)

Facilitators to Smoke-Free Homes and Vehicles

Interpersonal Talking with household members Ending relationship with partner Moving to a new location

“Moving out, that worked best. I got tired of fighting with them about the smoking.”

(20 year old single mother of two who had previously lived with her parents)

Facilitators That Worked Best

Interpersonal Facilitators Related to children Informing people home was smoke-free

“Letting people know that there’s no smoking in the house…it you get annoyed enough they get the point.”

(32 year old mother of five children)

Recommendations to Others

Being committed to the change Being consistent Quickly initiating the change Quitting smoking Learning about the effects of ETS

Limitations

Data were collected in follow-up interviews for RCT

Interviews that focused solely on smoke-free homes and vehicles may have provided more in-depth data

Implications

Multiple barriers existed for these parents, most of whom were mothers, many with low-SES

Most effective facilitators involved others yet parents most often relied on themselves

None identified health care providers as facilitators

Implications

No single course of action will suit all families

Health care providers need to assess each parent’s context and offer individualized suggestions

Conclusions

Most parents want to protect their children from ETS

“Do it for the kids.” (25 year old mother of two)

Finding meaningful ways to help parents achieve smoke-free status will greatly benefit children