Changing Exposure Perceptions: A Randomized Controlled Trial of an Intervention with Smoking Parents (original) (raw)
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Parental Perceptions of Children’s Exposure to Tobacco Smoke and Parental Smoking Behaviour
International Journal of Environmental Research and Public Health, 2020
Around 40% of children are exposed to tobacco smoke, increasing their risk of poor health. Previous research has demonstrated misunderstanding among smoking parents regarding children's exposure. The parental perceptions of exposure (PPE) measure uses visual and textual vignettes to assess awareness of exposure to smoke. The study aimed to determine whether PPE is related to biochemical and reported measures of exposure in children with smoking parents. Families with at least one smoking parent and a child ≤ age 8 were recruited. In total, 82 parents completed the PPE questionnaire, which was assessed on a scale of 1-7 with higher scores denoting a broader perception of exposure. Parents provided a sample of their child's hair and a self-report of parental smoking habits. Parents who reported smoking away from home had higher PPE ratings than parents who smoke in and around the home (p = 0.026), constituting a medium effect size. PPE corresponded with home smoking frequency, with rare or no home exposure associated with higher PPE scores compared to daily or weekly exposure (p < 0.001). PPE was not significantly related to hair nicotine but was a significant explanatory factor for home smoking location. PPE was significantly associated with parental smoking behaviour, including location and frequency. High PPE was associated with lower exposure according to parental report. This implies that parental understanding of exposure affects protective behaviour and constitutes a potential target for intervention to help protect children.
Parental Perceptions and Misconceptions of Child Tobacco Smoke Exposure
Nicotine & Tobacco Research
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.
BMC Public Health, 2018
Background: It is estimated that around 40% of children worldwide are exposed to tobacco smoke, largely by their parents. Discrepancies between biochemical measures of exposure and parental report imply that parents may be under-reporting children's exposure. Previous research has shown that there may be a fundamental misunderstanding among smoking parents as to what exactly exposure is and in what circumstances it occurs. Methods: We aimed to develop and validate a measure to assess parental perceptions of exposure (PPE) regarding child tobacco smoke exposure (TSE). A model was developed based on a qualitative study of smoking parents and a questionnaire constructed using pictures and vignettes to assess parental rating of children's exposure in hypothetical situations. The questionnaire was completed online by 220 Israeli parents recruited via social media. Exploratory factor analysis was performed, and reliability and internal consistency were assessed using test-retest reliability and Cronbach's alpha coefficient. Results: Factor analysis produced 6 factors for PPE which explained a cumulative total variance of 76.3%. Factors were termed: 1) secondhand exposure; 2) third-hand exposure; 3) perceived knowledge/certainty; 4) sensory perceptions; 5) time perceptions; and 6) distance perceptions. All sub-scales showed good internal consistency and variance. Test-retest reliability was high (r = 0.856, p = .001). Total PPE score and subscales were highly correlated with risk perceptions r = 0.766. Smokers scored significantly lower on PPE than non-smokers, defining fewer situations as involving greater exposure (p < 0.001). Logistic regression showed PPE was able to discriminate smoking status. Conclusions: Results provide supporting evidence for the PPE as a reliable and valid construct, which can be feasibly measured. Smokers perceived exposure less frequently than non-smokers. This new measure can shed light on parental smoking behaviour and may help us to increase parental awareness of exposure in order to potentially reduce children's exposure to tobacco smoke.
Secondhand Smoke Risk Communication: Effects on Parent Smokers’ Perceptions and Intentions
Journal of Health Communication, 2020
This study examined effective strategies to communicate with parent smokers about the risks of secondhand smoke (SHS) exposure to children. An online, between-subjects experimental survey was administered via TurkPrime Panels to recruit participants (N = 623) comprising adult smokers living with children (aged 0-15). Participants were assigned to messages conditions that differed by message recommendation (cessation; cessation+exposure reduction) and format (video; text-only) or to a no-message control. Participants in a message condition viewed a message, and all participants responded to questions about their perceptions and intentions. Parent smokers who viewed either message recommendation reported greater harm perceptions (p <.001), self-efficacy (p <.001), and help-seeking intentions (p <.05) than the no-message control group. Cessation+exposure reduction recommendations elicited greater quit intentions than the no-message control (p <.05). Compared to text-only, videos elicited greater reduce-exposure intentions (p <.05) and interpersonal communication intentions (p <.05). Only videos elicited greater quit intentions (p <.01) and help-seeking intentions (p <.01) than the nomessage control. Communication about this topic can be optimized by recommending both cessation and exposure-reduction behaviors (versus cessation only), and by using videos (versus traditional print/text-based materials). Every year in the United States, 480,000 people die from causes attributable to smoking (U.S. Department of Health & Human Services, 2014), including 41,000 who die from diseases caused by secondhand smoke (SHS) (Centers for Disease Control and Prevention, 2017). Of the 58 million Americans exposed to SHS (CDC, 2018a), infants and children are the most vulnerable to adverse health effects (CDC, 2015). Only 55% of smoking mothers quit smoking during pregnancy, and 70% of these relapse into smoking after childbirth (CDC, 2017; Lavery, Nair, Bass, & Collins, 2016). It is estimated that two in five children in the U.S. are exposed to SHS (CDC, 2018a; Tanski & Wilson, 2012). However, notable disparities exist for childhood exposure to SHS such that children in low-income communities, 3-to 11-year olds, and black children are at highest risk of SHS exposure (Centers for Disease Control and Prevention, 2015). Several environmental factors play a role in child exposure to SHS, including a lack of smokefree laws in public spaces or smokefree rules at home, and living in multiunit housing. US healthcare expenditures of SHS exposure among children living in public housing were more than 180 USD million in 2011 alone (Mason, Wheeler, & Brown, 2015). Exposure to SHS may also occur or be exacerbated when children live with adult smokers who smoke in the home (Centers for Disease Control and Prevention, 2015). If one adult in a household is a smoker, the other adults are also likely to be smokers (Groner, Ahijevych, Grossman, & Rich, 2000; Ostfeld, Esposito, Perl, & Hegyi, 2010), thus increasing SHS exposure. This observation is vital given that parental smoking is a potentially modifiable behavior. SHS refers to the smoke from the burning end of a tobacco product or exhaled by a smoker (CDC, 2018b). Thirdhand smoke (THS) is tobacco smoke residue that remains on surfaces long after exposure (Acuff, Fristoe, Hamblen, Smith, & Chen, 2015). Children exposed to SHS can have levels of cotininea byproduct of nicotine exposure-in their system comparable to that of an actual smoker (Gatzke-Kopp et al., 2018). Adverse health outcomes of SHS exposure can appear within the first few months of an infant's life, and SHS is a significant risk factor for Sudden Infant Death Syndrome (SIDS) (
Parental risk perceptions of child exposure to tobacco smoke
BMC Public Health, 2015
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.
Pediatrician Interventions and Thirdhand Smoke Beliefs of Parents
American Journal of Preventive Medicine, 2012
Background-Thirdhand smoke is residual tobacco smoke contamination that remains after a cigarette is extinguished. A national study indicates that adults' belief that thirdhand smoke (THS) harms children is associated with strict household no-smoking policies. The question of whether pediatricians can influence THS beliefs has not been assessed. Purpose-To identify prevalence of THS beliefs and associated factors among smoking parents, and the association of pediatrician intervention on parent belief that THS is harmful to their children. Methods-Exit interview data were collected from 1980 parents following a pediatric office visit. Parents' level of agreement or disagreement that THS can harm the health of babies and children was assessed. A multivariate logistic regression model was constructed to identify whether pediatricians' actions were independently associated with parental belief that THS can harm the health of babies and children. Data were collected from 2009 to 2011, and analyses were conducted in 2012. Results-Ninety-one percent of parents believed that THS can harm the health of babies and children. Fathers (AOR 0.59 [95% CI=0.42, 0.84]) and parents who smoked >10 cigarettes per day (AOR 0.63 [95% CI=0.45, 0.88]) were less likely to agree with this statement. In contrast, parents who received advice (AOR 1.60 [95% CI=1.04, 2.45]) to have a smokefree home or car or to quit smoking and parents who were referred (AOR 3.42 [95% CI=1.18, 9.94]) to a "quitline" or other cessation program were more likely to agree that THS can be harmful.
International Journal of Environmental Research and Public Health, 2013
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
Parent versus child reporting of tobacco smoke exposure at home and in the c
Aim To compare self-reported exposure to tobacco smoke in the home or in cars between parents and their pre-adolescent children. Methods We analysed data on self-reported exposure to secondhand smoke from 3,645 matched pairs of children at baseline (aged between 10 and 13 years) and their parents whether smokers or not, who were participants in Keeping Kids Smokefree (KKS), a community-based study in South Auckland, New Zealand from 2007-2009. The study aimed to reduce children's smoking initiation through parental behaviour change. The responses of the parent-child pairs were analysed using proportions, Kappa scores, and McNemar's Chi-squared test. Additionally, 679 children were biochemically tested for smoking exposure using exhaled carbon monoxide. Results There was approximately a 30% discordance between the self-reports of children and their parents, with parents reporting less smoking in homes or cars than their children. Kappa scores for parent-child agreement by ethnicity ranged from 0.15 to 0.41 for smoking at home and 0.17 to 0.54 for smoking in cars. Biochemical testing suggested that around 30% of children had been exposed to secondhand smoke, corroborating their self-reported proportion of 37% (baseline in the home) whereas few parents (11%) reported smoking in home or cars. Conclusion Parents were significantly less likely than children to report smoking inside the home or car. Biochemical testing indicated that children's reporting is more accurate. This has implications for future studies relying on self-reporting by children and/or their caregivers.
Health Education Research, 2008
Despite knowing the risks to their children's health, parents continue to expose their children to tobacco smoke prior to and after their birth. This study explores the factors influencing parent's behaviour in preventing the exposure of their (unborn) children to environmental tobacco smoke (ETS) and any changes to their smoking behaviour in the home during the first years of their children's lives. Whether or not they stopped smoking during pregnancy, the women did not protect themselves from breathing in other people's smoke. Yet once the baby was born, parents actively protected the baby from environmental tobacco, believing that the lungs of newborn babies were too immature to tolerate smoke. This protection lasted only for a matter of weeks for some babies, or stopped when they were 6-12 months old, linked to their parent's belief that older babies could tolerate or avoid smoke. These findings suggest that changes made to smoking during the first weeks of a baby's life are unlikely to be sustained, and key messages about the risks if ETS exposure need to be delivered repeatedly over the first 2 years of life and reenforced as the child gets older.
Tumori
Increasing smoke-free homes is an important public health goal, but only few interventions have yielded positive results. The aim of the "Don't smoke in our home" trial was to evaluate a counseling intervention focused on promoting totally smoke-free homes and cars (TSFHC) delivered to women with children resident in four Tuscan towns. We used a two-group randomized controlled trial design. Participants were asked about their smoking habits and about restrictions on smoking in their homes and cars. All women received a self-help booklet promoting TSFHC, and 110 women randomized to the intervention also attended brief counseling on second-hand smoke exposure protection and received three gifts to remember the commitment to TSFHC. Follow-up was conducted by phone after four months. We recruited 218 women, 64 of whom had a university degree and 131 of whom were smokers; 62% reported smoking indoors and 58% in cars. Before the intervention, nonsmokers were more likely to r...