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